By NextBestFitPatients can't know prices in advance
The same service can cost wildly different amounts at different places, and the price depends on the insurer's secret contract. Price-transparency rules exist but are hard to use and inconsistently followed.
Evidence
- Private insurers paid on average 254% of Medicare for hospital services, with enormous variation between hospitals.Sources: RAND Corporation (2024)
Who's affected
Who is hurt
- People with unaffordable deductibles or coinsurance: Secret contracts and inconsistent transparency make prices hard to know in advance.
- Employers: Opaque and variable prices make health costs hard to manage.
Who gains while it lasts
- Hospitals and specialist groups with high private prices: Opaque prices help sustain high charges.
- Health administration and software vendors: They profit from pricing complexity.
Under your mix of paths
Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
- Prices negotiated privately between thousands of payers and providers
Related costs
Open questions
- Should there be one public price for each service?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
A single fee schedule (single payer or all-payer rates) makes prices identical and public.
- +Patients can't know prices in advance
- −Limits choice or applies one rule to every setting
- −Faces political, industry, or legal opposition
Fully enforce the hospital and insurer transparency rules, with real penalties and standard formats.
- +Patients can't know prices in advance
- −Solves only part of the problem
Also addressed by paths for other problems
All-payer rate settingU.S. prices are far higher than in other countriesChosen
A public commission sets the same rates for public and private payers rather than separate payer-specific prices.