The most compelling argument against single-payer health insurance, for some, is that it eliminates the power of the marketplace to sort out the best providers at the best prices. Of course, the marketplace only works when consumers can get their hands on competitive quality and price information about medical and insurance providers.
By and large, that is not the case in California or the country. Forty years after HMOs and other business configurations transformed medical care—and a couple years into Obamacare—there is still nothing approaching a comprehensive resource for consumers to evaluate hospitals and medical groups.
It is a significant improvement over a number of very limited endeavors over the years that took a shot at comparing some prices of some procedures on regional bases, rating the quality of outcomes by medical providers or gathering public assessments of service. However, the website makes clear in its outreach to consumers to contribute their own information that there is much more work to be done.
The results, so far, appear to be useful. But even Doris Peter, director of Consumer Reports Health Ratings Center, said the website was a “first step.” She told Kaiser Health News, “When it comes to health care cost and quality, it's really a black box for consumers. They don't know how much they're going to pay.”
Insurance Commissioner Dave Jones likened the experience to “shopping with a bag over your head.” Now the bag has a couple of eyeholes, but there is limited peripheral vision. Price and quality generally remain as mysterious as the size of an insurance company’s Obamacare medical network and the names of its participants.
But you can do some specific things, such as the example described by R. Adams Dudley, MD, Director of UCSF's Center for Healthcare Value:
“We can, for instance, tell a pregnant woman not only about the C-section rate at a hospital and whether she'll be allowed to try for a vaginal delivery if she's had a C-section before, but also what percent of women at that hospital learn to breast feed before going home and how often complications happen.”
The woman can also find ratings for childbirth procedures at different hospitals. Overall, Cedars-Sinai Medical Center in Los Angeles is better at hip and joint replacements (rated a 4 out 5) than childbirth (rated a 3), according to the website. It rates a 2 for C-section rates, an exemplary 5 for avoiding episiotomy and 3 for the number of women who breastfed their newborn.
There are no ratings and skimpy information for many facilities. The eight Kaiser Permanente hospitals within 25 miles of San Francisco that did hip and knee replacement had no overall rating for lack of data in two of the four categories. No Kaiser information was available on success at “avoiding readmissions” and “avoiding surgical complications.” They did, however, have ratings for “overall patient experience,” five 4s and three 3s.
Twenty other hospitals in that geographic region did receive ratings from the website for hips and knees: Eight were rated 4, six checked in at 3 and six earned a 2. None of the 28 hospitals received a 5 from patients and eight scored a 4.
The website was built using $3.9 million in federal grant money courtesy of the Affordable Care Act. Hopefully, it will help the state avoid another “F” when next year’s “Report Card on State Price Transparency Laws” comes out. Only five states (pdf) escaped receiving a failing grade in July for leaving consumers in the lurch about health care price information.
A surge by California might buoy the report card’s authors, who scaled back the scope of this year’s publication because, “You will find little progress since last year and, in some cases, regression.”