In response to research indicating that healthcare costs go down when physicians are shown the cost of tests at the time of ordering, two medical ethicists from the Johns Hopkins University Berman Institute of Bioethics have outlined the ethical issues that they believe need to be considered when designing and displaying prices for physicians. Their Viewpoint article appears in a recent issue of the Journal of the American Medical Association.
The article highlights a core problem with price displays: In modern medicine, “price” can refer to various types of charges, including cost of service provision, cost plus profit, charges, or expected reimbursement, among others. Some of these prices may vary by as much as 10-fold—from $11 up to $142 for a CBC, for example. Displaying the right price is important; where the price came from and what it means may also be important to display.
“Price displays are growing in popularity, yet these different possible meanings of price have different ethical implications,” says Matthew DeCamp, MD, PhD, co-author of the study along with Kevin Riggs, MD, MPH. For example, DeCamp says, displaying the highest possible price might more effectively lower costs, but could it cause physicians not to order beneficial interventions? How do price displays relate to patients’ concerns about out-of-pocket expenses?
The authors recommend these ethical considerations be taken into account when deciding which price to display:
- Transparency: “At the very least, reference to the source of the price should be shown alongside the price display.”
- Informing patients: “Protecting patient autonomy requires informing patients that price displays are being used.”
- Protecting well-being: There must be protection against the “risk of patients not receiving beneficial services.”
- Ensuring fair treatment: “Fairness mandates that price displays should not systematically disadvantage certain patient groups,” for example, uninsured patients. “Displaying the same amount for all patients could help ensure they are treated fairly.” Learn more about the Berman Institute of Bioethics.