Blue Cross to pay NC patients up to $500 rebate for choosing cheaper doctor
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"There is also the big cost-saving potential where you can shop, find a high-quality provider, and really reduce your out-of-pocket costs," said
Insurers have for years sought to influence patient decisions through co-payments and high deductibles as a shared financial responsibility for medical costs.
Some health care experts are excited at the prospect of pulling back the veil on health care costs, saying that pricing transparency is long overdue. But others warn that using money to influence private medical decisions can be harmful, noting that not all doctors are equal.
"I would caution patients to be careful," said
So far, 10 of those companies have opted to offer SmartShopper to their employees.
The State Health Plan, the largest
Nationwide, SmartShopper has generated more than
Is it ethical?
Several medical ethicists praised SmartShopper as a technology that empowers the public on health care costs that have for far too long remained hidden in a black box.
"I like the idea of paying people to pay attention to what they're doing because of the principle of responsibility -- pay attention to the cost of your choices," said
And Dr.
But others said that paying people to choose one doctor over another raises concerns of improperly influencing vulnerable patients.
Some ethicists have said that financial inducements are relative to one's income and giving poor patients a financial incentive can amount to a form coercion.
"This approach has serious ethical deficiencies because the individuals who assume these risks are generally financially less well off," Fleck said. "My concern is that this BCBS program might be vulnerable to some of the same ethical concerns. The financially less well off will take more risks," if they see the chance for a
Cost vs. quality?
Like other insurers that offer SmartShopper,
One of the aspects of SmartShopper that makes health care professionals wary is that it lists all doctors in
"I know of surgeons on their plan who have lost their [practicing] privileges at hospitals but still were on the [health insurance] plan, how does that define quality?" said surgeon Dr.
"While many studies have shown there is no correlation between cost and quality when it comes to health care, all doctors listed meet strict standards required to be part of the Blue Cross NC network, including verification of their credentials being in good standing and meeting state licensure requirements," spokesman Vevurka said in a statement. "The costs listed also take quality measures into account as they represent the entire cost of the procedure, including such factors as efficiency, the length of hospital stay and the number of medical professional involved in the procedure."
SmartShopper might make some employers balk, too. Employers and organizations like the State Health Plan have to pay between
But many employees don't use SmartShopper even if they have access to it. An undisclosed number of employees doesn't bother to register on SmartShopper, and of those that do register, about 60 percent use it, said Mattio, the spokeswoman for Vitals.
In some cases a patient may not care how much health care costs, because the health insurer pays the bill. That's where the cash rebate comes in -- to give patients an incentive to choose the cheaper option even if they don't directly benefit.
SmartShopper pays cash rebates on more than 100 medical procedures, including colonoscopies, angioplasties, hernia repairs knee and hip replacements, and a variety of MRI scans and CT scans.
SmartShopper cash bonuses are not available for life-and-death conditions, like cancer treatment or advanced heart procedures.
"The range of procedures that SmartShopper covers are considered routine services and procedures," Mattio said by email. "Imaging services, like MRIs, mammograms and Xrays, don't differ much from one facility to the next. Same for infusion drugs. The exact same drug is administered whether it is at a hospital or infusion center or even in the comfort of a member's home."
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