Four years ago, Dave deBronkart spoke at a medical conference, with his face displayed on a giant screen. Afterward, a doctor told him that a spot on his face looked like basal cell carcinoma.
She was right. That cancer was unlikely to spread, but it needed to be treated, and deBronkart's health insurance policy had a $10,000 deductible. Any treatment, then, would come out of his pocket. How would he find the right treatment at the right price?
The reason deBronkart was attending the conference was that he is an advocate for patient involvement in health care. So he decided that, as an experiment, he would invite proposals on his blog, e-PatientDave. He outlined what he was looking for and asked health care providers to bid for his business.
No one did, of course. "I didn't expect to get a response," he said. "Hospitals don't have a 'submit a bid' department. But you hear over and over that patients are the reason for high health costs. I pursued it as far as I could to explore what happened when a patient tries to be a responsible consumer."
He began calling around to hospitals asking the price of various procedures. "The hospitals said 'we don't know; ask your insurance company.' The insurance company said 'we don't know; ask your hospital,'" said deBronkart. "That was when I smelled a great big rat."
After many, many calls, he chose his surgery: excision, total price $868. Today he is fine.
But his point stands: Health care operates very differently from anything else we buy.
"The actual information I needed in order to be an effective, responsible shopper was by policy blocked from me," he said in an interview. "It's not just a matter of lowering costs. It blocks innovation. Somebody does a good job — better quality, better price — but there's no way for people to discover them."
There is practically nothing that we shop for the same way we did 15 years ago. We compare prices online, look at quality ratings and reviews, and read about the experiences of others. We have endless information.
Except in health care. Most of us still buy it blind. We do as our doctor directs — and pray that our portion of the bill will be reasonable. We have very little information about quality and almost none about price. (In contrast to virtually every other field, price and quality are not related in health care.) And we find out the cost afterward.
This is a problem for patients with high deductibles, like deBronkart. It's also a huge problem for the country.
Is the idea of shopping for health care absurd? Well, you're not going to spend an ambulance ride browsing Hospital Compare on your phone. But most of health care is non-emergency and, therefore, shoppable: screenings, diagnostic tests, lab work, doctor visits, professional services such as physical therapy, scheduled surgeries.
This is just starting to happen.
One big reason is the increase in high-deductible plans like deBronkart's. Another factor is the new availability of data, led by the federal Center for Medicare and Medicaid Services. C.M.S. has released utilization and payment data for hospitals, physicians, nursing homes and home health agencies. It has also published quality data, in both raw and user-friendly form.