By NextBestFitEnforce price transparency rules
Fully enforce the hospital and insurer transparency rules, with real penalties and standard formats.
Interim enforcement until one price list exists.
Review ledgerHow this path connects
This path
Enforce price transparency rules
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Raise penalties for transparency non-compliance
- Standardize file formats and require patient-facing price estimates
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Patients can't know prices in advance
Enforcing price disclosure with penalties and standard formats makes prices available at low cost. Some employers use the data to negotiate.
What it creates or worsens
- Solves only part of the problem
Evidence that patients shop by price is weak, and disclosure alone does not reduce prices.
Who's affected
Who gains
- People with unaffordable deductibles or coinsurance
- Patients can't know prices in advance: Secret contracts and inconsistent transparency make prices hard to know in advance.
- Employers
- Patients can't know prices in advance: Opaque and variable prices make health costs hard to manage.
Who loses
- Hospitals and specialist groups with high private prices
- Patients can't know prices in advance: Opaque prices help sustain high charges.
- Health administration and software vendors
- Patients can't know prices in advance: They profit from pricing complexity.
Where it has been tried
- U.S. (2021–): Compliance has been partial; files are huge and hard to use.
- United States: CMS estimated that 70% of hospitals fully complied with both federal price-transparency requirements in November 2022, up from 27% in February 2021.