Why are U.S. hospital bills so high? Learn more about how price transparency can help cut costs.

CASE believes in both the sanctity of the doctor/patient relationship and a healthcare market that allows consumers to make informed choices about how best to tend to their medical needs.

America spends $3.2 trillion on healthcare in a year, or about $10,000 for every man, woman, and child in the country.

Image Credit to Petersen KFF: Health System Tracker 

 

Real healthcare reform involves removing barriers that prevent healthcare and insurance providers from offering the widest choice of options to the greatest number of consumers.

A history of price transparency:

Nobel laureate Kenneth J. Arrow first raised the issue of price transparency in healthcare in 1963. Since then, the cost of inpatient and outpatient care has risen steadily, significantly outpacing physician prices from 2007 to 2014.

In 2010, the Affordable Care Act (ACA) was the first to introduce price transparency legislation, but the issue was not a primary health policy lever until the latter half of the Trump administration. In 2019, the President signed an executive order adding additional transparency policies and guidelines to build upon the ACA. The progress was continued during the Biden Administration.

Shortly afterward, the U.S. Center for Medicare & Medicaid Services (CMS) finalized a rule requiring hospitals to post prices for more than 300 common “shoppable” goods and procedures. Congress aims to build upon this rule, recently introducing the bipartisan  “Lower Costs, More Transparency Act” scheduled to take effect in 2025. 

Despite federal efforts to improve transparency in recent years, medical bills remain the number one cause of bankruptcy in the United States. A lack of competition and accountability in the industry has allowed prices to rise beyond the level of affordability. Additionally, hospitals have refused to comply with transparency legislation. To date, CMS has issued more than 730 warning notices and 269 requests for corrective action plans (CAPs) aimed at addressing hospital non-compliance.

We have significant data to support price transparency as a primary driver for healthcare affordability. It is imperative that hospitals are held accountable to ensure that patients are no longer burdened by unbearable medical bills.

(Image credit to Cleverley Associates)

Hospitals, patients deserve fair and transparent pricing. It’s time to start prioritizing patient care over profits.  

How does price transparency lower costs?

• Informed decisions.
  • When patients have access to hospitals’ pricing information, they can make informed healthcare decisions. By comparing costs for procedures, tests, or visits, across providers, patients can select more affordable options.
• Increased competition.
  • Price transparency encourages patients to shop around for the most valuable services, weighing the cost with the expected quality. Providers are then forced to keep prices competitive to attract patients, potentially reducing the overall cost of care. 
• Greater accountability.
  • When hospitals have to provide clear pricing information, they can no longer hide behind unjust price hikes. Consumers can feel empowered to call out price gouging, forcing hospitals to stop overcharging for basic care.

 

      [OP-ED LINK]     [OP-ED LINK]           [OP-ED LINK]

How can you make a difference?

• Who is advocating for price transparency?
  • Along with CASE, there are a number of patient advocacy groups, policy organizations, and lawmakers pushing for increased price transparency in healthcare. For example, think tanks and other bipartisan coalitions have pushed for reforms. Additionally, non-profit groups like PatientsRightsAdvocates.org, have pioneered change through advocacy, testimony, media, legal research, and grassroots campaigns.
• Who has the power to enforce compliance? 
  • While significant changes have been made through federal action, state governments also play a key role in igniting change. States can implement and enforce their own transparency laws, requiring hospitals to publish clear pricing information. Strong state-level regulations and oversight are essential for holding providers accountable and ensuring compliance.
• What can you do?
  • Call State Offices
    • Reach out to your state representatives to demand stronger price transparency laws and express support for regulations that require providers to disclose prices upfront.
  • Support Advocacy Groups
    • Join and/or donate to organizations that are fighting for transparency in healthcare. Your support can help amplify the movement and push for meaningful policy changes.
  • Be an Advocate
    • Educate friends, family, and your community about the importance of price transparency. Share resources and encourage others to demand clear pricing information from their healthcare providers. Your voice is a powerful tool to help build momentum.

In the News:

• Op-Ed: Transparency in hospital pricing vital to health care reform
• Can NC trust our hospitals to be transparent about prices?
• The fight for transparent health care prices in America
• The battle over NJ hospital prices: Will more transparency lead to lower bills?
• Murphy’s Law: Local Hospitals Violate Price Transparency Rules
• Hospitals fail to be transparent about pricing, leaving patients in the dark
• Just more than a third of hospitals are complying with price transparency rules: report
• Hospitals Have Started Posting Their Prices Online. Here’s What They Reveal
• Hospital prices must now be transparent. For many consumers, they’re still anyone’s guess
• CMS issued over 300 warnings, but no fines, to hospitals falling short on price transparency last year