The impact of hospital price and quality transparency tools on healthcare spending: a systematic review

Abstract

Background Global spending on health was continuing to rise over the past 20 years. To reduce the growth rates, alleviate information asymmetry, and improve the efficiency of healthcare markets, global health systems have initiated price and quality transparency tools in the hospital industry in the last two decades. Objective The objective of this review is to synthesize whether, to what extent, and how hospital price and quality transparency tools affected 1) the price of healthcare procedures and services, 2) the payments of consumers, and 3) the premium of health insurance plans bonding with hospital networks. Methods A literature search of EMBASE, Web of Science, Econlit, Scopus, Pubmed, CINAHL, and PsychINFO was conducted, from inception to Oct 31, 2021. Reference lists and tracked citations of retrieved articles were hand-searched. Study characteristics were extracted, and included studies were scored through a risk of bias assessment framework. This systematic review was reported according to the PRISMA guidelines and registered in PROSPERO with registration No. CRD42022319070. Results Of 2157 records identified, 18 studies met the inclusion criteria. Near 40 percent of studies focused on hospital quality transparency tools, and more than 90 percent of studies were from the US. Hospital price transparency reduced the price of laboratory and imaging tests except for office-visit services. Hospital quality transparency declined the level or growth rates of healthcare spending, while it adversely and significantly raised the price of healthcare services and consumers’ payment in higher-ranked or rated facilities, which was referred to as the reputation premium in the healthcare industry. Hospital quality transparency not only leveraged private insurers bonding with a higher-rated hospital network to increase premiums, but also induced their anticipated pricing behaviors. Conclusion Hospital price and quality transparency was not effective as expected. Future research should explore the understudied consequences of hospital quality transparency programs, such as the reputation/rating premium and its policy intervention.

How Florida's facility fee variation can inform the future of emergency department price transparency

“…Many of those studies demonstrate that most patients don't even use price transparency tools. However, that may be due to the design of older price transparency tools where patients have reported they didn't really guide choice or save them money 12 …”

“…However, that may be due to the design of older price transparency tools where patients have reported they didn't really guide choice or save them money. 12 Ultimately, the health care price transparency journey has just begun. This will likely present many opportunities for EDs and hospitals to deliver higher value, differentiated ED services as the basis for competition may change.…”

“…Prior studies of transparent health care prices have found patients have only limited or even no price sensitivity. [8][9][10][11][12] Many of those studies demonstrate that most patients don't even use price transparency tools.…”

Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare

“…2,3 This would be invaluable not just for patients but also for other stakeholders, such as payers and researchers, as they work to identify high-quality, efficient providers in the market. 4 Research suggests that past efforts at price transparency have largely failed, so new approaches are needed. 5 To gather and include all relevant services in a single episode of care requires a fiscal tool known as an episode grouper.…”

“…For these new estimates to achieve their full potential, they will need to encompass the total cost of care by assigning all the services plausibly included in the perioperative care into a surgical episode price 2,3 . This would be invaluable not just for patients but also for other stakeholders, such as payers and researchers, as they work to identify high-quality, efficient providers in the market 4 . Research suggests that past efforts at price transparency have largely failed, so new approaches are needed 5 …”