Clean Bill(s) of Health: The Push for Price Transparency

Whether inside his classroom or in discussions with policymakers in Washington, D.C., Ben Chartock likes to talk about why so many Americans struggle to access affordable health care.

The assistant professor of Economics, who has spent the past decade studying various topics related to U.S. health care delivery, says that opaque pricing policies prevent consumers from making fully informed decisions about their health and well-being. “In nearly every other sector of our economy, consumers can compare the price and quality of goods and services prior to making a purchase,” Chartock explains. “But health care costs are both high and highly variable and there is not enough competition dampening these prices.”  

Through his research and teaching, Chartock is working to ensure that U.S. health care consumers — both as patients and as purchasers of insurance plans for employees — enjoy all the benefits of a highly innovative health system while minimizing the obstacles related to paying for care. Given that nearly 40% of Americans, including many with serious health conditions, report postponing or forgoing treatment due to cost concerns, it’s an important and necessary mission. And it’s one supported, in part, by Patient Rights Advocate, a Newton, Massachusetts-based nonprofit that recently awarded Chartock $250,000 for the development and publication of research addressing lowering health care costs and ensuring price transparency. 

This topic is a long-standing issue in the health care industry, Chartock says, since most Americans use private health insurance. Unlike Medicare and Medicaid, which have standardized rates established by federal and state governments, private insurers negotiate directly with health service providers to determine their own coverage costs.  

Influenced by a variety of factors, including customer demographics and the size of its provider network, these prices vary considerably, not only from company to company, but even among the plan options offered by a single insurer: In research published in JAMA Health Forum, Chartock reported that one national health insurance provider, Humana, charged its customers varying amounts for identical procedures based on their geographic location, with prices ranging from $69-$114 for routine office visits, $251-$456 for lower limb MRIs and $169-$320 for high-severity emergency room visits. 

Historically, insurers haven’t made coverage costs publicly available, meaning that most consumers only discover how much they owe when they receive a post-treatment bill. According to the most recent Bentley-Gallup Business in Society Report, which examines Americans’ opinions about where and how businesses are contributing positively to society, 95% of Americans believe health providers should tell them how much their care will cost upfront — but only 17% report that it happens. 

Recent federal legislation — most notably, the 2021 Hospital Price Transparency and 2022 Transparency in Coverage rules, which require hospitals and health insurers, respectively, to disclose pricing information for every provider and every procedure — has attempted to address this imbalance. But Chartock says that many hospitals and health insurers are skirting government guidelines by providing incomplete or intentionally incomprehensible data.  

“The information is often difficult to access and incredibly dense, making it virtually impossible for the average consumer to make accurate price comparisons,” he notes, adding that the Centers for Medicare and Medicaid Services, the federal agency responsible for monitoring disclosures, needs to establish clear-cut reporting standards and enforce penalties for noncompliance. 

Consumers also have a role to play in ensuring price transparency. “Informed health care consumerism is a powerful, nonpolitical lever for managing costs and improving patient satisfaction,” Chartock says. With employer-sponsored insurance constituting the single largest source of health coverage for Americans, he believes businesses can — and should — leverage their collective purchasing power to demand accurate, accessible and actionable information.  

It’s a message he emphasizes in the classroom, too. After all, Chartock says, “It may not be top of mind now, but the cost of health care is something every Bentley student will have to contend with upon graduating and entering the workforce.” In addition to teaching undergraduate courses in Intermediate Microeconomics (EC 224) and Health Economics (EC 343), he designed a graduate course in Microeconomic Foundations of Healthcare that he teaches as part of a customized MBA program Bentley developed in partnership with Beth Israel Lahey Health. And last fall, Chartock — an affiliate of Bentley’s Center for Health and Business, which brings together students, faculty, alumni and corporate and community partners to develop innovative and sustainable solutions for health industry challenges — engaged 250 first-year students in a discussion about health care price transparency.  

Ultimately, Chartock says, slowing the growth in health care spending in the U.S. will involve harnessing market forces and making difficult choices. “Regulators and politicians often come to the table with the best of intentions to solve complex problems,” he explains. “But market dynamics are strong and any policy that ignores economics is doomed to have little impact. It’s my job as a professor to teach Bentley students — tomorrow’s industry leaders — the role of economics in shaping an equitable and efficient health care system.”