Shopping for health care online? The odds are stacked against you

The internet is great place to shop for plane tickets, laundry detergent, artisan jewelry and pretty much anything else you might ever want to buy. But a new report says there’s one big exception — health care.

If you expect the World Wide Web to help you figure out how much you’ll need to pay to get your hip replaced, a painful joint isn’t your only problem. And if you think Google can tell you the cheapest place to go for a cholesterol test, just type “reality check” into that rectangular search bar.

Perhaps it doesn’t come as a great shock that you can’t simply order a brain MRI on Amazon. But you might be surprised to see just how badly the internet performed when Duke University researchers put it through its paces.

Their experiment was motivated by idea that patients will make more cost-effective decisions about their health care if they have to pay a chunk of the bill. Health economists say this type of cost-sharing can help reduce the number of unnecessary doctor’s visits, procedures and tests.

But in order for this to work, “patients require easy access to health care prices,” the Duke researchers explained in their report.

To see whether these prices were indeed available online, they picked four procedures (a blood test to measure cholesterol, a hip replacement, a brain MRI without contrast and an upper GI endoscopy) and eight cities (New York; Los Angeles; Chicago; Seattle; Baltimore; Charlotte, N.C.; Tallahassee, Fla.; and Manchester, N.H.). Then they tried to find the cost of each procedure in each city, using two different search engines (Google and Bing).

The 64 searches turned up 1,346 websites (not including ads) within the first two pages of results. But only 234 of them included geographically relevant price estimates,” the researchers found.

That’s just 17 percent. In other words, their chances of finding the information they were seeking were less than 1 in 5.

Heath care providers in all eight cities did a poor job of making their prices transparent to would-be patients. But some cities were better than others. For instance, 27 percent of websites from the Chicago area offered a price estimate for at least one of the four procedures. In Baltimore, only 7 percent of websites cleared that low bar.

Also, although all four procedures were difficult to price out, information about hip replacements was by far the most difficult to find, appearing on fewer than 5 percent of websites in the search results.

Even when prices were available, it was not clear how much of that cost would be covered by insurance and how much a patient would have to pay out of his or her pocket, the researchers said.

That oversight might help explain the dramatic range in prices posted online. For instance, the price for an MRI in Chicago ranged from $230 to $1,950. Likewise, a hip replacement in the Windy City might set you back anywhere from $27,000 to $80,671.

“There is substantial room for improvement in providing consumers with ready access to health care prices online,” the Duke team concluded.

That could be remedied by requiring health care providers to make price information available to the public, or by pooling information on health insurance claims and maintaining it in statewide databases, the researchers suggested.

“Given the increasing number of Americans facing high out-of-pocket health care expenses, we need to promote policies that make it easier for them to determine the price of their medical care in time to inform their health care choices,” they wrote.

Their research letter was published recently in JAMA Internal Medicine.

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