Shopping for health care: A few thoughts on how to do it

Credit: www.SeniorLiving.Org; Creative Commons license CC-BY-SA
Credit: www.SeniorLiving.Org; Creative Commons license CC-BY-SA

Summary: Yes, people are shopping for health care. Some are better at it than others, and some providers and payers (read: doctors/hospitals and insurers) are better than others about revealing information. We’re always interested to hear when people who haven’t encountered these truths come up against the real world. So when Sarah Kliff, the well-respected health care writer for Vox.com, wrote about her experience trying to get a better price for an MRI, I was really interested.

 


In her story, Kliff said she had a fracture that hadn’t healed properly. After she spent weeks in a walking cast and saw little improvement, her doctor recommended an MRI. Kliff scheduled an MRI at an academic center, then heard from her insurance company that they had a better choice that was less expensive. So, she went.

But when she went back to her doctor for the results, he said that it was hard to for him to get the MRI, because he wasn’t familiar with the facility she went to. So she waited for a while as the offices straightened this out. Then, the doctor told her that the quality of the MRI was a little blurry, and he wanted a better version (that could have been done at the expensive academic medical center where she was first sent!). Still, the scan was good enough for the doctor to diagnose a fracture.

In Kliff’s story she concluded that shopping for health care is hard.

At ClearHealthCosts, the company I founded, we’ve been studying and writing about this for years now. We’ve also been crowdsourcing prices with our partners at KQED public radio in San Francisco, KPCC public radio in Los Angeles and WHYY public radio in Philadelphia, as well as with MedPage Today, the provider information service that’s a wing of health giant Everyday Health. So I have a few observations.

My questions for Kliff:

  • Having been directed to a different MRI provider by the insurance company, did you ask the doctor if the quality at that provider is OK? This system is a mess, and we often hear of people being steered to a provider for reasons of money (the doctor’s in-network, or the gastrointestinal doctor owns an interest in the GI center where she sends patients for a colonoscopy, etc) or for reasons of quality (this place has old machines; please don’t go there).
  • Did you ask the same quality question of the insurance company that sent you to a different provider?
  • As a reporter, did you ask why there were no quality metrics posted publicly or made available in other ways? It might be because they don’t exist. Quality metrics are in their infancy. But that must eventually improve, and if we keep asking, one hopes that will help.

I also wonder if MRIs at the academic medical center where she was first sent ever delivers blurry scans.

Talking about quality and about money

I have a friend who works at a prestigious New York City hospital. When I asked him about the quality question, he laughed and said “Every MRI that comes into [our hospital from another center] gets a sticker up in the corner that says, “Poor quality. Must re-do,” or words to that effect. To his credit, he was kind of shamefaced about this – not gloating, truly just acknowledging that this is common practice and that it’s ridiculous that every single MRI not performed at his hospital would be flawed.

Also, Kliff said she’d saved her insurer money by going cheaper. But the insurer has power to save money itself: It contracts with both the expensive MRI provider and the inexpensive MRI provider. Why doesn’t it simply refuse to pay the higher rate? The answer, of course, depends on who you talk to: the expensive provider has market power; the expensive provider needs to get paid more because its care is better; the expensive provider needs to be compensated for uncompensated care, etc. But the truth is: the money that Kliff saved her insurance company will not be finding its way back to her soon, and also: high prices benefit many in the marketplace by creating an artificial view of pricing, and by scaring the pants off people (“A $6,000 MRI? Wow, glad I have insurance, and glad they negotiated it down to $2,000! Whew!”)

For many people, having choice in where they go for health care is a foreign experience.

It’s especially foreign for people who have not used much health care recently — and also for younger people. They just haven’t got as many health issues and may be more trusting than someone like me, who, at 61, has had her share of health care experiences.

Kliff’s conclusion: “My own health care experience is far from unique. But it was a helpful, first-person demonstration of how shopping for health care might not be a zero-sum game, and that even with basic services, there can be clear winners and losers.”

Yes, it’s hard — but we have to do it anyway

My conclusion: Yes, it’s hard. But we have to keep trying. Here’s a post about one person who did recently, and who walked away more or less satisfied. MRI prices vary a lot, from $255 to $6,221 in California, for example, so it pays to ask.

My advice to anyone who is trying to get good quality — at a fair price:

  • Ask about quality.
  • If they won’t give you an answer, ask again.
  • Ask why not.
  • Ask who’s making money off this.
  • Yes, the system makes it hard to get at the right answer. But that does not mean we should give up trying.

There are steps toward bringing more cost and quality transparency to health care. Of course we, as journalists, are partial to our data, at PriceCheck or ClearHealthCosts. Your insurance company may have some tools, as does this one that we wrote about — and we’d be glad to hear from you about your experiences, as we were glad to hear about Kliff’s experiences.

There are also sites like these:

People are saving money by asking questions about price. It won’t always work perfectly, but I hear every day from people who have saved money by asking some questions and doing some research.