Insurers will disclose the cost of medical services to clients: Trump introduced a new rule
The administration of US President Donald Trump has introduced a new rule requiring insurers to inform consumers in advance of the actual prices for medical tests and procedures. The White House hopes that this will stimulate competition and lead to lower prices in the US medical market. More details about the new rule told the publication NBC News.
The decision was made public just days before the election, although Trump has long spoken about the need. Another decision by the president, requiring the disclosure of prices for medical services on hospital websites, led to a PMI claim from representatives of the healthcare industry. They called the decision “business interference”.
The idea behind the new insurer regulations is to give patients more freedom, thereby lowering their costs.
The requirements will come into effect gradually over a four-year period, and patients will have to spend a lot of time figuring out which institution offers the best value for money. Don't forget about the political uncertainty surrounding the rule if Trump is not re-elected. However, representatives of the current administration are convinced that the changes will remain in force, regardless of the personality of the president. They argue that the goal of price transparency in health care goes beyond political preference.
“It will be impossible to retreat,” said Alex Azar, head of the Department of Health and Human Services. "How can you formulate an acceptable argument for why the cost of a particular procedure should be hidden from the patient?"
On the subject: How to Reduce US Medical Bills
Insurance companies argue that these regulations will boomerang economically and drive up costs. Hospitals and doctors now accepting patients at discounted rates will push for higher wages as soon as they see how much their competitors are getting.
The reform will be implemented in stages:
- In 2022 year insurers will need to open access to data files on the cost of various procedures, allowing technology companies to develop applications that will allow patients to see costs not only for their own insurance plan, but also for those of other insurance companies.
- With 2023 year insurers will be required to provide their clients with cost allocation information for the top 500 health services.
- With 2024 year insurers will have to provide customers with pricing information for all services and items covered by their insurance plans.
Patients will be able to use the online shopping tool to see the agreed rate between the doctor and the insurer, as well as an estimate of the costs of procedures, drugs, medical equipment, and any other items or services they may need.
Information will be available in advance so that an informed decision can be made. Nowadays, most patients find out how much they owe for their medical services only a few weeks after they are discharged, when they receive a bill.
“We need to show prices at the start, not at the finish,” said Seema Varma, head of Centers for Medicare and Medicaid Services. “In every industry, we have found that providing this information to our service users creates a new era of consumption.”
Varma said administration officials have been working on price disclosures since Trump came to power in 2017.
If Trump's rules can withstand legal challenges from the industry, it is unclear to what extent patients and their families will become a market-changing force. Patients usually follow the advice of their doctors. People choose doctors by reputation, advice from friends, or from lists of doctors who contract with their insurers. Therefore, it is not clear how important a price comparison tool will be in this case.
The issue of transparency in health care prices began to gain more and more attention during the Obama administration, as then-HHS secretary Kathleen Sibelius was in favor of disclosing list prices charged by hospitals. The Trump administration's initiative goes deeper to try to get the prices actually paid by the insurers.
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