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US-POLITICS-HEALTH-HOSPITALS
US to force hospitals to reveal rates
WASHINGTON, Nov 16, 2019 (BSS/AFP) – The Trump administration said Friday
it would begin forcing US hospitals to publish their prices of care and the
discounted deals they reach with insurers from 2021 in a bid to rein in
health care costs.
The Department of Health and Human Services (HHS) proposed a separate new
rule that would force private insurance companies to give patients cost
estimates before they see a doctor or get treatment.
The initiative is part of a wider effort to ensure more transparency in the
US health care industry, which is notorious for being opaque when it comes to
costs.
HHS Secretary Alex Azar said the move would help by “shining light on the
costs of our shadowy system and finally putting the American patient in
control.”
Currently, patients are often at a loss when they seek guidance on how much
a procedure will cost them. Some end up agreeing to procedures without
knowing the price they will pay.
“Under the status quo, health care prices are about as clear as mud to
patients,” said Seema Varma, the administrator of the Centers for Medicare
and Medicaid Services, an agency under HHS.
“Kept secret, these prices are simply dollar amounts on a ledger;
disclosed, they deliver fuel to the engines of competition among hospitals
and insurers.”
In the United States, costs for procedures are not fixed by any central
authority. They are instead negotiated between hospitals and private
insurers, which provide coverage for more than half of Americans.
A major insurance company may be able to obtain a better rate on a knee
operation than a small company.
A hospital network with a monopoly in a particular city can fix higher
prices than in cities where there is more competition.
For now, such negotiated prices are confidential. Insurers don’t know what
their competitors are paying, and patients often don’t know how much will
come out of their pocketbooks.
Even if a patient knows that the insurance company covers 80 percent of any
given procedure, the remainder owed by the patient is a moving financial
target.
The new proposed rule would address that issue.
The two rules are expected to end up in the courts, however, as the
hospital industry is unlikely to accept them.
BSS/AFP/GMR/1030 hrs