Newswise — Does your physician know the cost of the test he just ordered for you, and what are the ethical implications, either way? In response to research indicating that healthcare costs go down when physicians are shown the cost of tests at the time of ordering, a pair of medical ethicists at Johns Hopkins have outlined the ethical issues that need consideration when designing and displaying prices for physicians.

The Viewpoint article in a “Price, Cost, and Competition” theme issue of JAMA highlights a core problem with price displays: in modern medicine “price” can refer to various types of charges, including cost of service provision, cost plus profit, charges, or expected reimbursement, among others. Some of these prices may vary by as much as 10-fold – from $11 up to $142 for a complete blood count, for example. Displaying the right price is important, as well as where the price came from and what it means, may also be important to display.

“Price displays are growing in popularity, and yet these different possible meanings of price have different ethical implications,” says Matthew DeCamp, co-author of the study. For example, DeCamp says, displaying the highest possible price might more effectively lower costs, but could it cause physicians not to order beneficial interventions? How do price displays relate to patients’ concerns about out-of-pocket expenses?

“These and other ethical issues must be considered before the price displays become widely implemented,” says DeCamp. Both he and co-author Kevin Riggs are practicing physicians in the Johns Hopkins Division of General Internal Medicine and are affiliated with the university’s Berman Institute of Bioethics.

The authors recommend these ethical considerations be taken into account when deciding which price to display:

• Transparency — “At the very least, reference to the source of the price should be shown alongside the price display.”

• Informing Patients —“Protecting patient autonomy requires informing patients that price displays are being used.”

• Protecting Well-Being— there must be protection against the “risk of patients not receiving beneficial services.”

• Ensuring Fair Treatment — “Fairness mandates that price displays should not systematically disadvantage certain patient groups,” for example, uninsured patients. “Displaying the same amount for all patients could help ensure they are treated fairly.”

“This is new territory, clinically and ethically, and we need more research into how displays operate in practice,” says Riggs. “Displaying prices to physicians could help put resources to their best use, but to fully realize that potential these ethical considerations must be kept in mind.”

This research was supported by National Institutes of Health grant T32HL007180-38 (Riggs) and a Hecht-Levi Fellowship in Bioethics at the Johns Hopkins Berman Institute of Bioethics (Riggs).

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