Still Searching: How People Use Health Care Price Information in the United States

April 6, 2017

Historically, the health care system has not made it easy for people to find out how much their care will cost them out of pocket. Recently, insurers, state governments, employers and other entities have been trying to make health care price information more easily available to individuals and families. Although these price transparency efforts are new, we know from previous research that many Americans have tried to find price information before getting care. This new research reveals that Americans are still searching for price information, but obstacles remain to helping them find the information that can help them save money.

Public Agenda, with support from the Robert Wood Johnson Foundation and the New York State Health Foundation, set out to explore how Americans are trying to find and use health care price information and how residents of four states—New York, New Hampshire, Florida and Texas—are doing so.

Findings and implications are summarized below. You can download a PDF of the full report here and a research brief here.

MAIN FINDINGS

Finding 1: Half of Americans have tried to find price information before getting care. People who have to pay more out of pocket are more likely to have tried to find price information.

  • 50 percent of Americans have tried to find out before getting care how much they would have to pay out of pocket, not including copays, and/or how much their insurers would pay.
  • Higher percentages of Texas, Florida and New Hampshire residents have tried to find price information and have tried to compare prices than New York State residents and Americans overall.

Finding 2: Only some Americans have tried to compare prices. Of those who have tried to compare prices, more than half say they saved money.

  • 20 percent of Americans have tried to compare prices across multiple providers before getting care.
  • About one in three Americans—28 percent—have tried to find out a single provider’s price rather than comparing. Larger percentages of Texas, Florida and New Hampshire residents have tried to compare prices.

Finding 3: Most Americans do not think prices are a sign of quality in health care. Of those who have tried to compare prices, most have chosen less expensive care.

  • Using four different questions, we found most Americans understand that health care price and quality are not associated. Seventy percent of Americans say, for example, that higher prices are not typically a sign of better medical care. This is similar to what we found in New York State, Texas, Florida and New Hampshire.
  • 59 percent of Americans who have tried to compare prices say they chose a less expensive doctor, hospital, medical test or treatment.
  • Among people who have not ever tried to find price information before getting care, 40 percent indicate they would be inclined to choose less expensive doctors if they knew prices in advance. However, 43 percent of them would not be inclined to do so, and 17 percent don’t know.

Finding 4: Americans turn to friends, relatives and colleagues; insurance companies; doctors; and receptionists when they try to find price information.

  • In our national survey, 17 percent of residents of states with state-administered price information websites indicate they have heard of the names of their states’ websites. Seven percent of people in those states who have tried to find price information say they have used their states’ websites.

Finding 5: Potential barriers to increasing the use of price information by Americans include limited awareness of price variation and uncertainty about how to find price information.

  • Over half—56 percent—of Americans either believe doctors charge pretty much the same prices for the same services (37 percent) or they say they don’t know (19 percent). And 55 percent either believe hospitals charge pretty much the same prices for the same services (32 percent) or they say they don’t know (23 percent).
  • 57 percent of Americans who have not tried to find price information before getting care indicate they would like to know the prices of medical services in advance. However, 51 percent of them indicate they are not sure how to do so.

Finding 6: Americans want to know more about health care prices.

  • 63 percent say there is not enough information about how much medical services cost, 23 percent say there is enough information, and nearly 13 percent do not know. This finding is similar in New York State, Texas, Florida and New Hampshire.
  • 70 percent of Americans think it is a good idea for doctors and their staffs to discuss prices with patients before ordering or doing tests or procedures or referring them to specialists. However, only 28 percent say a doctor or their staff has brought up price in conversation with them.
  • 80 percent of Americans think it is important for their state governments to provide people with information that allows them to compare prices before getting care.

IMPLICATIONS

Efforts which aim to help the health care system work better by making prices more transparent should be informed by and responsive to the perspectives and needs of the American public. Based on these findings, Public Agenda outlines the following implications and questions for policymakers, insurers, employers and providers, as well as for-profit and nonprofit price information providers, to consider.

  • Help people compare prices to help them save money.
  • Direct price transparency efforts toward people who face high out-of-pocket costs

and toward those whose insurance coverage is unstable.

