Making things clear on cost and quality

President Bush's order for transparency is good, but it's only one step to ensure that patients get the correct read on doctors' costs and effectiveness.

Editorial. Nov. 6, 2006.

With his executive order requiring transparency in federally administered or sponsored health plans, President Bush has taken a highly influential step toward the important goal of getting all consumers the price and quality information they need to be in greater control of their health insurance decisions.

While President Bush's order encompasses the philosophy the AMA and others have when it comes to transparency, it's short on details. Also, private-pay plans are not affected by this mandate. Nevertheless, the rule -- even in what's missing -- does provide a starting point to describe what's really needed for reporting that works.

For transparency to be true to its name, consumers need to know that the price information reflects what they actually will pay their doctors. And the quality information needs to reflect the care patients actually will receive. Without getting those details correct, you don't have the fully informed decision-making that the medical profession and many stakeholders strive for in an age of greater consumer control over health costs.

The pricing part of the president's order, which takes effect Jan. 1, 2007, says each federal agency shall make available to beneficiaries and enrollees how much is paid "to providers in the health care program with which the agency, the issuer or [health] plan contracts."

Sounds clear enough, but given the fact that most federal agencies have set charges for physicians that don't vary, except by geography, this order won't achieve a key goal of transparency -- competitive pricing. Even the administration sees this move as mostly symbolic, a prod aimed at businesses to make the same demands from its insurers.