Why you shouldn’t make choices on healthcare costs alone

As healthcare costs and the average deductible and copay continue to rise, you may be looking for ways to lower the amount you’re paying for the care you receive. A recent report from the Health Care Cost Institute (HCCI) found that the cost of common services, from surgery to diagnostic tests and X-rays, can vary tremendously, even within the same state. That might suggest that you should shop for healthcare based on price. While price is one important factor to consider, choosing where to receive medical care is not a decision that you should base solely on cost.

Why do healthcare costs vary?

The HCCI report found that in some states, more than 20% of healthcare costs are twice the national average while in others more than 90% of the cost of these services are priced lower than the national average. Interestingly, there were even significant variations in price within states. In California, for example, knee replacement in one area of the state was almost $30,000 less than in another.

One probable cause for these variations in healthcare costs is the consolidation of hospitals. In some areas of the country, smaller hospitals have been brought together as part of a larger health system or have left the market. This reduces competition, which in turn may lead to higher prices for medical services.

Factors you should consider when choosing care

When deciding where to receive care, consider not only the cost, but also the quality of care. There are a number of sources of information that provide information on surgical complications, deaths, rates of readmission to the hospital, as well as the results of patient satisfaction surveys. While this information is valuable, it may not tell the whole story. Hospitals that take care of more complex patients may have greater experience and better outcomes than is represented by data that is not risk adjusted. Also, many hospitals choose not to provide data to all sources and thus the results give an incomplete picture of true quality.

The experience and expertise of your physician is another important factor to consider. You should ask your physician about:

• His or her credentials, including board certification and fellowship training
• How often he or she performs the procedure you need
• What his or her complication rate is and other outcome information, such as recovery time and potential complications

In some cases, you may want to consider seeking care at a medical center of excellence with more specialized experience rather than a community hospital that’s close to home, especially if you’ve been diagnosed with a serious or rare condition that most physicians and hospitals don’t treat frequently. At a center of excellence or academic medical center, you may be able to find a physician who specializes in treating your condition or is active in researching new treatments, which can give you access to more effective approaches and/or clinical trials.

While quality of care is extremely important, you should also feel comfortable with and confident in your physician:

• Does your physician explain your condition and treatment options in language you can understand?
• Are you able to ask questions and raise concerns?
• Is your physician open to discussing alternative options to the treatment that he or she has recommended and willing to explain the risks and benefits of each treatment?

Comparing healthcare costs can be valuable, since it doesn’t make sense to pay more for the same quality of care. But for the best outcomes, it’s important to make an informed decision about your care that takes into consideration quality and a patient-focused approach to care as well as cost.