  • Recognize the diversity of sources people use to try to find price information.
  • Equip medical professionals and their staffs to discuss prices with patients or to refer patients to reliable sources of price information.
  • Employers should find ways to build trust with more of their employees.
  • States should consider a range of ways to make price information more transparent.
  • Support further exploration of variations among states in how people find and use price information.

METHODOLOGY IN BRIEF

This brief summarizes findings from a nationally representative survey of 2,062 U.S. adults ages 18 and older and representative surveys of 808 adults in Texas, 802 adults in New York State, 819 adults in Florida and 826 adults in New Hampshire. Interviews were conducted from July through September 2016. Respondents could choose to complete the survey in English or Spanish. Data for both surveys were collected through 40 percent phone interviews, including cell phones, and 60 percent online surveys.

Support for this report was provided by the Robert Wood Johnson Foundation and the New York State Health Foundation (NYSHealth). The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation or of NYSHealth.

Americans bear a significant share of their health care costs in the form of high deductibles and insurance premiums, as well as copayments and, sometimes, coinsurance. Health care systems in the United States have historically not made it easy for people to find out how much their care will cost them. In 2016, 43 states received grades of “F” from Catalyst for Payment Reform for their price transparency laws. But in recent years, insurers, state governments, employers and other entities have been trying to make price information more easily available to individuals and families. In this changing landscape of price transparency, this research explores people’s behaviors, attitudes and perspectives related to health care price information.

Findings are based on a nationally representative survey of 2,062 U.S. adults and representative surveys of 802 New York State adults, 819 Florida adults, 808 Texas adults and 826 New Hampshire adults, conducted from July through September 2016 by telephone, including cell phones, and online.

This research was conducted by Public Agenda and funded by the Robert Wood Johnson Foundation and the New York State Health Foundation, and it follows up on a previous national survey conducted by Public Agenda with support from the Robert Wood Johnson Foundation, published in 2015. This nationally representative survey was conducted in conjunction with representative surveys in four states: Florida, New Hampshire, New York and Texas. (2017)

Read the New York State Brief

Read the New Hampshire Brief

Read the Florida Brief

Read the Texas Brief

This document provides the full methodology and topline for “Still Searching: How People Use Health Care Price Information in the United States.” As insurers, state governments, employers and other entities have been trying to make health care price information more easily available to individuals and families, Public Agenda research reveals that Americans are still searching for price information. Obstacles remain to helping them find the information that can help them save money. This nationally representative survey research was conducted by Public Agenda and funded by the Robert Wood Johnson Foundation and the New York State Health Foundation. It follows up on a previous national survey conducted by Public Agenda with support from the Robert Wood Johnson Foundation, published in 2015. (2017)

President Issues Executive Order Calling for Health Care Price Transparency
(Society for Human Resource Management, Wednesday, June 26th, 2019)

How providers, patients could benefit from CMS’ newly instated price transparency rule 
(Fierce Healthcare, Friday, January 4th, 2019)

David Schleifer on what quality measures matter most to patients
(Catalyst For Payment Reform, Monday, November 12th, 2018)

Why don’t more people shop for health care? Online tools exist, but most don’t use them
(Miami Herald, Monday, July 23rd, 2018)

Why don’t more people shop for health care? Online tools exist, but most don’t use them
(Chicago Tribune, Friday, July 20th, 2018)

Defining the Goals of Health Care Price Transparency: Not Just Shopping Around
(NEJM Catalyst, Tuesday, June 26th, 2018)

A Great Way To Find Lower Cost Health Care: Comparative Websites
(MomsRising.org, Tuesday, May 1st, 2018)

Promise and Reality of Price Transparency
(The New England Journal of Medicine , Thursday, April 5th, 2018)

A Wish List For 2018
(Huffington Post, Monday, December 4th, 2017)

Price Transparency Tools Are Still Struggling. We Offer Advice
(The Health Care Blog, Monday, October 23rd, 2017)

MYTHBUSTER: Consumers favor higher priced providers
(Catalyst for Payment Reform, Tuesday, September 26th, 2017)

Let The Sun Shine In On Health Care Costs
(Huffington Post, Tuesday, September 19th, 2017)

I’m the perfect person to price shop for an operation. But the process went terribly
(STAT, Thursday, September 14th, 2017)

For some consumers, loyalty outweighs price
(Modern Healthcare, Thursday, August 10th, 2017)

Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information
(Health Affairs, Monday, August 7th, 2017)

Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees And Retirees
(Health Affairs, Monday, August 7th, 2017)

The Right Way to Reform Health Care
(Foreign Affairs, Monday, July 31st, 2017)

Patients lukewarm toward price transparency tools
(FierceHealthcare, Tuesday, July 11th, 2017)

The Price of Health Care
(The New York Times, Sunday, June 18th, 2017)

Hospital systems look to Yelp in collecting patient data, feedback, says Health Affairs
(Healthcare Finance, Friday, May 26th, 2017)

The Burgeoning “Yelpification” Of Health Care: Foundations Help Consumers Hold A Scale And A Mirror To The Health Care System
(Health Affairs, Thursday, May 25th, 2017)

We should research our health care at least as well as our cars
(The Baltimore Sun, Monday, May 22nd, 2017)

Get Started: Intro to Transparency
(Catalyst for Payment Reform, Monday, May 1st, 2017)

How People Find and Use Price Information: Public Agenda’s Price Transparency Survey
(The Source on Healthcare Price & Competition, Thursday, April 27th, 2017)

Achieving the Promise of Price Transparency
(JAMA, Friday, April 21st, 2017)

Healthcare services: Employees want to find less costly care, but need HR’s help
(HR Morning, Friday, April 21st, 2017)

Comparison shopping for health care still a challenge
(Benefits Pro, Thursday, April 20th, 2017)

Even with insurance, American medical care can be ruinous
(The Economist, Thursday, April 20th, 2017)

How Healthcare Consumers Find and Use Price Information
(The Bio Report, Thursday, April 20th, 2017)

Employees Still Can’t Find Out How Much Health Providers Charge
(Society for Human Resource Management, Wednesday, April 19th, 2017)

How to make health price information more accessible to consumers
(Managed Healthcare Executive, Wednesday, April 19th, 2017)

Patients Trust Doctors with Their Lives-and Wallets
(Twin Cities Business, Wednesday, April 19th, 2017)

State’s health-shopping website to debut soon
(The Boston Globe, Friday, April 14th, 2017)

28% of Adults Say Docs Discuss Patient Financial Responsibility
(RevCycle Intelligence, Tuesday, April 11th, 2017)

Survey: 80% of Americans Want Their States to Post Health Care Prices
(Managed Care, Tuesday, April 11th, 2017)

Americans Seek Actionable Healthcare Price Information, Survey Finds
(Philanthropy News Digest, Monday, April 10th, 2017)

Survey: 1 in 5 patients comparison-shop for healthcare
(Fierce Healthcare, Monday, April 10th, 2017)

Texans want medical costs up front
(Benefits Pro, Monday, April 10th, 2017)

New Yorkers don’t really shop around for doctors
(Crain’s New York Business, Friday, April 7th, 2017)

Report: Public wants health care price transparency
(NonDoc Media, Friday, April 7th, 2017)

State residents not price comparing on docs: survey
(Crain’s New York Business, Friday, April 7th, 2017)

Study: 20% of Americans tried to compare multiple providers’ costs prior to care
(Becker’s Hospital Review, Friday, April 7th, 2017)

Most Texans Want To Know The Price Of Health Care In Advance, Study Says
(KUT Austin, Thursday, April 6th, 2017)

Making price transparency useful for patients
(Enjoy Travelling, Invalid Date)

Understanding How Americans Use Price Information in Health Care
(Sociology In Action, Invalid Date)

National survey and surveys in New York State, Florida, Texas, and New Hampshire point to a need for more actionable price information

DATE OF RELEASE: THURSDAY, APRIL 6TH, 2017

New York City – Americans are trying to find out how much their health care will cost, according to a newly-released national survey with supplemental surveys in New York State, Florida, Texas, and New Hampshire. As Americans increasingly bear a significant share of their health care costs out of pocket, research from Public Agenda, funded by the New York State Health Foundation and the Robert Wood Johnson Foundation, shows that some people are using price information to save money, but more work needs to be done to achieve widespread adoption and use of price information.

“With life’s essentials, such as housing, education and health care, becoming unaffordable for many Americans, we need to find ways to help contain these costs,” said Will Friedman, President of Public Agenda. “That’s why we were happy to conduct this research in partnership with the Robert Wood Johnson Foundation and the New York State Health Foundation. While price transparency alone is not enough to make health care affordable, it does have the potential to help people manage their health spending and save some money.”

