Shopping for health care costs not easy

I'd be interested in your experiences trying to figure out health care costs.

For several decades we've heard that one way to help curb health care costs is to be a savvy shopper. Shopping can help drive down costs, this reasoning goes, so find out the real cost of the health care you receive instead of complacently thinking it amounts only to that fixed co-pay you drop during a visit to the doctor or trip to the pharmacy.

Taken to the next step. shopping could land you the lowest price available and create the kind of competition we hear exists on behalf of consumers. That presumes, of course, that you'd be willing to dump a health care professional with whom you've developed a relationship simply to save some bucks.

The most direct way to determine costs is to ask. But as investigative reporter Steven R. Reed told us in a front-page Gazette story on Sunday, July 3, getting a direct answer has been far from guaranteed.

This topic has been interesting to me for some time because of the dilemma it presents: simply save costs or go to a doctor, pharmacist or other health care professional you trust regardless of cost? That is, if you even have the opportunity to make such a choice.

I've talked with several journalists about reporting on this over the past year. Coming up with a way to approach this story took some time as we discussed the challenges each potential approach presented. Among the many questions we tossed about were: How can you measure basic costs in a way that is authentic? Which procedures would you pick if you wanted to compare a few? How does insurance coverage affect costs? How do other medical conditions affect costs?

Doesn't a simple “sticker price” exist, and do health care providers use it to determine prices?

Insurance companies, facing criticism as their rates increase like clockwork in a time warp, tell customers that costs companies take on are going up rapidly because of the number of, procedures ordered by and prices charged to people seeking health care. Those giving advice, notably elected officials facing pressure to do something and insurance company representatives, call upon people to take some personal responsibility for the cost of medical visits and medicines.

Part of that admonishment to take personal responsibility is the sound advice we've all heard: watch what you put into your body and engage in regular exercise. But at times it includes that we should be more informed consumers.

Reed is one of the journalists I've pestered about this situation and he took on the story a little past the beginning of this year. Interestingly, as he was doing his reporting shifts were occurring in the hospital industry. Some moves toward providing more information took place during the months in which Reed was talking with hospital leaders.

Worth noting is that for some time you've been able to get a hint of the actual charge for a particular procedure if you have insurance. It is on your Explanation of Benefits, along with the contractually agreed upon price your insurance company has negotiated with the health care provider, and the difference between the two prices.

But many people don't have insurance. Even if they do, they don't have an Explanation of Benefits sitting around the house for a major procedure they may need for a first time.

The ability that exists in this world to treat diseases, trauma and other medical problems affecting our personal quality of life can astound you sometimes. We, as consumers, demand the service. We'd understand the expenses of doing all of that, and perhaps be more impactful when it comes to keeping costs down, if we could understand from the start something as simple as a base charge for a particular procedure.