Hospitals will be required to disclose and update details, including prices, for thousands of services
if the hospitals are going to like me too much any more with this,” quipped President Donald Trump on November 15th. He was referring to two bold initiatives unveiled earlier that day by Alex Azar, his health secretary, to rein in America’s soaring health-care costs. The administration finalised a rule, to take effect in 2021, which will double down on its effort to bring price transparency to hospital care.
In setting his sights on hospitals, Mr Trump is taking on a colossus. They accounted for nearly a third of America’s health-care costs in 2017, far more than the share of much-maligned drugmakers . The country has over 6,000 hospitals. Only 1,300 or so are private for-profit institutions; the rest are non-profit or government-run. The lack of an overt profit motive has done little to rein in prices, however.
According to the American Hospital Association, a lobby group, operating margins in the industry rose from 4.4% in 2007 to 6.4% in 2017. But many hospitals in rural areas, which suffer from undercapacity, and in poor urban areas, which have lots of uninsured patients, barely break even or lose money. Big for-profit chains likeHealthcare, with around 180 hospitals, can enjoy high margins. Non-profit institutions often plough those gains into expansion or salaries.
Others are more hopeful. Marty Makary of Johns Hopkins University, author of “The Price We Pay”, a new book about America’s health-care system, thinks that a small number of “proxy shoppers” can bring about powerful change once prices are revealed, even if most patients remain insensitive to prices. Dr Makary points out that in elective procedures likefertilisation, which enjoy full transparency, “prices fall and quality rises each year just like in every normal market.
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