One of the intended goals of publicly reporting the cost and quality of health care providers is to empower consumers to make informed decisions, thus contributing to improved efficiency of the health care system. While public quality reporting is well documented, less is known about public reporting of costs and the impact it has on consumers.
We sought to document current practices for public reporting Web sites that include measures of costs of health care providers, and aimed to assess if these practices are consumer centered.
Guided by discussions with Key Informants and a targeted literature review, we collected data from active public reporting Web sites in December 2013. We conducted a systematic scan to identify Web sites that report cost measures, and cataloged these measures. We then assessed the degree to which this cost reporting was consumer centered by applying our novel taxonomy, PRICE, that has five domains: (1) price transparency, (2) real comparisons, (3) information on value, (4) connect to care, and (5) ease of use. We assessed each of these domains across three criteria (for a total score of 15) and summarized the data using averages of the sum of criteria (in total and by domain).
We identified 372 Web sites of which 102 were duplicates and 211 were excluded after two stages of review. State departments of health or state hospital associations operated 75 percent of the 59 Web sites that reported costs at the provider or facility level. All the Web sites reported on inpatient care and 71 percent reported average charges. Only 2 percent of these Web sites reported out-of-pocket costs, 7 percent reported costs using symbols or figures, and 14 percent reported current-year data. The PRICE taxonomy produced a median consumer centeredness score (summed across all domains) of 8 of 15, with a range from 4 to 11. For the included Web sites, ease of use was the highest rated domain (mean of 2.6 out of 3) and information on value was the lowest (0.7 out of 3).
Several factors limit the effectiveness of current public reporting of costs practices. These include a focus on charges (rather than consumers' out-of-pocket expenses), heterogeneity and ambiguity in the cost measures and data sources, and a lack of consumer-centered interfaces that allow the customization of searches that are relevant to consumers. Other limiting factors are the paucity of Web sites that provide cost and quality data, a lack of public awareness, and the need for research demonstrating the impact of publicly reported cost measures.