Introduction

It is well known that health care spending in the United States is much higher than similar countries but that this does not result in better health outcomes []. Research has shown that this higher spending is driven by high prices rather than greater utilization of care []. Until recently, publicly available information on health care prices has been scarce [,]. This began to change when the hospital price transparency (HPT) went into effect on January 1, 2021 [].

HPT requires hospitals to post prices or negotiated rates of common, “shoppable,” services, as defined by the Centers for Medicare and Medicaid (CMS), in a machine-readable format. Examples of these shoppable services include common blood tests and radiology services such as X-rays and mammograms. In July 2022, the CMS also mandated that payers post the prices for a more expansive set of services, under the Transparency in Coverage (TIC) regulation []. Thanks to HPT and TIC, health care prices are no longer hidden from the public.

CMS’s stated goal [,] for these transparency initiatives is to help inform consumers about the cost of medical services prior to receiving them, as this information can help people make informed decisions about where they receive services. Additionally, transparency about prices could lead to greater competition and potentially lower prices and health care spending.

These transparency initiatives can be impactful if people are aware that they can access information on health care prices for decision-making, especially for shoppable services with comparable quality across providers. This impact is only actualized if hospitals comply with CMS requirements to provide complete and accurate data on prices in a timely manner.

This paper aims to examine whether people are aware that they can look up prices of health care services prior to receiving care, and whether this newly available information is being used.

MethodsOverview

The data for this study come from a nationally representative survey conducted by Gallup in partnership with West Health Institute from November 2023 through January 2024 that included 5149 randomly selected adults aged 18 years and older from across all 50 states and the District of Columbia from the Gallup Panel [].

Ethical Considerations

The survey received ethical approval from Gallup’s internal institutional review board for all human subject and external reporting considerations (2023-10-04). Participation in the survey was voluntary. All the responses were deidentified and no personal health information or other sensitive personal information was shared with the authors. Web respondents were offered an incentive of $5 while mail respondents were offered an incentive of $2.

Survey

The survey response rate was 38%. Further details on the sampling strategy are in . The survey consisted of questions on people’s experiences and perceptions of health care in America. For this study, we focus on four questions: respondents’ (1) awareness of, (2) use of, and (3) and (4) opinions about compliance with price transparency laws. Percentages were estimated as the count of responses divided by the number of respondents, multiplied by 100. Probability sampling weights provided by Gallup were used to weight the estimated percentages and to calculate the population estimates.

ResultsLow Awareness of Price Transparency

Almost three-quarters of respondents (73%) were not aware that they could look up prices for common health care services provided by hospitals. Men were less likely (77%) than women (70%) to be aware of HPT. Lack of awareness was similar across all ages ().

Table 1. Awareness of price transparency.CharacteristicsResponses, %Population size, N
YesNo
Are you aware that hospitals are required to post prices on their website?
Full sample (n=4946)2773248,092,303
Gender

Male (n=2513)2377124,047,066

Female (n=2371)3070118,640,004
Race

White (n=3091)2872194,419,832

Non-Whitea (n=1827)237751,826,750
Age (years)

18-29 (n=345)277343,876,733

30-39 (n=619)277344,685,260

40-49 (n=576)257541,625,267

50-64 (n=1551)257560,433,949

65 years and older (n=1855)297157,471,094Have you ever looked up the price of a healthcare service before going to a hospital?
Full sample (n=4954)1981248,212,278
Gender

Male (n=2523)2179123,971,168

Female (n=2369)1684118,835,877
Race

White (n=3096)2377194,756,253

Non-White (n=1830)188251,610,304
Age (years)

18-29 (n=346)297143,614,198

30-39 (n=620)237744,980,477

40-49 (n=575)208041,553,530

50-64 (n=1554)168460,512,956

65 and older (n=1859)118957,551,117

aThe category “non-White” is used because there was 1 race/ethnicity variable instead of 2 separate variables for race and ethnicity. The non-White group included a mix of races and ethnicities.

Limited Use of Price Transparency Data

Less than 20% of respondents said they had looked up the price of a medical service prior to their visit. Younger respondents (age 18-29 years; 29%) were more likely than older respondents (aged ≥65 years; 11%) to have ever looked up a price prior to going to a hospital.

Opinions About Enforcing Compliance

Overall, 78% of respondents preferred stricter penalties for hospitals that have not yet released their prices, and only 26% were in favor of CMS allowing hospitals more time to comply with the HPT requirements ().

Table 2. Opinions on enforcement of price transparency rules.CharacteristicsResponses, %Population size, N
Disagree or strongly disagreeNeutralAgree or strongly agree
The federal government should impose and enforce stronger penalties on the hospitals that have not made their negotiated prices public.
Full sample (n=5004)51778249,963,323
Gender

Male (n=2534)71975124,394,088

Female (n=2408)41581120,164,001
Race

White (n=3122)61678195,617,984

Non-Whitea (n=1854)5187852,499,618
Age (years)

18-29 (n=348)3187944,314,231

30-39 (n=617)5138144,620,889

40-49 (n=575)5157941,571,949

50-64 (n=1571)6177761,030,674

65 and older (n=1893)6187558,425,579The federal government should allow more time for hospitals to comply before strictly enforcing the law.
Full sample (n=4958)512326248,828,600
Gender

Male (n=2510)462628123,838,600

Female (n=2386)562023119,584,767
Race

White (n=3102)542323195,228,742

Non-White (n=1828)40243651,754,137
Age (years)

18-29 (n=347)45243144,180,940

30-39 (n=618)56202344,916,392

40-49 (n=576)57232041,625,267

50-64 (n=1557)55202460,693,140

65 and older (n=1860)45272857,412,860

aThe category “non-White” is used because there was 1 race/ethnicity variable instead of 2 separate variables for race and ethnicity. The non-White group included a mix of races and ethnicities.

Discussion

Increased price transparency has the potential to increase competition and decrease health care spending in the United States [,,]. It can also help consumers of health care make informed decisions []. We found limited awareness and use of HPT data among the public, but there is a strong desire for transparency in health care prices. It should be noted that these findings are based on self-reported data and might differ from actual awareness and use of HPT. The CMS should improve compliance among hospitals by aggressively enforcing the existing penalties []. Public awareness efforts could also lead to increased use by consumers.

YP is an employee of Gary and Mary West Health Institute. DM is the founder and CEO of Simple Healthcare. Both organizations have a goal of lowering health care costs in the United States.

Edited by T de Azevedo Cardoso; submitted 17.07.24; peer-reviewed by S Siegenthaler, GS Booth, W van Harten; comments to author 19.09.24; revised version received 18.10.24; accepted 05.11.24; published 12.12.24.

©Yuvraj Pathak, David Muhlestein. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 12.12.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.i-jmr.org/, as well as this copyright and license information must be included.