by Nick Jacobs

Transparency in healthcare will facilitate the improvement of performance and quality by providing hospitals and physicians with the additional information necessary for benchmarking their work. It will obviously assist patients as they attempt to make informed decisions regarding their potential care. Finally, transparency will improve quality and efficiency by encouraging private insurers and public programs through providing necessary information to them to make necessary decisions. Transparency is not the end-all, but it is a solid start.

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Having dealt with insurance companies, car dealers, computer sales specialists, architects, construction companies, stock brokers, and any number of other professions, it is obvious that any steps toward transparency would significantly move us in the right direction, toward truth, justice and the American way, but none of these topics raise as much passion as conversations about transparency in healthcare.

A little over a year ago, I was informed that a retirement policy endorsed by a former employer had gone bad, and, co-incidentally, it had cost me five years of my personal savings. Could a lack of transparency that may have resulted in personal gain for those involved in selling the product have contributed? One can only guess.

When we realize that we have lost hard earned money, the result is anger, disillusionment, and frustration. When, however, we realize that a loved one has lost their ability to walk because of a lack of information needed to make an appropriate clinical decision, the passion becomes significantly more extreme. We talk a lot about transparency in healthcare, but, not unlike most professions, the jargon, complexity, and intricacies of the profession's jargon keep all but the most learned individuals from sorting through the risks and rewards of each clinical decision.

Do you want coated or uncoated stents? Should you try controlling this situation with medication, open heart surgery or angioplasty? Will I do better with 20 mg. of cholesterol medicine or 40 mg. and what is the potential side affect of this new drug? These questions are incredibly complex, individual, sometimes life and death oriented questions. Simple transparency is not necessarily the answer here.

Let’s be candid and face the stark realities of transparency. Patients are, by and large, the least prepared to command greater quality. Usually we are facing these hard-hitting decisions when we are experiencing some type of health crisis. Shopping for the best of anything at that time is improbable. To further complicate things, the power of an individual as weighed against that of an insurance company, all levels of government, and the myriad of professional societies is infinitesimal when it comes to influencing transparency related issues.

Sara R. Collins, PhD. and Karen Davis, PhD. in their article “Transparency in Health Care: The Time Has Come” written for the Commonwealth Fund, describe the fact that higher patient cost-sharing and high deductible health plans are the wrong prescription; that price information is of little or no value, and that the current state of information is inadequate. They do suggest that the following steps should be considered:

Medicare should take a leadership role in requiring more transparency.

A National Quality Coordination Board should be established.

Continued investment in health information technology must be embraced.

Fundamental changes should occur within current payment methods.

And Health Savings Account legislation to reduce potentially harmful effect on vulnerable populations should be enacted.

They conclude that price transparency is a good beginning step but only a beginning.

With my two decades of healthcare experience securely tucked away, it is important to recognize that we all have the right to question, the right to look for outcome results, and the permission to get the information needed to help us make informed decisions about our personal futures.