Austin Frakt has a post on doctor self-referrals (docs refer more when they have a financial interest in the referral). It elicited this comment, which I am reposting because it so admirably cuts to the chase on what is important here:
If physicians were forced to publish all-inclusive pricing for their services, it wouldn’t matter that they recommend their own facilities and expensive equipment, since competition would force physicians to moderate any excesses. [Emphasis mine]
The fact that every service, facility, drug and piece of equipment comes unbundled, with all the pricing quite hidden, is what conspires to cheat the patient and consumer. I just got pricing from an ophthalmologist in Austin for cataract surgery. His office didn’t know how much the facility charges, anesthesiologist charges, or drug charges would be, but gave me numbers to call. I called the numbers, but the anesthesiologist needed the CPT code for the procedure and the procedure’s duration, requiring me to go back to the ophthalmologist. The total cost for one eye came to $4400.
I called and e-mailed for prices in Thailand, Costa Rica, Prague, Monterrey, Nuevo Laredo and Rio de Janeiro. Not only did they quote me all-inclusive prices — in some cases including lodging–but the total in Monterrey was $1400 (18000 pesos) per eye, excluding travel and lodging, and basically the same (2000 to 3000 reals) in Rio de Janeiro, where I have a home I visit every year anyway. The other foreign places were even cheaper.
Do you see the problem with the policy suggestion in sentence one? No one is forcing providers in other countries to publish all inclusive pricing. U.S. providers offer unbundled services because that is the way they maximize against third-party payment formulas. The foreign providers cited are all competing for patients spending their own money. No force is needed when patients control the dollars.