Californians don't have easy access to actual prices for medical care, according to a national report card that gave the state an F for its dismal showing.
California had plenty of company. Overall, 45 states received an F in the report issued Tuesday by two nonprofit healthcare groups that analyzed government efforts to make pricing information widely available to consumers.
This issue has taken on greater importance in recent years as patients shoulder a growing share of healthcare costs from higher deductibles and other insurance changes.
The two organizations, Catalyst for Payment Reform and the Health Care Incentives Improvement Institute, looked at state laws and regulations on requiring doctors and hospitals to share prices and at whether the data was easily accessible on public websites or through claims databases.
"Consumers need information on what their healthcare will cost them before they get it," said Suzanne Delbanco, executive director of Catalyst for Payment Reform, an employer-backed group in San Francisco. "True price transparency, at least in the public sphere, is not a reality in most places."
Only two states, Maine and Massachusetts, earned a B on the report card. No state received an A.
New Hampshire, which did earn an A in last year's report card, dropped to an F because its healthcare price website isn't working and may remain down for an extended period, according to the report's authors.
Policy experts say wider disclosure of medical prices would enable patients to comparison shop and would cause healthcare providers to compete more on cost and quality.
Under a state law that took effect in 2006, California hospitals must publish their average charges for the most common procedures on a state website. But relatively few hospitals take the extra step of listing prices on their own websites.
The other problem, experts say, is that no one actually pays those charges reported to California officials, not even the uninsured. Insured patients would be responsible for a reduced price negotiated by their insurer, and the discount would vary based on the company.
A bevy of private websites have sought to fill the void by offering average prices for many procedures or medical tests.
Some insurers and employers have tried to assist patients by creating online tools that show a range of prices among network providers.
But Delbanco said government efforts are key to help employees of small firms, people who buy their own health coverage and the uninsured who don't have access to information through big employers.
She applauded efforts by some individual hospitals and large physician groups to post specific prices for common procedures. However, Delbanco said, "we need an Expedia for all this, rather than each airline website."