The research found that:

  • Fifty percent of Americans have tried to find out how much their health care would cost them before getting care. Similarly, about half of New York State residents—48 percent—have tried to find price information. In other states, an even greater percentage of people have tried to find price information: 56 percent of Floridians, 57 percent of New Hampshire residents and 59 percent of Texans.
  • Just over half of people who compared prices saved money. Most people who tried to find price information did not actually compare multiple providers’ prices. But of the one in five Americans who tried to compare prices when they sought price information, 53 percent say they saved money.
  • Despite recent efforts by insurers, state governments, employers and other entities to make health care price information more easily available, 63 percent of Americans say there is not enough information about how much medical services cost.
  • Most Americans don’t think saving money on health care means skimping on quality. Seventy percent of Americans say higher prices are not a sign of better quality care.
  • Websites are not the most commonly used source for price information. Online health care price information tools have proliferated in recent years. But among the 50 percent of Americans who have tried to find health care price information, websites are not the most commonly used source. Fifty-five percent of people who have tried to find price information asked a friend, relative or colleague, and 48 percent contacted their insurance company by phone or used their insurer’s website to find prices. Just under half of people who tried to find price information asked their doctor, and roughly the same percent asked a receptionist or other staff in their doctor’s office. Only 20 percent used the internet other than their insurance company’s website.
  • A surprising number of people do not know that providers charge different prices for the same services. Just under half of Americans are aware that hospitals’ prices can vary, and just under half are aware that doctors’ prices can vary.

“Timely, reliable price information is more important than ever before, especially as consumers—burdened by rising out-of-pocket costs—are increasingly expected to shop around for health care services,” said David Sandman, Ph.D., President and CEO of the New York State Health Foundation. “New Yorkers mirror the rest of the country in needing pricing information from trusted or independent sources. Doctors, employers, health plans and state governments all have a role to play to make price information more transparent so that patients and their families can seek and receive high-quality, affordable care.”

The research also found that, with many states considering whether to make prices more transparent, 80 percent of Americans agree that it is important for their state governments to provide comparative price information. Most also say that it is a good idea for doctors and their staffs to discuss prices with patients, although few people have actually discussed prices with their providers.

“In order for any of us to make informed decisions that meet our own health care goals and needs, we must have clear and transparent information. And while price information is just one part of that equation, this research points to a real and important gap between what people want and what they have access to,” said Andrea Ducas, MPH, program officer at the Robert Wood Johnson Foundation. “Price transparency is a critical part of making the health care system more accountable to the people it is serving.”

Survey findings are summarized in the new report, “Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas, and New Hampshire.” The research was supported by the Robert Wood Johnson Foundation and the New York State Health Foundation. Findings are based on a nationally representative survey of 2,062 U.S. adults and on representative surveys of 802 adults in New York State, 808 adults in Texas, 819 adults in Florida and 826 adults in New Hampshire, all conducted in July to September 2016, as well as on focus groups in Texas and New Hampshire. The report from Public Agenda updates a 2015 report, which was the first nationally representative survey of how Americans seek and use health care price information.

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About Public Agenda

Public Agenda helps build a democracy that works for everyone. By elevating a diversity of voices, forging common ground, and improving dialogue and collaboration among leaders and communities, Public Agenda fuels progress on critical issues, including education, health care and community engagement. Founded in 1975, Public Agenda is a nonpartisan, nonprofit organization based in New York City. Find Public Agenda online at PublicAgenda.org, on Facebook at facebook.com/PublicAgenda and on Twitter at @PublicAgenda.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working with others to build a national Culture of Health enabling everyone in America to live longer, healthier lives. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

About the New York State Health Foundation

The New York State Health Foundation (NYSHealth) is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Today, NYSHealth concentrates its work in two strategic priority areas: building healthy communities and empowering health care consumers. The Foundation is committed to making grants, informing health policy and practice, spreading effective programs to improve the health care system and the health of New Yorkers, serving as a neutral convener of health leaders across the State, and providing technical assistance to its grantees and partners. Find NYSHealth online at www.nyshealth.org and on Twitter at @nys_health.