title: Does price transparency legislation allow the uninsured to shop for care?
abstract: BACKGROUND
  The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer.
  
  
  OBJECTIVE
  To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement.
  
  
  METHODS
  We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy.
  
  
  METHODS
  Three hundred and fifty-three hospitals in California.
  
  
  METHODS
  Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures.
  
  
  RESULTS
  Only 28% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15%) did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p<0.001), cholecystectomy ($14,014 vs. $7,196; p<0.001) and colonoscopy ($2,017 vs. $216; p<0.001).
  
  
  CONCLUSIONS
  Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.
authors: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Kate Stockwell
authors: KS
authors: Farrell
authors: Leonard J
authors: LJ
authors: Finocchio
authors: Amal N
authors: AN
authors: Trivedi
authors: Ateev
authors: A
authors: Mehrotra
mesh_terms: D002140:California; D054626:Consumer Health Information / Q000191:economics / Q000331:legislation & jurisprudence*; D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence*; D005102:Health Expenditures / Q000331:legislation & jurisprudence; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000331:legislation & jurisprudence*; D017057:Medically Uninsured / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D014481:United States