By, Dylan McKeon
Baldwin High School
A 2023 study in Philadelphia found that nearly 60% of residents faced healthcare affordability challenges due to unclear pricing and high costs. This lack of transparency often leads to financial stress, delayed care, and medical debt, particularly among the uninsured and underinsured. For example, 31,295 people in Philadelphia County are uninsured, making them less likely to seek care for chronic conditions, worsening health disparities.
While the No Surprises Act aims to protect against unexpected out-of-network bills, many still delay or forgo care due to cost concerns. A proposed reform would require healthcare providers in Philadelphia to publicly disclose the cost of common treatments and procedures, both online and in-office, along with estimated out-of-pocket expenses based on insurance plans.
This reform would empower patients to make informed decisions, reduce financial stress, and encourage competition among providers to lower costs. However, challenges include resistance from providers and insurers, as well as the complexity of medical billing. Despite these obstacles, the reform aims to improve healthcare access and affordability, ensuring all Philadelphians can receive the care they need without fear of surprise bills or medical debt.
In a study done in 2023 about healthcare cost transparency in Philadelphia, it revealed that nearly 3 in 5 of the people who responded experienced at least one healthcare affordability burden in the last year. This troubling statistic reveals the city's issues surrounding healthcare pricing, whether the prices are too high or if it is the hospitals inability to be clear about pricing. This issue leaves many residents unknowing, which could possibly lead them to financial distress, delayed treatment, and medical debt. With such widespread uncertainty, it is apparent that hospitals need to be more transparent with pricing so people can receive necessary treatment.
Healthcare cost transparency is essential for improving healthcare affordability and accessibility for residents in Philadelphia. When patients are uninformed about the cost of care until after they have received it, it leaves many forced to make difficult decisions about their health. These unknown expenses are known as surprise billing, which is when you receive an unexpected bill from an out-of-network provider or facility. Although the No Surprise Act which was implemented on January 1, 2022, may protect you from surprise billing, the insufficiency of the act was seen in a survey from November 2023 where over half the respondents delayed or went without healthcare that year because of the cost. In 2023 many residents in Philadelphia were experiencing hardships with healthcare and their financial status, in a study it was recorded that 61% of respondents reported being “worried” or “very worried” about affording medical costs from a serious illness or accident. In Philadelphia counties there is a high rate of uninsured and underinsured people. In Philadelphia county there are 31,295 residents that are uninsured, this leaves these 31,295 people less likely to receive treatment for chronic conditions like diabetes, cancer, and heart diseases. This lack of insurance coverage not only exacerbates health disparities but also results in higher long-term costs, as untreated conditions often lead to more severe health issues that require expensive emergency procedures. The combination of high uninsured rates, inadequate insurance coverage, and the absence of price transparency, leaves many Philadelphia residents unable to access the medical treatment they need. As mentioned before, the No Surprise Act was implemented in Pennsylvania for people to receive a good faith estimate that must be provided 3 days before a service is furnished. Recently, in July of 2024, a bipartisan bill to increase hospital price transparency was passed by the state house.
My proposed reform requires all healthcare providers in Philadelphia, including hospitals, outpatient clinics, and specialist practices, to publicly disclose the cost of common treatments and procedures both online and in-office. This includes clear, upfront pricing for medical services, and out of pocket costs. This reform addresses Philadelphia's healthcare affordability crisis, improving both access and equity while enabling patients to make informed and financially responsible healthcare decisions.
Lawmakers introduce bills in either the House of Representatives or the Senate. Healthcare legislation can start in either chamber. The House must also introduce any bills pertaining to healthcare, this is also known as the “power of the purse”. It's the House’s responsibility because the House is more directly representative of the population than the Senate. The proposed legislation goes through public hearings. After the hearings, the committee makes recommendations. Legislators open the bill for public debate in the full chamber, and any member of the chamber can comment or propose an amendment. Amendments are voted on individually. If it passes, it goes to the other chamber. In many cases, the other chamber rejects the bill. A conference committee is formed of members of both the House and the Senate. This conference committee meets to negotiate the specifics of the bill, eventually arriving at a compromise that satisfies all parties. When this step is complete, a revote in the House and Senate occurs, and the bill passes or fails.
Many hospitals and medical practices may resist disclosing their prices to the public because it could result in price competition, reduced revenue, or public scrutiny. There would also be a big reliance on people to keep the costs updated. It is also easy for providers to not be able to provide an accurate price for some services because of the complexity of medical billing. Insurance companies would also be reluctant to provide pricing information and out-of-pocket costs as it may expose gaps in coverage and cause more exasperation in the public.
This problem can be easily resolvable if it was mandated to provide a public price list for treatments online and in the office. This would allow for patients to compare treatment prices so they don’t have to suffer through medical debt or going without the care and attention they need and deserve. Patients would no longer have to suffer through medical debt or face the difficult choice of going without necessary care due to cost. This shift would also encourage competition among healthcare providers, driving down prices and improving the overall quality of care. Ultimately, healthcare cost transparency is not just about being able to save money but ensuring that everyone is able to obtain the care they need.
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