The Mystery of Healthcare Pricing and Its Negative Effect on Patients

April 1, 2021
April 1, 2021

Healthcare providers must add how patients experience the financial side of healthcare to the many areas that require their focus and staff training, according to the HealthStream article, “Footing the Bill - Improving the Patient Financial Experience Is Increasingly Critical for Provider Profitability.” This blog post is the fifth in a series of excerpts from the article.

Healthcare pricing remains a veiled mystery.

The Trump administration has continued Obama-era efforts to ease consumer angst by mandating more transparency in healthcare pricing, including making hospital charges available online as of January 2019. On the consumer level, it’s tempting to compare healthcare to other consumer deliverables when it comes to costs. Restaurants post prices on menus, why shouldn’t a hospital? At a restaurant, however, the menu price is a fixed cost that’s not up for debate. The diner won’t need to speak to the restaurant owner, the chef, and the raw-goods providers to find out the actual cost of the meal’s components, and then enter into a contractual negotiation to ascertain his or her part.

It’s Hard to Know the Final Cost before Receiving Care

Healthcare, on the other hand, involves multiple stakeholders at many different intersections in the patient-care transaction. The new online postings for hospital procedures are the base price for a procedure, but do not reflect the final cost. NBC News medical contributor Dr. Natalie Azar compared it to a list price for a new car, not the final cost the consumer pays (Pawlowski, 2018).

“The concern is there’s a big difference between what the list price is and what the actual transaction price is—the cost the patient is responsible for,” she explained.

A “Gotcha” Situation

That final cost is reached after co-pays, deductibles, co-insurance, and hosts of other factors are considered, all of which vary from patient to patient. And that doesn’t even tap into the consumer sentiment that much of healthcare costs remain a “gotcha” situation. According to the KFF report, 4 in 10 insured adults said that in the last year they had received an unexpected medical bill, and 1 in 10 reported getting a “surprise” medical bill from an out-of-network provider in the past year.


Pawlowski, A., & Dunn, L., “Hospitals to list procedure prices under new law: What you need to know,” December 28, 2018, Retrieved at

This article also includes:

  • Healthcare is expensive.
  • Healthcare Costs Generate Patient Anxiety
  • Providing high-quality healthcare means delivering on many components.
  • High-deductible plans expand coverage but depress outcomes.
  • Premiums continue to rise, and consumers continue to demand coverage.
  • Patients are avoiding care, which drives up costs and depresses outcomes.
  • Providers think they are powerless in this situation.


Download the full article here.