Research Brief How New Hampshire A research brief from Public Agenda Residents Use Health Care by David Schleifer, Rebecca Silliman and Chloe Rinehart Price Information APRIL 2017 This brief explores how New Hampshire residents are trying to find and use health care price information, their attitudes about prices and how their attitudes and behaviors compare to those of Americans overall. Important findings include: New Hampshire • 7 percent of New Hampshire residents have tried to find information about health 5 care prices before getting care, including 24 percent who have tried to compare prices across multiple providers. • f New Hampshire residents who have tried to compare prices, 60 percent report O saving money. • 9 percent of New Hampshire residents say higher prices are not typically a sign of 7 better quality medical care. • 4 percent of New Hampshire residents are not aware that doctors’ prices vary, and 4 41 percent are not aware that hospitals’ prices vary. • 6 percent of New Hampshire residents think it is important for their state government 8 to provide people with comparative price information. Support for this report was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation. How New Hampshire Residents Use Health Care Price Information 1 New Hampshire residents, like many Americans, bear a significant share of their health care costs in the form of high deductibles and insurance premiums, as well as copayments and, sometimes, coinsurance.1 Health care systems in the United States have historically not made it easy for people to find out how much their care will cost them. New Hampshire, however, was one of three states that received a grade of “A” for its price transparency laws from Catalyst for Payment Reform in 2016.2 Health insurers in New Hampshire must disclose price information to their members.3 The state also runs a free website providing price information that is specific to each resident’s insurer, deductible size and coinsurance.4 In this unique landscape of price transparency, this research explores New Hampshire residents’ behaviors, attitudes and perspectives related to health care price information. Findings are based on a representative survey of 826 adults in New Hampshire and a nationally representative survey of 2,062 U.S. adults, conducted from July through September 2016 by telephone, including cell phones, and online.5 For more details about the methodology, see page 18 of this research brief. The research was conducted by Public Agenda and funded by the Robert Wood Johnson Foundation. A report on findings from the national survey and briefs on findings from surveys in New York State, Florida and Texas, as well as topline findings, full methodology, question wordings and sample characteristics, are available at http://www.publicagenda.org/pages/ still-searching. 2 How New Hampshire Residents Use Health Care Price Information MAIN FINDINGS Over half of New Hampshire residents have tried 1 to find price information before getting care. Fifty-seven percent of New Hampshire residents have tried to find out before getting care how much they would have to pay out of pocket—not including copays—and/or how much their insurers would pay. Our research found a smaller proportion of Americans overall—50 percent—have tried to find price information before getting care.6 Insured New Hampshire residents with deductibles are just as likely to have tried to find price information before getting care as those without deductibles. Our national survey found that insured Americans with deductibles are more likely to have tried to find price information before getting care than those without deductibles. In New Hampshire, however, insured people with deductibles are just as likely to have tried to find price information as those without deductibles. Among insured New Hampshire residents with deductibles, 59 percent have tried to find price information before getting care. A similar percentage—56 percent—of those without deductibles have tried to find price information; see figure 1. How New Hampshire Residents Use Health Care Price Information 3 Insured New Hampshire residents with deductibles are just as likely to have tried to find price information as those without deductibles. Figure 1. Percent who say they have tried to find price information before getting care, by deductible status by state: Deductible No deductible 59%* New Hampshire 56%* Base: urrently insured: National, C n = 1,853; New Hampshire, 57% n = 759. National Group estimates are statistically 40% different from each other at the p < .05 level, except those indicated by a *. About a quarter of New Hampshire residents have tried to compare prices. Of those who have tried to compare prices, more than half 2 say they saved money. One promise of health care price transparency is that people will use price information to “shop around”—that is, they will compare two or more providers’ prices and consider price in their health care decision-making. Twenty-four percent of New Hampshire residents have tried to compare prices across multiple providers before getting care. Nationally, fewer Americans—20 percent—have tried to compare prices; see figure 2. 4 How New Hampshire Residents Use Health Care Price Information About 1 in 4 New Hampshire residents has tried to compare prices across multiple providers before getting care. Figure 2. Percent who say they have done one of the following before getting care: Tried to compare multiple Tried to check one Have not tried to find providers' prices provider's price price information New Hampshire 24% 30% 2%† 43% National 20% 28% 2%† 50% Base: ll respondents: National, N = 2,062; New Hampshire, N = 826. A † Indicates people who report having tried to find price information before getting care but answer “don’t know” or refuse to answer when asked whether they have tried to compare prices across multiple providers or not. Of New Hampshire residents who have tried to compare prices, more than half report saving money. Sixty percent of New Hampshire residents who have tried to compare multiple providers’ prices before getting care report saving money, while only 23 percent of those who have tried to check one provider’s price report saving money; see figure 3. New Hampshire residents who have tried to compare prices report saving money. Figure 3. Percent who say they saved money when they have tried to find price information before getting care: People who have tried to compare People who have tried to check multiple providers' prices one provider’s price 60% New Hampshire 23% Base: ave tried to find out price H information at least once before 53% getting care: National, n = 1,019; New Hampshire, n = 475. National 28% Group estimates are statistically different from each other at the p < .05 level. How New Hampshire Residents Use Health Care Price Information 5 New Hampshire residents who have tried to compare prices are more likely to make health care decisions for another adult family member. We found that 42 percent of New Hampshire residents who have tried to compare prices make health care decisions for another adult family member. But only 22 percent of those who have not ever tried to find price information make health care decisions for another adult family member. Similarly, among Americans overall, those who have tried to compare prices are more likely to make health care decisions for another adult family member; see figure 4. New Hampshire residents who have tried to compare prices are more likely to make health care decisions for another adult family member. Figure 4. Percent who say they make health care decisions for another adult family member: People who have tried to compare People who have tried to People who have not tried multiple providers’ prices check one provider’s price to find price information 42%† New Hampshire 24%* 22%* Base: ll respondents: National, A N = 2,062; New Hampshire, N = 826. Estimates for New Hampshire groups indicated by * are not statistically 46% different from each other; groups indicated by * are statistically different from groups indicated by † at the National 30% p < .05 level. All three national group estimates are 23% statistically different from each other at the p < .05 level 6 How New Hampshire Residents Use Health Care Price Information Most New Hampshire residents do not think prices are a sign of quality in health care. Of 3 those who have tried to compare prices, most have chosen less expensive care. Before the publication of our 2015 report, some health care experts expressed the concern that making price information transparent could actually lead people to choose higher-priced care.7 This concern was based on the assumption that people think price is a sign of quality in health care. But this research indicates most New Hampshire residents do not believe price and quality are associated in health care. Findings from our national survey and from our 2015 research similarly indicate that most Americans do not believe price and quality are associated.8 Most New Hampshire residents do not think higher-priced care is better quality. Seventy-nine percent of New Hampshire residents say higher prices are not typically a sign of better quality medical care. Similarly, 70 percent of Americans overall say the same; see figure 5. Most New Hampshire residents do not think higher prices are typically a sign of better quality care. Figure 5. Percent who say yes, no or don’t know to the following question: Would you say higher prices are typically a sign of better quality medical care, or not? Yes No Don't know New Hampshire 13% 79% 7% National 17% 70% 14% Base: Random quarter: National, n = 529; New Hampshire, n = 203. Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the chart. Of New Hampshire residents who have tried to compare prices, many say they chose less expensive care. Sixty-seven percent of New Hampshire residents who have tried to compare prices say they chose a less expensive doctor, hospital, medical test or treatment, as compared to 16 percent of New Hampshire residents who have tried to check a single provider’s price. Nationally, of Americans who have tried to compare prices, 59 percent say they chose less expensive care. Only 17 percent of Americans who have tried to check a single provider’s price say they did so; see figure 6. How New Hampshire Residents Use Health Care Price Information 7 New Hampshire residents who have tried to compare prices chose less expensive care. Figure 6. Percent who say they have used price information to choose a less expensive doctor, hospital, medical test or treatment: People who have tried to compare People who have tried to multiple providers’ prices check one provider’s price 67% New Hampshire 16% Base: ave tried to find out price H information at least once before 59% getting care: National, n = 1,019; New Hampshire, n = 475. National 17% Group estimates are