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Raising Awareness and Asking Questions About Health Care Costs

Pop quiz: When it comes to health care, what's the difference between cost, charge, and payment?

This question opened a recent article I read regarding medical schools teaching new doctors to talk to patients about price. Knowing the nuances between the definitions of cost, charge and payment isn’t something most consumers understand, nor do they really have to. I believe simply raising awareness that there can be a big difference in what you (or your insurance company on your behalf) might pay for health care depending on where you go and treatment options you choose is just as important. Training doctors to understand the potential financial impact of their recommendations and having those conversations with their patients is an important step in the right direction in raising awareness of price transparency.

In general, it has gotten much easier to find information about what we are buying. We can easily find out what a car or washing machine is going to cost by scanning the internet, reading through the latest consumer reports, and getting opinions from family or friends. We are accustomed to doing research to ensure we are paying what we consider to be the best price for the level of quality we are seeking.

So why don’t we do the same when it comes to purchasing health care? There are a number of reasons. At the root, it gets back to awareness and feeling the direct pocket book pain. The majority of insured consumers haven’t historically been directly impacted by price and aren’t aware that their decisions could result in a rise in premiums next year. That’s changing as high deductible plans are becoming the norm. Consumers may also be hesitant to ask their health care provider or insurance company how much something is going to cost before they seek care. Even when both awareness of choice and willingness to ask exist, it remains very difficult to find answers on how much something is going to cost.

Colorado is rated as one of the top three transparent states in the country per a report card released earlier this summer, thanks in part to the price information available on the Colorado All Payer Claims Database (CO APCD). CIVHC is working hard to increase the number of services available, but we know that simply putting information on a website, although extremely important and a big part of our focus, won’t solve rising health care costs alone. Collectively – as payers, providers, policy makers, communities, consumers, and advocacy organizations – we must raise the bar to educate and continue to push forward solutions.

First and foremost, as a society we need to feel and believe that:

  • It is ok to talk about cost, charge and payments.
  • It is ok, and I should ask my doctor or hospital what it is going to cost me or my insurance company before having the procedure or service.
  • It is ok for a doctor to know what another doctor is going to charge before he refers his patient.

I admit that raising awareness and overcoming social norms is much easier said than done. I continually challenge the CIVHC team and would like to challenge our health care partners across the state and country to raise the bar as well. As organizations we must continue to:

  • Explore and remove barriers to providing easily understood cost and quality information,
  • Increasingly provide meaningful transparent health care cost, quality and utilization information for consumers and health care providers, and
  • Educate consumers that it is ok to ask a doctor or facility what health care services will cost them.

As a nation, we are already chipping away at the established culture of silence by making information on choice readily available. The Centers for Medicare & Medicaid (CMS) has taken important steps to remove barriers to reporting Medicare and Medicaid price information. Colorado has several quality and price resources available including the Hospital Report Card, Bridges to Excellence and the CO APCD. CIVHC is continually improving the CO APCD with support of many entities including The Colorado Trust who recently provided a grant for additional enhancements.

The medical school article I read ended with “…it's becoming second nature for [Medical] students to consider whether a test is necessary, given its price tag. And that means that in the future, they'll be better prepared when their patients start quizzing them about costs.”

Because it is OK to ask!

About the Author: Ana English is CIVHC's President and CEO. Contact her at

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