University of California, Berkeley, Berkeley2Castlight Health, San Francisco, California.
Castlight Health, San Francisco, California3Stanford University, Stanford, California.
JAMA. 2014;312(16):1670-6. doi: 10.1001/jama.2014.13373.
Recent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent.
To determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services.
Payments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving this service. Multivariable generalized linear model regressions with propensity score adjustment controlled for demographic, geographic, and procedure differences. To test for selection bias, payments for individuals who used the platform to search for services (searchers) were compared with those who did not use the platform to search for services (nonsearchers) in the period before the platform was available. The exposure was the use of the price transparency platform to search for laboratory tests, advanced imaging services, or clinician office visits before receiving care for that service.
Medical claims from 2010-2013 of 502,949 patients who were insured in the United States by 18 employers who provided a price transparency platform to their employees.
The primary outcome was total claims payments (the sum of employer and employee spending for each claim) for laboratory tests, advanced imaging services, and clinician office visits.
Following access to the platform, 5.9% of 2,988,663 laboratory test claims, 6.9% of 76,768 advanced imaging claims, and 26.8% of 2,653,227 clinician office visit claims were associated with a prior search on the price transparency platform. Before having access to the price transparency platform, searchers had higher claims payments than nonsearchers for laboratory tests (4.11%; 95% CI, 1.87%-6.41%), higher payments for advanced imaging services (5.57%; 95% CI, 1.83%-9.44%), and no difference in payments for clinician office visits (0.26%; 95% CI; 0.53%-0.005%). Following access to the price transparency platform, relative claim payments for searchers were lower for searchers than nonsearchers by 13.93% (95% CI, 10.28%-17.43%) for laboratory tests, 13.15% (95% CI, 9.49%-16.66%) for advanced imaging, and 1.02% (95% CI, 0.57%-1.47%) for clinician office visits. The absolute payment differences were $3.45 (95% CI, $1.78-$5.12) for laboratory tests, $124.74 (95% CI, $83.06-$166.42) for advanced imaging services, and $1.18 (95% CI, $0.66-$1.70) for clinician office visits.
Use of price transparency information was associated with lower total claims payments for common medical services. The magnitude of the difference was largest for advanced imaging services and smallest for clinical office visits. Patient access to pricing information before obtaining clinical services may result in lower overall payments made for clinical care.
最近的政府和私人倡议试图通过提高医疗保健价格的透明度来降低医疗成本。
确定使用雇主赞助的私人价格透明度平台是否与 3 种常见医疗服务的索赔支付额降低有关。
在使用服务之前，对在定价网站上搜索过价格的患者和未在接受该服务之前进行过研究的患者的临床服务提供的费用进行比较。使用倾向评分调整的多变量广义线性模型回归控制了人口统计学、地理位置和程序差异。为了测试选择偏差，比较了在平台可用之前使用平台搜索服务的个人（搜索者）和未使用平台搜索服务的个人（非搜索者）的支付情况。暴露是在接受该服务之前使用价格透明度平台搜索实验室检查、高级成像服务或临床医生就诊的情况。
2010 年至 2013 年期间，美国 18 家雇主为其员工提供价格透明度平台，共有 502949 名参保患者的医疗索赔。
主要结果是实验室检查、高级成像服务和临床医生就诊的总索赔支付额（每项索赔中雇主和员工的支出总和）。
在获得平台访问权限后，2988663 份实验室测试索赔中有 5.9%、76768 份高级成像索赔中有 6.9%和 2653227 份临床医生就诊索赔中有 5.9%与价格透明度平台上的预先搜索有关。在获得价格透明度平台访问权限之前，搜索者的实验室测试索赔支付额（4.11%；95%CI，1.87%-6.41%）、高级成像服务的支付额（5.57%；95%CI，1.83%-9.44%）高于非搜索者，临床医生就诊的支付额无差异（0.26%；95%CI；0.53%-0.005%）。在获得价格透明度平台访问权限后，与非搜索者相比，搜索者的相对索赔支付额分别降低了 13.93%（95%CI，10.28%-17.43%）、13.15%（95%CI，9.49%-16.66%）和 1.02%（95%CI，0.57%-1.47%）实验室检查、高级成像服务和临床医生就诊。绝对支付差异分别为 3.45 美元（95%CI，1.78-5.12 美元）、124.74 美元（95%CI，83.06-166.42 美元）和 1.18 美元（95%CI，0.66-1.70 美元）。
使用价格透明度信息与常见医疗服务的总索赔支付额降低有关。差异的幅度在高级成像服务中最大，在临床就诊中最小。患者在获得临床服务之前获得定价信息可能会导致临床护理的总支付额降低。
