For nearly two decades, state governments have attempted to address the problem of rising insurance deductibles by passing legislation aimed at improving consumers' access to medical cost information. Today, only six states have some sort of publicly accessible cost database in place, and they may not be helpful to consumers.
In the U.S., 19 states have passed legislation calling for the creation of databases that capture and track payments for medical procedures by insurers or healthcare providers, known as all-payer claims databases. The federal government has issued $87 million in grants to help these states create sites where patients can compare costs to treat medical conditions.
Only six states have produced some type of public cost-comparison website:
- California
- Colorado
- Maine
- New Hampshire
- Virginia
- West Virginia
National nonprofit research group Public Citizen conducted a study of the efficacy of these websites and their usefulness to consumers. Below are three findings.
1. Of those six states, the Public Citizen report highlighted serious deficiencies in both the infrastructure and accuracy of information in their databases. Only one of the six websites provided cost estimates for five of the most commonly shopped for medical procedures: colonoscopy, CT scan of the head, inguinal hernia repair, knee replacement and MRI scan.
2. To differentiate between medical expenses, the databases used the terms "price," "charge" and "cost" or "payment," making it difficult for a layman to determine how much they would pay for medical services. Typically, databases used the terms as following:
- Price was the total amount a provider expected to be paid by both payers and patients.
- Charge was the dollar amount a healthcare provider set for services rendered before negotiating any discounts.
- Cost or payment was the total expense incurred to deliver healthcare services.
3. Some databases' contained outdated or incomplete claims and cost information, according to Public Citizen. Privately insured residents in Colorado, for instance, can only access claims information for procedures from 2012.