Health care cost transparency no panacea

It has been an article of faith among many of those concerned about soaring health care costs, including Gov. Charlie Baker: Pull back the covers on the costs of health care procedures and services and the invisible hand of consumers making smart choices will drive sense and efficiency into a dysfunctional and costly market.

That makes a new study, published in the Journal of the American Medical Association, disappointing news. The research, directed by investigators at Harvard Medical School, looked at the practices of 149,000 employees of two large companies who were given access to a tool letting them compare prices for health care services. Just 10 percent of them used the tool, and those employees did not spend any less than those in a comparison group of nearly 300,000 employees.

“There’s a lot of enthusiasm in the health care system about increasing price transparency, to both help patients become better consumers and to decrease health care spending. And, unfortunately, in our results, we do not find that providing price transparency decreases health care spending,” the study’s senior author, Dr. Ateev Mehrotra, tells WBUR’s Carey Goldberg.

Amy Whitcomb Slemmer, the head of the Massachusetts advocacy group Health Care for All, tells the Globe the study does not refute the value of health care pricing transparency. “I would hesitate to draw big conclusions from this particular study,” she says. She said the tool used in the study did not include information on quality along with prices, and says the low usage rate by employees suggests it was not “user-friendly.”

Barbara Anthony, a health care fellow at the Pioneer Institute, told the Globe the message from the study is not that we should give up on the idea of transparency helping to tackle the health care cost problem, but that insurers need to “double down” efforts to motivate consumers to choose lower-cost, but “high-value” services.

The state has put a big marker down on the issue through a law requiring greater health care cost transparency. But getting consumers to shop for health care the same way they’d compare prices for a new refrigerator will not be easy. Many patients take direction about specialty care from their primary care doctor and are not likely to challenge referrals. And no one is going to ask to go to the lower-cost hospital while in an ambulance with a possible heart attack, Mehrotra tells WBUR.

The Globe’s Felice Freyer writes that the state Health Policy Commission, formed in 2012 to help tackle the health care cost crisis, concluded in March that “enabling consumers to make price-conscious choices cannot, by itself, address the problem of price variations.”

The clearest sign of the difficulty of getting the market to sort things out and ensure that lower-cost care of equal quality wins out is a looming November ballot question on hospital costs.

The ballot question would limit hospital price variation to no more than 20 percent above or 10 percent below “the carrier-specific average relative price” for a particular service. In practice, it is aimed at reining in costs at Partners HealthCare, owner of Mass. General and Brigham and Women’s hospitals, the health care giant that many blame for the state’s high costs, despite its protests to the contrary.

Baker, a free-market champion who oversaw the end of hospital price controls in the early 1990s as state health and human services secretary, would be loathe to see price regulation make its way back into the state’s health care landscape.

“There are very few examples that I can find anywhere where price regulation has worked as well as full blown transparency,” Baker said in September when asked about the new push to control hospital prices.

He may be right. But it also may be true that, unlike other markets, “full blown transparency” in health care is much easier said than done.

–MICHAEL JONAS

 

BEACON HILL

The Baker administration is pushing natural gas and hydroelectricity as the two main ingredients in the governor’s energy combo platter. (CommonWealth) Pipeline opponents rally at the State House. (State House News)

State Rep. Ben Swan and his son, Ben Swan Jr., both filed signatures to run for the seat held by the father. Since the Swans have said they would not run against each other, would-be opponents saw the last-minute entrance into the race of the younger Swan as a way to forestall opponents. Springfield City Councilor Bud Williams, who said the elder Swan had assured him recently he was running for reelection, called the move “sneaky.” (Masslive)

A Harvard think tank faults the Baker administration for stalled rural broadband service in western Massachusetts. (Masslive)

MUNICIPAL MATTERS

A proposed Starbucks in South Boston becomes a flashpoint for debate about gentrification and change in the neighborhood. (Boston Globe)

The Dudley Board of Selectman offer to voters a plan to buy a farm where the Islamic Society of Greater Worcester wants to build an Islamic cemetery. (WBUR)

Several city councilors in Fall River are raising concerns over Mayor Jasiel Correia’s plan to sign a 10-year contract with a private trash hauler, saying ordinances require that only city workers pick up trash. (Herald News)

