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 Under reference pricing, which is commonly used in Europe for
medications, insurers reimburse up to a certain limit, depending on
the medication or service, and the patient must pay the rest out of
pocket if the price charged is higher. Patients have an incentive to
choose medications or services as close to the reference price as
possible to reduce their own spending.
“There’s no reason to believe the quality of the tests varies across
labs,” said lead author James C. Robinson of the University of
California, Berkeley.
Some insurers and employers in the U.S. already use reference
pricing for surgical and diagnostic procedures. In the new study,
the researchers investigated how laboratory prices and selection
changed for employees of Safeway, the national retailer grocery
chain, after the company implemented reference pricing for
laboratory tests in March of 2011.
Anthem, the insurer managing Safeway’s health plan, negotiated
reference prices for lab tests based on the price distribution of
those tests by region. Employees who chose a lab that charged less
than or equal to the reference price had to pay their usual
deductible but had no additional costs for the test.
In 2010, a basic metabolic panel cost between $6 and $126, and a
lipid panel ranged from $9 to $75, depending on the lab.
The study team compared claims data for more than 30,000 Safeway
employees from 2010 to 2013 to data on about 180,000 other people
insured by Anthem but not subject to reference pricing. In total,
they looked at more than 2 million claims and 285 diagnostic test
types.
Researchers found that Safeway employees had an average of five to
six tests per year, which did not change over time.
But before 2011, almost half of tests were at laboratories that
charged more than the reference price, which declined to 16 percent
of tests in 2013, and some of that decline was due to reference
pricing, the authors conclude in JAMA Internal Medicine.
In the year after implementing reference pricing, the average price
paid per test by Safeway decreased from $27.72 to $18.90, while the
price stayed the same over time for Anthem enrollees not subject to
reference pricing.
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“Reference pricing can’t be used across all types of healthcare,”
Robinson told Reuters Health. Aspects of urgent care and tests that
take place in a hospital may not be appropriate for reference
pricing, he said.
“While being treated for cancer, we don’t expect the patient to shop
the market,” Robinson noted. But most of medicine is non-emergency,
he said.
“People don’t pay attention to price when their employer is paying,”
he said. Patients who shop around incentivize providers and labs to
compete on the basis of price. Reference pricing puts some, but not
most, of the cost of a service on the patient, so it should steer
people to lower cost services rather than stopping them from seeking
care at all, he added.
“It’s often a good idea for consumers to let the insurer work harder
for them as a purchasing agent through approaches like reference
pricing,” said Paul B. Ginsburg of the Brookings Institution in
Washington, D.C., who wrote an editorial accompanying the new
results.
But patients need to be informed that they are subject to reference
pricing, he added.
“The biggest problem is the lack of awareness that there’s a
reference price in effect,” which is really up to the employer or
insurer to communicate, Ginsburg told Reuters Health.
SOURCE: http://bit.ly/2abrV9c and http://bit.ly/2a4GfS5 JAMA
Internal Medicine, online July 25, 2016.
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