Bringing Down Billing: The Road to Transparency in US Healthcare Costs

It’s important that when you’re feeling unwell, you go and see a doctor and get yourself checked out. After all, it can be easy to misinterpret symptoms when trying to diagnose yourself - which can be a very costly mistake if you’ve got a serious health condition.

How much do you think the doctor will charge? For many of us, the billing system can be obscured, uninterpretable, and frustrating to handle. Many lawmakers have raised concerns - after all, if fast food outlets have to advertise the price of a burger and fries, why can’t a doctor list their prices before you choose to use them?

This can be particularly important, particularly when the time of specialized nurses such as online PNHNP program graduates is more vital than ever. What will recently introduced legislation, known as the Lower Costs, More Transparency Act, do to drive down medical expenses - can transparency help?

The Enormity of U.S. Healthcare

Healthcare is an enormous industry in the United States. The National Health Expenditure Fact Sheet, a study published by the Centers for Medicare & Medicaid Services, found that in 2022, healthcare expenditure totaled more than $4.5 trillion - more than one-sixth of GDP.

This figure averages to approximately $13,493 per person - more money per person than any other developed nation. Yet, health outcomes are poor - with data showing that life expectancy in the U.S. is declining - with significant divides, depending on where you live.

The American healthcare industry, as enormous as it is, has faced substantial challenges in the last decade. From cyberattacks to global pandemics, clinics and hospitals have faced an assortment of obstacles - and patients often find themselves the victim of these challenges.

With the enormity of the U.S. healthcare sector, it can be challenging to navigate - finding providers, insurance coverage, or even understanding what costs are involved are often hidden from payers. As a result, the patient becomes the victim of a system of complexity.

The Challenge of Healthcare Costs

One of the biggest challenges that face healthcare patients when getting treatment is trying to determine whether costs are covered by health insurance. The U.S. healthcare system is notoriously complex - and while there are ways to get an idea of if you’ll be covered against unexpected medical bills, getting the information can often require going through multiple stakeholders - from healthcare providers to clinicians, and even to insurers.

It’s well documented that Americans have significant concerns about their ability to pay for healthcare - in fact, a recent study found that 59% of Americans were worried about their ability to pay medical bills in the year ahead, and 19% had simply not paid a medical bill because they couldn’t afford it.

This concern about billing can be a barrier to getting medical care - if patients feel uncertain or uncomfortable about the potential of high costs for treatment, they may choose to delay or postpone medical treatment due to cost concerns. Recent data, published by Gallup, noted that more Americans than ever were self-reporting delays to health care, due to the costs involved.

Bill Shock and Awe

Another concern for patients, already facing stress due to increased medical costs, is the risk of an unexpected bill. Navigating the healthcare system can be notoriously difficult, and on average, about 18% of Americans received at least one of these ‘surprise’ bills when going through the healthcare system.

Most surprises are great - perhaps a friend coming over to celebrate an event, or a surprise celebration, such as a birthday. In the healthcare sector, surprise costs in care are an unwelcome event - and with such high costs, and low levels of information, surprise billing can also have a big impact on household budgets.

A surprise bill goes as follows; a patient goes to receive medical treatment, and they may receive treatment from several providers. Due to the diversity of healthcare insurers, it’s not uncommon to receive care from a medical specialist that is not within-network - that is, covered by your insurance. As a result, a provider may then send a bill to you, for receiving the services of an out-of-network provider.

This can be even messier in scenarios where an out-of-network provider may work and an in-work facility - say, an anesthetist who works at a hospital as a replacement. This would then result in a ‘surprise’ bill to the patient - albeit a very unpleasant surprise.

While the No Surprises Act has been in place for more than two years, aiming to limit the ability of healthcare providers to produce surprise bills, a review of the act identified deficiencies. As a result, further legislation was developed to help improve transparency in healthcare costs.

Lower Costs, More Transparency

For healthcare systems to succeed, research has found that access and affordability are two key conditions to providing a healthcare system that meets the needs of all Americans. Recent bipartisan legislation, known as the Lower Costs, More Transparency Act, aspires to address the challenges posed by surprise billing in the healthcare sector.

The act aims to improve transparency in healthcare pricing - by extending transparency rules to cover a wider range of use cases. By introducing greater transparency, patients will have the information they need to make an informed decision on costs, without the shock of an after-care bill. It will also force healthcare providers, such as hospitals, to publicly list the prices they charge patients - a far cry from the previous billing system.

These bills represent a concerted effort by both major sides of politics to introduce lasting reform in the healthcare sector - and it’s hoped that these efforts will help to reduce the risk of surprise bills, bringing confidence back to the healthcare sector.

Much like the Beatles song, the journey towards transparency in healthcare costs is a long and winding road. It’s clear that reforms fundamentally take time - and as can be seen with the No Surprises Act, sometimes additional steps need to be taken. The Lower Costs, More Transparency Act doesn’t look like it will revolutionize healthcare in America - however, it may just begin to break down some of the obstacles that ordinary Americans face when receiving healthcare.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes