Saloner Brendan, Cope Lisa Clemans, Hempstead Katherine, Rhodes Karin V, Polsky Daniel, Kenney Genevieve M
Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway/Room 344, Baltimore, MD, 21205, USA.
The Urban Institute, Washington, DC, USA.
J Gen Intern Med. 2017 Jul;32(7):815-821. doi: 10.1007/s11606-017-4003-4. Epub 2017 Feb 6.
Cost-sharing in health insurance plans creates incentives for patients to shop for lower prices, but it is unknown what price information patients can obtain when scheduling office visits.
To determine whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices, and geographic areas.
Simulated patient methodology in which trained interviewers posed as non-elderly adults seeking new patient primary care appointments. Caller insurance type (employer-sponsored insurance [ESI], Marketplace, or uninsured) and plan were experimentally manipulated. Callers who were offered a visit asked for price information. Unadjusted means and regression-adjusted differences by insurance, office types, and geography were calculated.
Calls to a representative sample of primary care offices in ten states in 2014: Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas (N = 7865).
Callers recorded whether they were able to obtain a price. If not, they recorded whether they were referred to other sources for price information.
Overall, 61.8% of callers with ESI were able to obtain a price, versus 89.2% of uninsured and 47.3% of Marketplace callers (P < 0.001 for differences). Price information was also more readily available in small offices and in counties with high uninsured rates. Among callers not receiving a price, 72.1% of callers with ESI were referred to other sources (billing office or insurance company), versus 25.8% of uninsured and 50.9% of Marketplace callers (P < 0.001). A small fraction of insured callers were told their visit would be free. If not free, mean visit prices ranged from $157 for uninsured to $165 for ESI (P < 0.05). Prices were significantly lower at federally qualified health centers (FQHCs), smaller offices, and in counties with high uninsured and low-income rates.
Price information is often unavailable for privately insured patients seeking primary care visits at the time a visit is scheduled.
医疗保险计划中的费用分担促使患者寻求更低价格，但患者在预约门诊时能获取哪些价格信息尚不清楚。
确定新患者能否获取初级保健就诊的价格信息，并识别不同保险类型、医疗机构及地理区域之间的差异。
采用模拟患者方法，由经过培训的访员假扮非老年成年人，寻求新患者初级保健预约。通过实验操纵来电者的保险类型（雇主赞助保险[ESI]、医保市场保险或无保险）和保险计划。获得就诊机会的来电者询问价格信息。计算未调整的均值以及按保险、医疗机构类型和地理位置进行回归调整后的差异。
2014年对十个州（阿肯色州、佐治亚州、爱荷华州、伊利诺伊州、马萨诸塞州、蒙大拿州、新泽西州、俄勒冈州、宾夕法尼亚州和得克萨斯州）的初级保健医疗机构代表性样本进行电话调查（N = 7865）。
来电者记录他们是否能够获取价格信息。如果不能，记录他们是否被转介到其他获取价格信息的来源。
总体而言，61.8%的ESI来电者能够获取价格信息，相比之下，89.2%的无保险来电者和47.3%的医保市场保险来电者能够获取价格信息（差异P < 0.001）。在小型医疗机构和未参保率高的县，价格信息也更容易获取。在未获得价格信息的来电者中，72.1%的ESI来电者被转介到其他来源（计费办公室或保险公司），相比之下，25.8%的无保险来电者和50.9%的医保市场保险来电者被转介到其他来源（P < 0.001）。一小部分参保来电者被告知就诊免费。如果不免费，平均就诊价格从无保险者的157美元到ESI参保者的165美元不等（P < 0.05）。在联邦合格健康中心（FQHCs）、小型医疗机构以及未参保率高和低收入率高的县，价格显著更低。
对于寻求初级保健就诊的私人参保患者，在预约就诊时通常无法获取价格信息。
