In roughly 70% of the stories we review, the costs of healthcare interventions are not adequately discussed in the eyes of our independent expert reviewers. Yet healthcare costs in the U.S. take a huge toll on consumers, and having insurance is no guarantee that you’ll have manageable medical bills.
When reporting on a new treatment intervention–whether it’s a drug, device, surgery or none of the above (such as psychotherapy)–reporters should discuss what the likely costs of the intervention will be to consumers, and if insurance is likely to cover said treatment.
We also recommend asking sources about (or independently researching) the overall anticipated cost-effectiveness of a new intervention. In some cases, a new intervention might have an initially high price tag compared to the standard treatment, but may be overall more affordable in the long run if it reduces associated costs (such as reduces the need for physical therapy or add-on medications). For the average cash-strapped U.S. consumer, these are vital details.
Granted, given the opacity of healthcare costs in this country, pricing is not an easy thing to find out. We recognize that estimates or comparisons to similar treatments might be the best you can do on deadline.
Along with directly asking your sources how much the intervention costs (or is expected to cost), this list of resources may help you track down some numbers:
Resources for finding costs of healthcare
This enormous trove of U.S. Center for Medicare and Medicaid Services data lists prices that doctors bill Medicare for, and what Medicare pays out in return. While it may not contain prices for the latest or experimental interventions, it’s still a useful tool to find out how much the standard treatment costs. For example, are you writing about a new way to perform hip replacement surgery? There’s a plethora of data on how much doctors bill for the type of surgery Medicare approves. Downside? The database is not easy to dive right into–it’s massive and not user friendly. For example, you will need to separately look up anesthesia costs for hip replacement, along with physical therapy, hospital stay charges, and so on. When the dataset was initially released in 2014, the Association of Health Care Journalists provided information on how to wade in. We suggest starting there if you’re unsure how to use CMS data.
GoodRx can show users the prices, coupons, discounts and savings tips for prescriptions at pharmacies near their inputted location. The site says that it “collects millions of prices and discounts from pharmacies, drug manufacturers and other sources” and does not charge for its services.
AHCJ drug pricing tipsheet (membership required)
This AHCJ tip sheet, compiled by a Wall Street Journal journalist who did a 2015 deep dive into U.S. drug pricing, lists a dozen or so sites that can help reporters get information on prices.
Operated by the Health Care Cost Institute (which is also worth a look), this site lets you look up costs of “care bundles” for common problems or interventions, and compares regions to state and national averages.
FairHealth Medical Costs Lookup
Using a database based on insurance claims, this site allows users to get an estimate for medical services in their area. The organization was created as part of a lawsuit’s settlement terms brought by New York State against health insurers for pricing problems. The site states that it owns and operates data based on billions of claims filed since 2002.
This user-friendly, journalist-created and crowdsourced site lets you look up the costs of some treatments in several major cities. It is not comprehensive, but is a good starting point to get a sense of how much certain things cost even after insurance is factored in. The founders explain on AHCJ the inspiration for the project, and helpfully provide “six things to remember” when reporting on costs.
Healthcare Cost and Utilization Project (HCUP)
While not easy to navigate as a first-time user, HCUP contains a wealth of information on health statistics and information on hospital inpatient and emergency department utilization, including average costs for treatments. HCUP is operated by the Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services. They do offer tutorials for those wanting to take a deep dive. As well, AHRQ’s Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.
According to the site, it’s a free consumer guide to help users determine fair prices in their areas for healthcare services. It represents a payment amount that many high-quality providers accept from insurance companies as payment in full, and it is usually less than the stated “billed charges” amount.
Tips for finding information on costs of healthcare
- HealthNewsReview.org associate editor Kat Stone recommends Marv Shepherd, PhD, Director of the Center for Pharmacoeconomic Studies at the University of Texas. “He is a national expert on drug pricing and highly recommended for anyone wanting to better understand how drug prices are set.”
- AHCJ board member Sabriya Rice recommends contacting experts at the Institute for Clinical and Economic Review for help. When it comes to cancer, Rice also recommended Dr. Peter Bach’s http://www.drugabacus.org/.
- Health care plans sometimes post costs for common procedures and/or diagnoses (e.g., an annual cost of diabetes care), and that info may be publicly available for reporters in some cases. But that doesn’t tell you comparative costs, or the potential costs associated with introducing a new product or service. You might be able to find cost-benefit and cost-efficiency studies that have been doing by looking on PubMed or Google. New products and services will often not have such studies done yet. Stock analysts may be helpful in providing a ballpark estimate in such cases.
- Ask the patients you interview to share the “explanation of benefits” statements that they get from their insurers. Obviously the amount varies by insurer and also by provider, so you can’t make global statements based on one patient’s EOB. But you can find out about a specific case and also get a ballpark. Also, if the patient signs a release, the insurance company may tell you what they paid for an episode of care (as opposed to individual services).
Got a tip you’d like to share? Please email us.