statistically different from each other at the p < .05 level. Among New Hampshire residents who have tried to check a single provider’s price before getting care, 52 percent indicate that if they compared prices, they would be inclined to choose less expensive doctors. However, 36 percent of them would not be inclined to do so, and 11 percent don’t know. Among New Hampshire residents who have not ever tried to find price information before getting care, 41 percent indicate they would be inclined to choose less expensive doctors if they knew prices in advance. However, 50 percent of them would not be inclined to do so, and 9 percent don’t know. New Hampshire residents turn to friends, relatives and colleagues; insurance companies; 4 doctors; and receptionists when they try to find price information. Researchers have found that few people use online price information tools when those tools are offered to them by their insurers or employers.9 This has led some experts to assume people are not interested in price information and do not care how much their health care costs.10 However, as our survey found, online tools are only one among many sources people use to try to find price information. 8 How New Hampshire Residents Use Health Care Price Information The sources that New Hampshire residents most commonly use to try to find price information include friends, relatives and colleagues; insurance companies; doctors; and receptionists. Few people report trying to find price information by using websites other than their insurers’; see figure 7. New Hampshire residents turn to the following sources for price information: Figure 7. Percent who say they have tried to find price information before getting care, from the following sources: New Hampshire National 58% A friend, relative or colleague 55% Their insurance company, 52% by phone or web* 48% 48% Their doctor 46% A receptionist or other 44% doctor’s office staff 45% 37%** A hospital's billing department 31%** Base: ave tried to find out prices H 26% for medical care in advance at A nurse least once: National, n = 1,019; 29% New Hampshire, n = 475. *Base: ave tried to find out prices H The internet, other than their 23% for medical care in advance at least once and currently or insurance company’s website 20% ever insured: National, n = 997; New Hampshire, n = 470. While most group estimates are not 12%** statistically different, ** indicates those A mobile phone app that are statistically different at the 17%** p < .05 level. How New Hampshire Residents Use Health Care Price Information 9 New Hampshire residents who have not ever tried to find price information before getting care say they would be likely to use sources similar to those used by people who have tried to find price information. We asked New Hampshire residents who have not ever tried to find price information which sources they would be likely to use if they wanted to find out prices before getting medical care. The sources they indicate they are likely to use include calling their insurance companies or looking on their insurers’ websites (48 percent) and asking their doctors (48 percent). As noted above, among New Hampshire residents who have already tried to find price information, 23 percent used websites other than their insurers’ and 12 percent used a mobile phone app. However, higher percentages of New Hampshire residents who have not ever tried to find price information indicate they would be likely to use those sources if they wanted to find out prices before getting medical care: 38 percent indicate they would use websites other than their insurers’ and 21 percent indicate they would use a mobile phone app. Few New Hampshire residents have heard of their state’s price information website. Only 18 percent of New Hampshire residents say they have heard of New Hampshire Health Cost, the health care price information website administered by the state of New Hampshire.11 In our national survey, 17 percent of residents of states with state-administered price information websites indicate they have heard of the names of their states’ websites; see figure 8.12 Few people have heard of their states’ price information websites. Figure 8. Percent who say they have heard of their states’ price information websites, they have not heard of them or they are not sure: Have heard of it Have not Unsure New Hampshire 18% 76% 5% National (only states with 17% 76% 7% state-run websites)* Base: ll respondents: New Hampshire, N = 826. A * Base: ive in one of the 21 states with a state-run website: National, n = 967. L Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the chart. Doctors, pharmacists and advocacy groups or nonprofit organizations are trusted sources of price information. Fewer New Hampshire residents would trust their employers for price information. We found most New Hampshire residents—78 percent—would trust their doctors a great deal or some when it comes to finding out about the price of medical care; see figure 9. 