By Arthur Garson Jr.
President Trump’s new executive order, which requires hospitals to share information with patients about the cost of medical care, might seem like a good idea. After all, many of us know well just how frustrating it can be when a hospital, clinician or insurer can’t or won’t share information about costs until after our surgery, test or procedure is complete —if ever.
But there is a serious danger with the new order: a simple list could intimidate or confuse patients, and it may actually turn them off from getting needed data.
As a physician, I know that the eventual goal must be to inform patients about their care. That means sharing with them not only the cost of their care but also what they are paying for, and why they need to buy it.
For patients, it’s increasingly important to understand those costs because employers are forcing employees to pay a growing share of medical bills. Informed patients also save themselves and the health care system money — as much as 20 percent, according to one study. For example, if they don’t understand why they are taking a medication, they are less likely to take it, increasing the downstream costs as their condition worsens.
But we have a huge problem. Only 4 to 6 percent of people use quality and cost data for medical decision-making.
Simply disclosing prices, which the administration is focused on, would definitely make it easier for patients to make better decisions about medical costs. But it takes much more than that.
A recent example shows what happens when efforts at transparency fall short. Last year, the Trump administration expanded the availability of a type of health insurance that has been called “skimpy” by Consumer Reports. These plans — which are expensive, exclude coverage for pre-existing conditions and generally don’t cover drugs or long hospitals stays —are far from what most people consider normal health insurance.
Insurance companies selling them were required to provide a disclaimer with these plans, indicating they were quite different from typical insurance. You can imagine how important that disclaimer is. It’s designed to inform patients what they are, and are not, buying.
My delight that there was a disclaimer turned to horror when I found I could barely understand it. Ianalyzed it using software showing what grade level is required to understand a paragraph. The disclaimer required a second-year, graduate-school education.
Fortunately, some policymakers understand the value in bringing clarity to patients. Texas Insurance Commissioner Kent Sullivan, for example, has created a program called Plain Language with the “goal to use plain language in everything the agency does — on the website, in writing, even on the phone.”
We should take this even further. I believe all medical information should be required to be presented at a sixth-grade reading level.
Additionally, we could create a new job function. Think of it as H&R Block for your health, with experts helping patients make decisions about how much insurance they need and how much health care they can afford. The benefits of this support would vastly outweigh the costs, since it would help people to make the best decisions about how to spend their money and contribute to a healthier population.
Transparency needs context. We must make medical instructions, and data on quality and price, more understandable. Just publishing the numbers isn’t good enough for patients.
Garson, MD, MPH, is director of the Texas Medical Center Health Policy Institute. He was the vice president of Texas Children’s Hospital for health care quality and a former medical school dean.