Q&A: Use of price transparency tool for childbirth increased from 2011 to 2016
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The percentage of pregnant patients who used a price transparency tool prior to delivery more than doubled within the first 6 years of its availability, according to findings published in JAMA Network Open.
Price transparency tools can be used for clinician and facility selection as well as informational and financial planning purposes, Rebecca Gourevitch, MS, PhD candidate in health policy at Harvard University, and colleagues wrote.
The web-based price transparency tool was launched by a national commercial health insurance company in 2010. It provides patients with estimates of total and out-of-pocket costs for specific clinicians, facilities and services.
In a descriptive, cross-sectional study, Gourevitch and colleagues analyzed data on two cohorts of pregnant patients. The data, which were collected from the health insurance company that launched the price tool, included price tool queries from Jan. 1, 2011, to Dec. 31, 2012, and Jan. 1, 2015, to Dec. 31, 2016. Patients involved in the study were aged 19 to 45 years and had a vaginal or cesarean section delivery during the two study periods. Among the 253,606 patients included in the analysis, 131,224 were in the 2011 to 2012 cohort and 122,382 were in the 2015 to 2016 cohort.
Gourevitch and colleagues reported that use of the price tool increased from 5.9% during the first study period to 13% during the second study period. About half of patients (43.9%) first used the tool during their first trimester of pregnancy. Patients with higher co-insurance (11% or more) who used the tool spent more money out of pocket than patients who never used the tool, with a mean difference of $59.57 (95% CI, 33.44-85.96) among those who used the tool in early pregnancy and $73.33 (95% CI, 32.04-115.29) among those who used it later in their pregnancy.
“Although this association cannot be interpreted as a causal relationship between searching and spending, it raises important hypotheses about the unobserved characteristics of searchers that are also associated with higher delivery spending,” Gourevitch and colleagues wrote. “The results of this study suggest that this association is unlikely to be attributed to searchers selecting higher-cost facilities compared with nonsearchers.”
Rates of searching differed depending on a vaginal or cesarean delivery, from 5% in 2011 to 2012 to 10.8% in 2015 to 2016 for a vaginal delivery and 2.8% to 5.6% for a cesarean delivery (P < .001). Patients who had a previous cesarean delivery were less likely to use the price tool, the researchers noted.
Healio Primary Care spoke with Gourevitch to learn more about the price transparency tool and how it can potentially benefit patients.
Healio Primary Care: What surprised you about the results?
Gourevitch: I was surprised that we saw such a large increase in the rate of use of the price transparency tool over just 4 years. In 2011 to 2012, just after the price transparency tool was released, only 6% of pregnant patients used it prior to delivery. Just 4 years later, from 2015 to 2016, use of the tool had more than doubled to 13% of patients. While 13% is a low percentage of patients, this increase is large.
Healio Primary Care: Is this price transparency tool something that can be recommended by physicians to patients?
Gourevitch: Physicians can certainly recommend that their patients consult price transparency tools. For example, when a physician refers a patient to routine care — like an MRI, lab test or a colonoscopy — they can let their patients know that these kinds of tools are available to help them choose a lower-cost provider. Our study only examined one insurance company’s tool, but most commercial insurance carriers offer similar tools. Some states also provide price transparency tools to assist patients in comparing prices across providers.
Healio Primary Care: Childbirth is very expensive in the U.S. What impact did the pricing tool have on cost savings and planning?
Gourevitch: When patients search on the tool, they see estimates of how much they would have to spend to deliver at the hospitals in their area. They could use that information for financial planning. However, we cannot tell from our study data how much this information changed patients’ plans or whether it led to cost savings. We don’t find an association between using the tool and delivering at lower-cost hospitals, but that doesn’t necessarily mean that using the tool has no impact on savings or planning.
Healio Primary Care: Can you explain why patients who used the tool spent more money on delivery?
Gourevitch: Our analyses report on patterns of care, but not whether using the tool leads patients to have higher or lower spending. In our study population, we observed that patients who use the price transparency tool have somewhat higher spending on delivery. We cannot explain why this is the case. Some exploratory analyses suggest that patients who use the tool may already have been planning to deliver at an expensive hospital, and some may have more expensive care for other reasons, like having some more medical complexity or preferring more intensive care during delivery.
Healio Primary Care: Data on use of the tool was included up to 2016. Do you expect use to have increased or decreased in the years since?
Gourevitch: We don’t know whether search rates have continued to increase, have plateaued around 13%, or have decreased. There’s not much known about use of these tools over the past 5 years.
Healio Primary Care: What are the next steps for this research?
Gourevitch: We are interested in whether patients who use pricing tools have fewer anticipated health care costs or feel better prepared for health care spending — on childbirth and other kinds of care.
People with private insurance have been facing high, and rising, out-of-pocket costs of childbirth. More research is needed to understand which patients are facing the highest costs of care and how these costs impact their use of health care services during pregnancy, delivery and postpartum. We hope that health care systems, insurance companies and policymakers will consider policy options to make sure that all Americans can afford to start or grow their families when they want to.
Healio Primary Care: Anything else to add?
Gourevitch: The choice of an obstetric care provider is very personal and multifaceted. Most price transparency tools provide limited, if any, information about provider quality. Pregnancy and childbirth are areas where patients may have very strong preferences for quality — both in terms of clinical outcomes and in finding a provider that makes them feel comfortable, listened to and respected. Convenience of care may also be very important to pregnant patients. As providers, insurers and employers continue to increase transparency of health care prices, it is important that they also include information on the quality of care.
Reference:
Gourevitch RA, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.21410.