Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?
BACKGROUND
Cost-sharing in health insurance plans creates incentives for patients to shop for lower prices, but it is unknown what price information patients can obtain when scheduling office visits.


OBJECTIVE
To determine whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices, and geographic areas.


METHODS
Simulated patient methodology in which trained interviewers posed as non-elderly adults seeking new patient primary care appointments. Caller insurance type (employer-sponsored insurance [ESI], Marketplace, or uninsured) and plan were experimentally manipulated. Callers who were offered a visit asked for price information. Unadjusted means and regression-adjusted differences by insurance, office types, and geography were calculated.


METHODS
Calls to a representative sample of primary care offices in ten states in 2014: Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas (N = 7865).


METHODS
Callers recorded whether they were able to obtain a price. If not, they recorded whether they were referred to other sources for price information.


RESULTS
Overall, 61.8% of callers with ESI were able to obtain a price, versus 89.2% of uninsured and 47.3% of Marketplace callers (P < 0.001 for differences). Price information was also more readily available in small offices and in counties with high uninsured rates. Among callers not receiving a price, 72.1% of callers with ESI were referred to other sources (billing office or insurance company), versus 25.8% of uninsured and 50.9% of Marketplace callers (P < 0.001). A small fraction of insured callers were told their visit would be free. If not free, mean visit prices ranged from $157 for uninsured to $165 for ESI (P < 0.05). Prices were significantly lower at federally qualified health centers (FQHCs), smaller offices, and in counties with high uninsured and low-income rates.


CONCLUSIONS
Price information is often unavailable for privately insured patients seeking primary care visits at the time a visit is scheduled.
Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway/Room 344, Baltimore, MD, 21205, USA. bsaloner@jhu.edu.
Brendan
B
Saloner
The Urban Institute, Washington, DC, USA.
Lisa Clemans
LC
Cope
Robert Wood Johnson Foundation, Princeton, NJ, USA.
Katherine
K
Hempstead
Northwell Health/Hofstra Medical School, Great Neck, NY, USA.
Karin V
KV
Rhodes
University of Pennsylvania, Philadelphia, PA, USA.
Daniel
D
Polsky
The Urban Institute, Washington, DC, USA.
Genevieve M
GM
Kenney
D000328:Adult; D001071:Appointments and Schedules; D005260:Female; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D017057:Medically Uninsured; D009819:Office Visits / Q000191:economics*; D010358:Patient Participation / Q000191:economics* / Q000379:methods; D011320:Primary Health Care / Q000191:economics*
Affordable Care Act; audit; insurance; price transparency; primary care