Why you shouldn’t make healthcare choices based on cost alone

As healthcare costs, deductibles, and copays continue to rise, you may be looking for ways to lower the amount you’re paying for the care you receive. A recent report from the Health Care Cost Institute (HCCI) found that the cost of common services—from surgery to diagnostic tests, and X-rays—can vary tremendously, even within the same state. That might motivate you to shop for healthcare based on price. But while price is one important factor to consider, choosing where to receive medical care isn’t a decision you should base solely on cost.

Why do healthcare costs vary?

The HCCI report found that in some states, more than 20% of healthcare services cost 2X the national average while in other states almost all (more than 90%) of healthcare services are priced lower than the national average. Interestingly, there were even significant variations in price within states. In California, for example, a knee replacement in one area of the state cost almost $30,000 less than in another.

One likely cause for these cost variations is the consolidation of hospitals. In some areas of the country, smaller hospitals have been brought together as part of larger health systems or have left the market. This reduces competition, which in turn may lead to higher prices for medical services.

Factors you should consider when choosing care

When deciding where to receive care, consider not just the cost, but also the quality of care. There are a number of sources for information on surgical complications, deaths, rates of readmission to the hospital, as well as the results of patient satisfaction surveys. But while this information is valuable, it may not tell the whole story. Hospitals that take care of more complex patients may have greater experience and better outcomes than the data (which isn’t risk adjusted) shows. Also, many hospitals choose not to provide data to all sources; so results may give an incomplete picture of true quality.

The experience and expertise of your physician is another important factor to consider. Make sure to ask them about:

• Their credentials, including board certification and fellowship training
• How often they’ve performed the procedure you need
• What their complication rate is and other outcome information, such as recovery time and potential complications

In some cases, you may want to consider seeking care at a medical center of excellence with more specialized experience, rather than a community hospital that’s close to home. This may be especially the case if you’ve been diagnosed with a serious or rare condition that most physicians and hospitals don’t frequently treat. At a center of excellence or academic medical center, you may be able to find a physician who specializes in treating your condition or is active in researching new treatments, which may give you access to more effective approaches and/or clinical trials.

While quality of care is extremely important, you should also feel comfortable with and confident in your physician:

• Does your physician explain your condition and treatment options in language you can understand?
• Are you able to ask questions and raise concerns?
• Are they open to discussing alternative options to the recommended treatment, and are they willing to explain the risks and benefits of each treatment?

Comparing healthcare costs can be valuable, since it doesn’t make sense to pay more for the same quality of care. But for the best outcomes, it’s important to make an informed decision about your care that takes into consideration quality and a patient-focused approach as well as cost.