Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

In the Journal of General Internal Medicine, Brendan Saloner, Daniel Polsky, Karin Rhodes, and colleagues investigate whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices and geographic areas. Cost-sharing in insurance plans incentivizes patients to shop for lower prices, but can patients obtain price information when scheduling office visits? The authors used a simulated patient methodology in which trained interviewers posed as patients (with different types of insurance) seeking new primary care appointments. Interviewers made calls to a representative sample of primary care offices in ten states in 2014. The authors find that 61.8% of callers with employer-sponsored insurance (ESI) were able to obtain a price compared to 89.9% of uninsured and 47.3% of Marketplace callers. Price information was more readily available in small offices and in counties with high uninsured rates. Mean visit prices ranged from $158 for uninsured to $165 for ESI. Prices were significantly lower at federally qualified health centers, smaller offices and in counties with high uninsured and low-income rates. The limited price transparency presents a challenge for insurance designs that encourage patients to shop around for best prices.