Let’s go shopping!

No, this is not a reference to the annual Association of Women Surgeons networking breakfast at Nordstrom during the American College of Surgeons Clinical Congress.  Ah, Akris Punto, how do I love thee?  Let me count the ways…

Nor is it a reference to the new Women in Surgery Committee event this year at the St. John store, which evidently resulted in over $500K in sales in a two hour period on Tuesday evening.  For the record, 5% of those sales go to the American College of Surgeons Foundation, so it was philanthropic shopping (if there is such a thing).

It’s a reference to healthcare, and how we provide our patients with choices about their care.  Last month, my pediatric surgery colleagues published a prospective study in which they demonstrated that charge awareness impacted treatment choices made by parents of children with appendicitis.  While there are many interesting points that can be raised about the study, the standout point for me was the error in my assumption that parents would choose the more expensive option, even when told that it is in every other way equivalent.  While this may be true for a subset of parents (qualitative data on why parents made the choice they did would be fascinating!), the majority of parents happily go with the less expensive but equal quality option.

While their study demonstrated proof of this concept for surgical patients and pediatric patients, a new study examining price transparency and insurer claims payments had similar findings.  Although a limited number of patients in the sample searched pricing of lab tests, imaging, and clinical visits, those who did had lower claims payments.  It can be argued that the $3.45 in payment differences for lab tests isn’t much at an individual level (it wouldn’t get me out of Blue Bottle in the Bay Area), but if we consider economy of scale this can add up quickly.

As we face a fundamental need to transform how we think about and deliver health care in the United States, cost transparency seems to be an important piece of that puzzle.  The U.S. currently has the dubious distinction of spending the greatest percentage of GDP of any nation on health expenditures, and that near-18% figure is not sustainable in the long term.  Further, while that 18% is providing good care, it isn’t the world’s highest-quality care.  There’s an imperative to resolving both of these issues; price transparency with our patients, and ourselves as healthcare providers, is apparently a good starting place.