“Visible” is not “transparent.” Let us see prices.

Note addition, Nov. 28, at bottom.

A (ahem) friendly suggestion: let’s be explicit in what we ask for. Here’s a recent pet peeve :-) …

“Visible” is not “transparent.”

I keep hearing complaints about irresponsible patients as a leading cause of our cost problems. But, hospitals, insurance, and policy people: Don’t complain about our spending if you can’t tell us what it’ll cost before we make decisions. If you don’t know, you’re out of control – don’t blame patients for that.:-)

See, “visible” describes the thing we want to see. (Prices.) “Transparent” is an abstraction. It diverts attention from the prices, by focusing on the barrier.

If we can’t see prices, how can we control them?

If you go into a restaurant and the menu has no prices, how are you supposed to stick to a budget? Yet in last year’s Health Leaders reader survey, patient irresponsibility was listed in the top five causes of rising costs – and nowhere did they note that inability to see prices might be a factor.

Here’s the impact on ordinary citizens: If I mention “transparency” to people in my community, most have no idea what I mean. But when I say “We need to see what things cost – and nobody can tell us,” everybody does see what a problem that is.

Visible prices, please. Before we make our purchase decisions.

Added Nov. 28:

A few weeks later I was in a Mexican restaurant, and the menu illustrated this point, and posted on Facebook:

Margaritas menu Sept 2012

“Health policy lesson: this drinks menu has no prices – do you ask for ‘price transparency’? No, you ask for the prices! (Unless you’re a sucker.) Sometimes in healthcare we leave our common sense behind; easy to fix. Just realize it.”

10 comments to “Visible” is not “transparent.” Let us see prices.

  • Another aspect of medical treatment pricing, which price visibility would expose but not necessarily explain like transparency would, is what category of service a treatment option falls under. Example: the humble wart. Now, you can get a Dr. Scholls Freeze Away kit for about a tenspot, right? No biggie, but if one’s persistent and/or you overburn yourself maybe you think, as I once did years back, that your local primary doc’s office may have a wee better whizbang freezer or some clinical knowledge you lack. In the invisible nontransparent days you then get a bill for several HUNDRED dollars! You call to investigate, empowered patient that you are, and are told that the billing code is for SURGERY. Wait, you say: we had thought that be definition surgery required cutting, or at least breaking through an epidermis. Nah, they say. So you try to haggle out of this inanity and the ofc mgr will only budge 10%.

    Now I’m not certain but wouldn’t be surprised that for bigger more substantial treatments we might encounter both visibility and transparency as issues.

  • How much transparency will be required tho? How deep into the costs of things will we have to look to see a true base cost? I recently wrote at Things I Need to Change

    One of the biggest question in the diabetes world is why test strips cost so damn much, especially considering the volume produced on a daily basis. If I remember correctly, Roche produces 1,500,000 strips per day and they are still $1 apiece without insurance.

    Recently, during the 2012 Roche Social Media Summit, the participants were taken on a tour of the manufacturing facilities. Everyone was quite impressed with the technology and the nice clean production area full of large impressive machines. They general take-away by the attendees was that they could see why the strips “cost” so much, which, I am sure, Roche wanted to happen.

    However, from a costing perspective the bright shiny machines and a massive production area actually tell you ZERO about the true costs involved. Honestly, I don’t expect Roche to share that type of information and honestly would be amazed if they do. Not because I think there is “gouging” going on (or do I?), but because that would be a poor business decision in a competitive marketplace.

    One thing I find odd about that marketplace is that, except for a few notable exception (i.e. Walmart brand strips), all the strips are very close in price.

    It seems to me that someone is probably making one hell of a lot of money from this lack of transparency. it seems that it may be relatively simple to move the “waste” from an area of open view to one that is still shrouded in darkness.

    • e-Patient Dave

      Scott, I’m not taking sides on this but re pricing, I’ll note –

      There are many approaches to pricing. There’s cost-based pricing, there’s market-based pricing (whatever people will pay), there are other approaches.

      There may or may not be someone making tons of money – I don’t know – that’s certainly true of that iPad inventor company, whatever their name was.

      Personally I have a bias against any company (or industry) holding anyone else captive and extracting money from them, when the party has no choice. (Like, nobody HAS to buy an iPad.) But I have no info about the industry you describe to guess whether anyone is or isn’t doing it.

      Has anyone tried to enter that market and been blocked?

      • Dave,

        Odd you should mention market-based pricing, insulin is often used as an example of a product that consumers will pay ANY price to get.

        Insulin isn’t truly insulin any more either, it’s an analog, a bio-similar drug. After 90 years, there are still no generics the FDA is partially to blame for that since they have just now started to provide guidance for the production of bio-similar as generics.

        What I’ve read about this so far is that they feel that the generics will need to go through the same approval process as the non-generics. I doubt that many generics manufacturers will be willing to that kind of time and money in addition to the normal costs of a technology transfer.

        When patents expire, pharma companies usually develop an “improved” biologic and take the older one off the market. Thus keeping generics out of the picture with new patents.

        That’s the pricing world that Type 1 diabetics live in

  • Dave,

    Thanks — this is awesome.

    You’re right: enough is enough. It’s time for transparency in pricing — and after that, there can be a real conversation about value. As in, for example, is a $2000 MRI better than a $295 MRI? Who gets to decide? We’re trying to get a start on this at clearhealthcosts.com, and we would be happy to join hands with you, Scott, Bart — and the rest of the empowered patient community.

    We should know what stuff costs. cheers jeanne

    • e-Patient Dave

      Jeanne,

      > It’s time for transparency in pricing

      Ahem: did you read this post?? :) I’m saying let’s drop the abstraction and say it’s time for VISIBLE pricing.

  • I couldn’t agree more. In fact, our business model is based on the conviction that patients need easy access to quality and cost information, specific to their test or procedure and including their health plan’s negotiated discount. Check out http://www.tandemcare.com and https://www.harvardpilgrim.org/portal/page?_pageid=213,382716&_dad=portal&_schema=PORTAL.

  • The roar for price transparency rises, adding voices from all over. Actually, the LA Times has done some great stories on the topic of “how much is that?” – here’s the latest, from a columnist who’s having his 2nd knee replacement:

    http://www.latimes.com/news/local/la-me-0106-lopez-knee-20130106,0,6017679.column

  • You should just say “gimme my damn prices.”

  • [...] I was interviewed by Joan Justice of HealthWorks Collective. She’d picked up on my “visible pricing” rant, and couldn’t agree more, so we did this nine minute Skype interview.  Her full [...]

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