Transparency offerings within the healthcare sector are growing as consumer directed healthcare (CDHC) is becoming a focus in the U.S.  CDHC often involves a high-deductible plan, often combined with health savings accounts (HSAs), which require people to pay more out of pocket. 

One of the most unusual and widespread offerings targeted at consumers involves HCA's 165 hospitals' HCA’s plan that will allow consumers to make better decisions about their health care and to better control the amount of money they spend on services.  Over the next few months, HCA Inc., the nation's largest hospital chain, will begin telling patients in advance how much they'll pay.

HCA’s program began in October as a trial at about 10 hospitals in Dallas, and the company launched the service Friday at hospitals in San Antonio and Austin, Texas, spokesman Ed Fishbough said. Nashville-based HCA, which announced its price transparency initiative last spring, plans to start posting prices at its 13 hospitals in Tennessee this spring and have the program at most of its 165 U.S. hospitals by midsummer, Fishbough said.

Uninsured patients at HCA facilities can follow a link on a hospital's Web site to see a range of prices for common procedures. Patients who have health insurance will be given detailed instructions on how to call for an estimate, he said. HCA can't easily post prices for insured patients because discounts, deductibles and co-payments can vary greatly among health plans.

Several commercial Web sites and insurers such as BlueCross BlueShield of Tennessee, the state's largest, already are posting some price information online.  For example, HealthGrades.com sells reports for $7.95 giving the average cost for selected procedures in different parts of the country. It also compares Medicare payments for those procedures at local hospitals, based on 2005 reports.  BlueCross, meanwhile, allows its members go online to see local hospitals ranked from least expensive to most expensive. But it doesn't provide costs for specific procedures at specific facilities.

Vanderbilt University Medical Center, Nashville's largest hospital, and Saint Thomas Health Services, which owns Saint Thomas and Baptist hospitals, don't put prices online, but they'll give estimates to patients who request them.  Saint Thomas Hospital has been providing estimates for about five years and averages one request a day, spokeswoman Rebecca Climer said. Vanderbilt provides estimates only to uninsured patients.

"If they are insured, we will not do that," said Warren Beck, the teaching hospital's director of finance. Vanderbilt won't quote prices to insured patients because benefits vary greatly from one health plan to another, he said. "If we give them an answer that is not based on fact, then the patient is holding us to that," he said. "We really don't want to go there." Beck said few patients call to check prices, but he said the trend toward transparency has forced the school to hire a consulting firm to help it review its charges. "Part of what's happened is that there are a lot of national Web sites out there that are taking a look at public information and feeding the information to ever who is surfing the Internet," he said.

Historically, hospitals and other health-care providers have avoiding talking about prices, partly for competitive reasons, but also because patients seldom pay full price. Health plans negotiate with hospitals to get lower prices and then ask patients to pay a fraction of the charges in the form of deductibles and co-payments.

On average, the annual cost of health care for an employee has doubled since 2000, to about $8,300 a year, according to the human resources firm Hewitt Associates. Prices have prompted some employers offer high-deductible health plans and health savings accounts in hopes of reducing their own premiums by asking workers to pay more.

In a speech in May — the same day HCA Chairman Jack O. Bovender Jr. said his company would make transparency "a top priority" — President Bush told an industry group that patients "have no idea what the actual cost of their treatment is." "When patients and consumers see how their health-care dollars are spent, they demand more value for their money," he said.

But some experts say price isn't everything. As a practical matter, patients don't shop for care the same way they do for cars or appliances, said Bill Vaughan, a senior policy analyst for Consumers Union, which publishes Consumer Reports magazine.

"The thought that I'm going to argue with my doctor over where to go for treatment, that's not the way most of us think," Vaughan said. "It's a simplistic view of the health-care problem." Price is one thing to consider, but quality of care is more important, he said. It's possible that a hospital that charges more provides better care, he said.

HCA's hospital Web sites say nothing about the quality of care at the facilities. Since the HCA trial program began, 209 people have called for estimates at all 10 Dallas-area hospitals combined.

With hospitals under increased political pressure to be more open about prices, the Tennessee Hospital Association is preparing a hospital-charge Web site that will be launched sometime this spring, President Craig Becker said.

"We'd rather get it out there, do it ourselves, before we're told we have to do it … (but) I think most people really don't know how much the prices are," he said.  Most people are interested only in their co-payment or deductible, in how much of their money they'll have to spend, and that depends on their individual insurance policy, he said. His group's Web site won't have quality information, but a spokeswoman said it would have a link to the "Hospital Compare" feature on the Department of Health & Human Services' Web site, which offers quality information.