Mashpee Town Meeting voters rejected two land-related articles pushed by the Mashpee Wampanoag tribe, reigniting old tensions and triggering an effort by tribe members to run for town offices and become more involved in the local government. (Cape Cod Times)

Norwell Town Meeting voters rejected a proposal by selectmen to allow billboards along Route 3. (Patriot Ledger)

ELECTIONS

Ted Cruz drops out after a resounding loss in Indiana, giving Donald Trump a clear path to the Republican nomination. (New York Times) A Globe editorial calls on the Never Trump movement among Republican leaders not to wither in the face of his all but certain nomination. The Huffington Post, which once refused to cover Trump anywhere except on its entertainment pages, ran his victory story under the headline “WELP.” (Look up the meaning of WELP here.)

Bernie Sanders: I’m not dead yet. (U.S. News & World Report)

The Herald endorses Republican Patrick O’Connor in next week’s special election for an open state Senate seat on the South Shore.

BUSINESS/ECONOMY

Scot Lehigh says the federal probe of union strong-arming allegations is exposing a long-running and unhealthy dynamic concerning the role of unions and development in Boston. (Boston Globe)

EDUCATION

Most public school teachers in Massachusetts are not underpaid. (Boston Business Journal)

The state auditor’s office says former Bridgewater State University President Dana Mohler-Faria paid back $12,000 because of discrepancies in documentation for the $270,000 he received for unused sick time when he retired. (The Enterprise)

Sydney Chaffee, a ninth-grade humanities teacher at Codman Academy Charter Public School in Dorchester, was named Massachusetts teacher of the year, the first time the honor has gone to a teacher at a charter school. (Boston Globe)

An Eagle-Tribune editorial praises Gov. Charlie Baker’s Commonwealth Commitment plan to make college more affordable.

HEALTH/HEALTH CARE

Overdose deaths continue to rise across the state, but advocates say some progress is being made. (Gloucester Times)

A Harvard study finds little evidence that shopping for health care lowers costs. (WBUR)

The boards of Southcoast Health System and Rhode Island-based Care New England have voted to move forward with a plan to merge and create an eight-hospital organization blanketing southern New England. (Standard-Times)

State officials say six surprise inspections at Pembroke Hospital found a number of “urgent patient care” violations. (Patriot Ledger)

The National Bureau of Economic Research found millions enrolled in government-backed health plans under Obamacare who would have been eligible for no-cost insurance even before passage of the law. (U.S. News & World Report)

TRANSPORTATION

Boston Duck Tours claims the driver who was involved in a fatal collision with a woman riding a scooter had an “exemplary” driving record, even though the company had received reports from the state showing he had accrued three speeding tickets in the last six years. (Boston Herald)

The Worcester Regional Transit Authority cancels a bus route connecting Holy Cross, Assumption College, and Worcester State University after Holy Cross withdraws a subsidy. Holy Cross officials say not enough people were riding the bus. (Telegram & Gazette)

A member of the National Transportation Safety Board says  the Metro in Washington has a “severe learning disability” when it comes to rider safety. (Washington Post)

ENERGY/ENVIRONMENT

Rep. Thomas Golden, the House’s point person on energy, says an offshore wind initiative will be included in energy legislation he is helping to draft. (Bloomberg News)

Clawing its way into today’s Download: A lobster tale of audacious crustaceous protectionism pitting the full might of the Massachusetts congressional delegation against deceptively friendly, peace-loving friendly Sweden. (WGBH) The story has been circulating for some time. (Associated Press)

CRIMINAL JUSTICE/COURTS

On the job training: A chemist at a state lab in Amherst was high on methamphetamines or other drugs almost every day she was at work for eight years, according a state investigation. (Boston Globe)

Lawrence Mayor Daniel Rivera promises greater diligence delivering restraining orders in the wake of a domestic shooting incident. (Eagle-Tribune)

MEDIA

The Globe offers another round of buyouts. (Media Nation)

Melissa Ludtke, formerly of Sports Illustrated, says harassment of women sportswriters is worse than ever. (WBUR) CommonWealth’s Jack Sullivan wrote on this issue late last week.

The Tampa Bay Times buys and folds up the Tampa Tribune. (Poynter)

The New York Times reports a $14 million net loss in the first quarter of 2016 as digital subscriptions rise to 1.2 million. (New York Times)