Price Shopping for Health Care. Results of a National Survey of Patients

Background:  The wide variation in health care prices within markets, increasing patient cost-sharing, and numerous price transparency initiatives suggest opportunity for patients to pay lower prices if they “price shop” for health care. We conducted a nationally-representative patient survey to assess how often patients are price shopping, factors that lead patients to shop for care, and the barriers to price shopping.  We were particularly interested in the role of higher patient cost sharing through higher deductibles.

Methods: We conducted a national survey in March 2015 of 2,999 non-institutionalized US adults aged 18-64 who received medical care in the prior 12 months. We examined two components of price shopping (1) actively seeking out out-of-pocket cost information before receiving care by either calling the provider/ health plan, or using a price transparency website and (2) comparing and selecting providers, at least in part, based on out-of-pocket cost.  All respondents were also asked about their general views on shopping for care.

Results: A minority of respondents (12.8%) who paid some money out-of-pocket for their care actively sought information about their out-of-pocket costs before receiving care. Lower income respondents (income <$30,000) were more likely to seek out this information than higher income respondents (income >$100,000) (17.9% vs  10.6%). Few respondents (10.1%) considered other providers and even fewer (3.1%) compared costs across providers. Those visiting a physical therapist or urgent care or retail clinic were the most likely to compare costs across providers.  Higher deductibles were associated with only modestly higher, and not statistically significant, likelihoods of comparing costs across providers ($0 deductible, 1.4%, 1-$1249 deductible, 2.6%, >$1250 deductible, 3.5%). The key barriers do not appear to include interest in price shopping, as 85.0% of patients said that they would use price shopping websites or resources if they were to become available. Further, most respondents (80.3%) believe there is no relationship between health care cost and quality.  The common barriers to price shopping were perceived lack of available price information, lack of alternative options for care in their community, and a desire not to disrupt existing provider relationships.

Conclusions: Americans appear supportive of the notion of price shopping for health care, but despite greater need for price information few patients price shop in practice.  Simply increasing “skin the game” through higher deductibles appears insufficient to induce price shopping. Key barriers include a desire among patients to not disrupt existing relationships with a provider and perceived lack of available price information.