Advocates for accessible health care price information have given 34 of the 50 states a grade of F on their efforts to help consumers obtain cost data to help them shop around for medical care.

The 16 states receiving passing grades in the Report Card on State Price Transparency Laws represent a marked improvement from the last survey, in 2017, when only seven of the states got passing grades.

The report, complied by Catalyst for Payment Reform, in conjunction with The Source on Healthcare Price and Competition at the University of California Hastings College of Law, seeks to promote transparency in health care price information in order to facilitate price shopping as well as expose extreme price variations, call attention to overpricing and promote competition and lower prices.

Maine and New Hampshire were the only states to receive grades of A in the report. Colorado, Connecticut, Maryland and Massachusetts were each awarded a B, while Florida, Minnesota, New Mexico, Oregon and Virginia each received a C. Arkansas, California, Utah, Vermont and Washington each was awarded a D in the report, and the remaining states each received an F.

But the advances in access to information come amid dramatic growth in health expenses for U.S. households, with rising costs serving to reduce access to care for both the insured and uninsured, the report says.

"We want to ensure all Americans have access to price information–we would like to see all the states move quickly on that. However, having studied this for a number of years, the fact that we are seeing progress is encouraging," Suzanne Delbanco, executive director of Catalyst for Payment Reform, said in an interview.

The need for transparent health care pricing is even more pressing under the COVID-19 pandemic because many consumers are facing job loss and losing their health insurance, while others will be facing rising health care premiums and copayments in the months ahead, said Delbanco.

"The costs of the COVID-19 pandemic and a severely troubled economy reemphasize the importance of transparency," Delbanco said. "Access to price information in the private sector is largely in the hands of health plans and providers, so it can be up to the states to ensure that citizens have access to meaningful price information."

States that scored the highest for health care price transparency in the report were those that have passed legislation creating a state-run database of pricing for common medical procedures at various hospitals and health care providers, or those where the information is gathered by a private entity pursuant to state law, Delbanco said. Catalyst favors the creation of a so-called all-payer claims database (APCD), pooling about expenditures by Medicare, Medicaid and private insurance companies, for a complete view of what providers are charging.

APCDs typically collect data from multiple payers, including commercial health plans, state employee health benefit programs, Medicaid and Medicare, and sometimes self-insured employer plans, the report said. APCDs are considered superior data sources because they include the amounts actually paid, not the amount charged, which often differ significantly. But Delbanco admits that collecting such data can be challenging, even in states with a legislative mandate, because providers have to agree to provide it in a certain format.

In some places, legislation to create state health care pricing databases has been opposed by hospitals, Delbanco said. Prices are not regulated and widespread consolidations of health care providers has allowed them to have a large amount of market power, she said.

"Community health systems have tremendous clout. They are large employers and are looked on fondly in many communities. It becomes very challenging to regulate them in a meaningful way, so they seem to raise prices above what we consider competitive levels," Delbanco said.

A robust set of price data will include information on a wide range of inpatient and outpatient procedures and services, instead of one or the other, or only a limited list of procedures and services. And a robust set of price data will include information on physicians and hospitals, instead of just one or the other, the report said. It is more meaningful to see the entire price for a health care event or episode, rather than to see only a hospital or facility price, or only a physician price, for a specific service.

Read more:

Instant Insights /

When it comes to price transparency, majority of states receive a failing grade

More From HR Executive

Related Stories

Recommended For You