A Helpful Spotlight on the Need for More Health Care Transparency

BIOtech Now
Brian Newell

This week, the Trump administration addressed a problem confronting a growing number of Americans: surprise medical bills. As Peter Sullivan with The Hill reported,

“President Trump on Wednesday spoke out against surprise medical bills that patients often cannot afford, highlighting an issue that has received bipartisan concern in Congress.

“‘The health care system too often harms people with some unfair surprises … medical bills and the like,’ Trump said at a roundtable at the White House, along with patients who had received unexpectedly large bills from hospitals. …

“Several stories of patients who landed surprise medical bills have gotten widespread attention and helped galvanize calls for action in recent months.” 

The stories that have gained public attention represent only a small number of those impacted by this costly and shocking practice.

According to a poll by the Kaiser Family Foundation, roughly 40 percent of adults under the age of 65 received a bill in the previous 12 months for a health care service that was more costly than expected or that they thought was covered by their insurance. Many of these patients were unexpectedly on the hook for $2,000 or more. The poll also found that roughly 2 out of 3 individuals fear receiving a surprise medical bill — a greater fear than paying insurance deductibles or prescription drug costs. A recent study by NORC at the University of Chicago found similar results.

After conducting a year-long investigation of the extraordinary pricing and billing practices of the hospital industry, Sarah Kliff with Vox explained:

“In so many ways, patients find themselves in a vulnerable position during these encounters with the health care system. The result is often high — and unpredictable — bills. Hospitals are not transparent about the cost of their services, their prices vary wildly from one ER to another, and it’s hard to tell which doctors are covered by insurance (even if the hospital itself is covered). In many cases, patients can’t be certain what they owe until they receive a bill in the mail, sometimes weeks or months later.”

States have been stepping up to provide patients stronger protections against surprise medical billing. And fortunately, as The Hill notes, there is also bipartisan interest on Capitol Hill in finding a solution. The attention offered by the president and his administration on this important issue is a hopeful sign of future action. But policymakers shouldn’t stop there.

While cracking down on surprise billing practices is a worthy goal, there is an urgent need for greater transparency across the broader health care system, and that includes how patients receive access to prescription medicines. Too often patients lack basic information from their insurance companies about which medicines are covered by their health plan and how much those medicines will cost out of pocket. That can often lead to a separate set of shock when patients go to the pharmacy.

The Council for Affordable Health Coverage – which is made up of a diverse group of health care stakeholders – issued a comprehensive plan to help make prescription drugs more accessible and affordable. The council (of which BIO is a member) noted in its report:

“Consumer needs are as diverse as the treatments and plans available to them. They must have access to relevant, understandable, and actionable information to make optimal decisions about their health needs. Consumer engagement over health management, treatment decisions, and coverage selection can help improve access and adherence to treatment, slow or halt disease progression, and lower out-of-pocket and system costs.”

The council’s report urges policymakers to focus on reforms that would empower patients to make the most informed decisions that would best meet their health care needs.

As with most of the myriad challenges facing our health care system, the best solution is a holistic one. As policymakers look to tackle the growing problem of surprise medical billing, let’s hope they also take action to provide more transparency across the broader health care system. Wouldn’t that be a pleasant surprise?

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