Quality and Price

There has been a significant push in recent years to help health care consumers be more aware of the price of various health care services and products.  Given the increased cost-sharing shouldered by patients, they are incented to be aware of price differences.  One concern about providing more information on prices is that for some consumers, higher prices might be viewed as an indicator of better quality.  In fact, recent research that we blogged on a few days ago supported that view and found little association between access to a price transparency tool and lower health spending.  A survey in Health Affairs, however, finds that for most patients, there is no clear link between prices and quality in health care.  (HA Article)   The researchers surveyed 2010 adults in 2014.  Two pairs of questions were asked, one about medical care in general and the other about doctors specifically.  Each pair had one question about the relationship between high price and high quality and one about the relationship between low prices and lower quality.  The order of the pairs and the questions within the pairs was varied randomly.

Across all questions, 58% to 71% (depending on the question) of consumers say there is no relationship between price and quality, although a substantial minority, 21% to 24% say there is.  The framing of the question affected the responses.  If asked if higher prices was a sign of better medical care quality, 71% said no.  If asked if lower prices were a sign of lower quality care, 63% said no.  When asked if a doctor who charges more than another physician for the same service is providing better quality, 67% said no; but when asked if a doctor who charges lower prices is providing lower quality only 58% said no.  The questions framed in terms of lower prices also elicited more “unsure” responses.  Interestingly, patients who reported comparing prices before seeking services were more likely to believe there is a link between higher prices and better quality.  African-Americans, Hispanics, and young people were much more likely to see a price/quality connection.  In addition, surrogate decision makers also had a greater perception of such a connection.  The survey reflects the importance of how information is presented to consumers in shaping their decisions.  If we really believe in patient autonomy, however, we have to be careful that the science of information presentation isn’t used to steer patients in a particular direction, as opposed to helping them make more rational choices.