Shopping for Doctors
Most people shop around for major purchases like cars and homes, but few people comparison-shop for medical services, which can be just as expensive. In fact, most people probably don’t even ask the doctor what his fee is. They seem uncomfortable talking about price when it comes to health. It seems too important to haggle over.
Yet, with medical costs soaring, informed consumers should be able to compare prices and take that into consideration if they choose to in selecting a doctor. The problem is that it’s hard to get the necessary information. It’s considered unethical for doctors to advertise their fees.
Two years ago the state of Maryland decided to do something about that. Using the Freedom of Information Act, the attorney general, Stephen H. Sachs, persuaded the federal government to turn over Medicare-reimbursement filings of more than 10,000 health-care providers in the state--including physicians, psychologists, podiatrists, optometrists, physical therapists and the like. The voluminous statistics were analyzed--some procedures were performed and billed more than 100,000 times in a year--and “usual and customary fees” were determined for each provider. The conclusion is that there is a tremendous variation in fees among providers in the same area.
For example, the fee for cataract removal in Baltimore ranged from $1,500 to $2,500. The fee for a hysterectomy in rural Allegheny County ranged from $725 to $1,325. The fee for a new patient’s initial visit to an internist in Baltimore ranged from $50 to $175.
This summer the state will publish all of this information and make available comparison price lists of individual doctors and other providers by community and specialty. A companion booklet, “Health Care Shoppers Guide,” addresses the quality issues involved. All doctors are not the same, but it’s hard for consumers to know how to compare them. The booklet explains, for example, how much time a comprehensive physical examination should take, and what should be done.
Some people believe that doctors who charge more are better doctors--the so-called Gucci factor. But the Maryland Medical Assn. says in the shopper’s guide that “paying higher fees does not necessarily insure higher care, and paying lower fees does not necessarily sacrifice the quality of care.”
It will be interesting to see what happens when the state starts distributing the price lists this summer. Will the invisible hand of the marketplace force the high-priced doctors to lower their fees? Or will the lower-priced doctors conclude that they have been chumps and raise theirs?
In either case the state and the Johns Hopkins School of Public Health, which did the computer analysis of the data, have performed a remarkable public service that should be emulated throughout the country. This important information has been a guarded professional secret for too long.
