Shopping for Primary Care: What Can Patients Learn When They Ask for Price?

Health care prices matter greatly to individuals who pay entirely out-of-pocket for services. This group has historically consisted of the uninsured, but increasingly includes individuals with private health insurance. The number of people with private insurance has grown under the Affordable Care Act (ACA) and many new enrollees have marketplace plans that carry large annual deductibles (>$2,000 per year). Large deductibles are also increasingly common in employer-sponsored insurance. Shifting spending risk from insurers to patients is intended to encourage the pursuit of lower-cost and higher value care, and ultimately to increase competition among providers. However, it is unknown whether individuals searching for health care have an adequate ability to shop for low-cost options.

We conducted an experimental study in 2014 that simulated the experiences of uninsured and privately-insured individuals (either marketplace or employer-sponsored insurance) seeking new patient primary care visits. A representative sample of primary care offices in ten diverse states was called. Callers asked for a check-up appointment or evaluation for hypertension. If offered an appointment, callers asked for the price of the visit; those with private insurance indicated that they had not yet met their annual deductible. Callers recorded whether they were referred to any other resources. If offered a price of more than $100, they also asked whether they could bring $75 to the visit and pay the rest later (i.e., receive a “payment plan”).

Overall, 61.3% of callers with employer plans offered an appointment were able to receive a price, compared to 87.9% for uninsured and 46.6% for marketplace callers. About 15% of callers with private insurance quoted a price were told that their visit would be free (likely reflecting a preventive care provision in the ACA). Among those who were not told the visit would be free, mean prices were $150 (uninsured), $154 (marketplace), and $161 (employer-sponsored coverage). Across insurance groups, most (two-thirds) of the callers were not able to receive a payment plan. Among callers unable to obtain a price, 71.4% of those with employer plans were referred to other resources to find price information compared to 23.3% of the uninsured and 50.8% of the marketplace callers.

In regression models, price information was less available at offices with more than 3 physicians, at internal medicine practices (as opposed to family medicine), and at community health centers (CHCs). Conditional on receiving a price, prices were significantly lower at small practices, family medicine practices, and at CHCs. Callers to CHCs were also significantly more likely to receive a payment plan. Prices were more available, and lower on average, at offices in low-income counties.

Although engaged consumers should be able to price shop for care, gaining access to prices before a visit is challenging in primary care, especially for marketplace enrollees. Prices quoted to consumers averaged above $150 in most settings (except CHCs), representing a financial burden for low-income individuals. Policies that require price transparency, coupled with efforts to steer individuals toward low-cost options, could increase access and reduce financial burden.