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Health Care Reform:

Health Insurance & Affordable Care Act

Charges Vary Widely From Hospital to Hospital: FAQ

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As the government tries to drive down costs of health care, insurance companies will be under greater pressure to get better rates in hospitals, says Custer.

"Insurers may be squeezed a bit between consumers and providers," he says.

Under the Affordable Care Act, hospitals will follow the lead of the Medicare pricing system, billing for episodes rather than services. And rates may be capped for the episode, depending on whether it's stroke care or internal bleeding, for example.

That's a positive, says Custer. "Right now, we pay for each service," he says. "If we begin to pay for an episode of care and weigh payment on the quality of care provided, providers will be given incentive to give only care that is necessary and to identify the most appropriate services.''

So, how should ordinary people choose a hospital if they need one?

Think quality rather than cost.

Pricing varies for reasons other than the actual cost of the services provided, anyway, so you're better off looking at quality-of-care information, says Custer.

That's not easy information to gather these days. But  some of that data are available in the "Hospital Compare'' section of the Department of Health and Human Services web site.

"Consumers are going to have to do a lot more to make choices," he says.

The American Academy of Family Physicians says in a statement that people need both pricing and quality-of-care data to make informed choices. "That would allow patients to have a conversation with their primary care physician and then make the best decision for their individual needs," the statement reads.

If you're not on Medicare, will you be able to find out how much a service will cost you?

That's questionable. HHS is providing $87 million in grants to states to set up data review centers, with the goal of improving health pricing oversight and transparency.

The Rate Review Grant Program would provide states with the money to collect, analyze, and publish health pricing and medical claims reimbursement information.

Also, there's a movement underway, mostly led by large employers, to gain greater price transparency from health care providers. Today, many firms that provide employee health benefits, and most insurers, offer a pricing tool to help people determine their medical costs before they go for care. The goal in part is to encourage people to become better health care consumers by comparing providers on price vs. quality. 

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