10 How New Hampshire Residents Use Health Care Price Information Health care providers are trusted sources of price information. Figure 9. Percent who say they do or would trust each of the following a great deal or some as a source of information about the price of medical care: New Hampshire National 78% Their doctor 77% 75%** Pharmacists 67%** Advocacy groups or other non-profit 74%** organizations that provide education and support for patients 62%** 72% Their hospital 67% A nurse or other nursing staff 70%** in their doctor’s office 64%** 68% Their insurance company* 68% Companies and organizations that rate 69%** health care providers and hospitals 62%** Their friends, relatives and co-workers 62% 58% 60% Patient reviews 57% Federal, state or local 59%** government agencies 53%** Base: ll respondents: National, A N = 2,062; New Hampshire, Private companies that 56% N = 826. provide price information 56% * Base: urrently insured: National, C n = 995; New Hampshire, n = 446. A receptionist or other staff 51% † Base: urrently employed and not C self-employed: National, in their doctor’s office 56% n = 1,176; New Hampshire, n = 441. While most group estimates are not 51% statistically different, ** indicates Their employer † those that are statistically different 51% at the p < .05 level. How New Hampshire Residents Use Health Care Price Information 11 Most New Hampshire residents—78 percent—think insurance companies are mostly interested in making money. Fewer think that of doctors or hospitals. Only 12 percent think insurers have patients’ best interests in mind, and 8 percent do not know. When asked the same question about hospitals and doctors, 40 percent of New Hampshire residents say they think hospitals are mostly interested in making money, and 25 percent think doctors are; see figure 10. Most New Hampshire residents think insurance companies are mostly interested in making money. Fewer think that of doctors or hospitals. Figure 10. Percent who say they think each of the following is mostly interested in making money or mostly has patients’ best interests in mind, or that they don’t know: Are mostly interested in making money Mostly have patients' best interests in mind Don't know INSURANCE COMPANIES New 78% Hampshire 12% 7% 68% National 20% 11% HOSPITALS New 40% Hampshire 53% 7% 38% National 47% 13% DOCTORS New 25% Hampshire 64% 8% 27% National 63% 9% Base: All respondents: National, N = 2,062; New Hampshire, N = 826. Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the chart. 12 How New Hampshire Residents Use Health Care Price Information Potential barriers to increasing the use of price information among New Hampshire residents 5 include limited awareness of price variation and uncertainty about how to find price information. Awareness of price variation among New Hampshire residents is limited. When it comes to doctors, 54 percent of New Hampshire residents say some charge more than others for the same services. But nearly half—44 percent—either believe doctors charge pretty much the same prices for the same services (27 percent) or they don’t know (17 percent); see figure 11a. When it comes to hospitals, 59 percent of New Hampshire residents say some charge more than others for the same services. But the rest—41 percent—either believe hospitals charge pretty much the same prices for the same services (25 percent) or they don’t know (16 percent); see figure 11b. Awareness of price variation is limited. Figure 11a. Percent who say they think the following about doctors in their insurance networks or in their areas: Some charge more than others They charge pretty much the Don't know for the same services same prices for the same services New Hampshire 54% 27% 17% National 44% 37% 19% Base: andom half: National, n = 1,025; New Hampshire, n = 419. R Figure 11b. Percent who say they think the following about hospitals in their insurance networks or in their areas: Some charge more than others They charge pretty much the Don't know for the same services same prices for the same services New Hampshire 59% 25% 16% National 45% 32% 23% Base: Random half: National, n = 1,025; New Hampshire, n = 418. Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the charts. How New Hampshire Residents Use Health Care Price Information 13 Of New Hampshire residents who have not tried to find price information, 58 percent indicate they are not sure how to do so. Sixty percent of New Hampshire residents who have not tried to find price information before getting care indicate they would like to know the prices of medical services in advance. However, 58 percent of them indicate they are not sure how to do so. New Hampshire residents want to know more 6 about health care prices. New Hampshire residents say there is not enough health care price information. Seventy-six percent of New Hampshire residents and a smaller percentage of Americans overall—63 percent —say there is not enough information about how much medical services cost; see figure 12. Seventy-six percent of New Hampshire residents say there is not enough health care price information. Figure 12. Percent who say one of the following statements comes closest to their view: Overall, there is not enough information Overall, there is enough information Don't know about how much medical services cost about how much medical services cost New 76% Hampshire 16% 8% 63% National 23% 13% Base: All respondents: National, N = 2,062; New Hampshire, N = 826. Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the chart. Most New Hampshire residents think it is important for their state government to provide price information. Eighty-six percent of New Hampshire residents and 80 percent of Americans overall think it is important for their state governments to provide people with information that 14 How New Hampshire Residents Use Health Care Price Information allows them to compare prices before getting care. Because our survey did not ask how important it is for other entities—such as insurers or employers—to provide comparative price information, this finding may say as much about people’s desire for more information about health care prices as it does about their desire for information specifically from their state government. Most people in New Hampshire favor doctors and their staffs discussing prices with patients. However, fewer say a doctor or their staff has brought up price in conversation with them. Seventy-six percent of New Hampshire residents and 70 percent of Americans overall think it is a good idea for doctors and their staffs to discuss prices with patients before ordering or doing tests or procedures or referring them to specialists; see figure 13a. However, only 28 percent of New Hampshire residents and 28 percent of Americans overall say that a doctor or their staff has brought up price in conversation with them; see figure 13b. Most New Hampshire residents favor doctors and their staffs discussing prices with patients. Fewer report that a doctor or their staff has brought up price in conversation with them. Figure 13a. Percent who say it is or is not a good idea for doctors and their staffs to discuss prices with patients before ordering or doing tests, procedures or referrals, or that they do not know: Yes, I think it's a good idea No, I don't think it's a good idea Don't know New Hampshire 76% 9% 14% National 70% 12% 17% Base: All respondents: National, N = 2,062; New Hampshire, N = 826. Figure 13b. Percent who say a doctor or their staff has or has not brought up in conversation with them the price of a test, procedure or referral, or that they do not know: They have They have not Don't know New Hampshire 28% 70% 2% National 28% 66% 5% Base: All respondents: National, N = 2,062; New Hampshire, N = 826. Numbers may not add up to 100 percent due to rounding and the less than one percent of respondents who refused the question and are not represented in the charts. How New Hampshire Residents Use Health Care Price Information 15 IMPLICATIONS Based on these findings, this brief concludes with implications and questions for policymakers, insurers, employers and providers, as well as for-profit and nonprofit price information providers, so efforts to make prices more transparent will be informed by and responsive to the perspectives and needs of people in New Hampshire and Americans overall. • elp people compare prices to help them save money. This research found that trying H to compare prices across multiple providers is less common than trying to check one provider’s price. Yet New Hampshire residents who have tried to compare prices are more likely to report saving money. This suggests that just making the price information available is not enough to help people save money. Insurers, employers and policymakers should also adopt strategies to encourage people to compare prices. These might include creating financial incentives to compare prices, building awareness of price variation, experimenting with reference pricing or other creative benefit designs, or building information systems that make multiple prices available for comparison. • ecognize the diversity of sources people use to try to find price information. Besides R friends, relatives and colleagues, the sources that New Hampshire residents most commonly use to try to find price information include calling insurers and using insurers’ websites, as well as asking doctors or receptionists. While online price information tools are proliferating, few New Hampshire residents have heard of their state’s price information website or have used sites besides their insurers’. Policymakers, employers and others interested in helping people find price information should consider in-person or phone sources—like receptionists or insurers’ customer service representatives—as part of the price information infrastructure 16 How New Hampshire Residents Use Health Care Price Information and should consider how to ensure those sources are meeting people’s needs efficiently. Past research has used insurance claims data to study whether people save money by using online price information tools provided by employers and insurers. But future research should also consider the impacts of in-person and phone sources of price information. • quip medical professionals and their staffs to discuss prices with patients or to refer E patients to reliable sources of price information. Doctors and their staffs emerged as trusted sources of price information for many New Hampshire residents in this research, and many New Hampshire residents favor doctors and their staffs talking to patients about price. How can doctors and their staffs—including receptionists and nurses—be equipped to handle these conversations? These professionals may not need to be able to tell people exactly what certain medical services will cost them, but they could discuss costs and coverage more generally and guide people toward more specific price information if necessary. • mployers should find ways to build trust with more of their employees. Some E employers have already invested in price information tools for their employees. Yet the percentage of New Hampshire residents who would trust their employers as potential sources of price information is lower than the percentages who would trust other potential sources. Employers and employees could both benefit from lower health care spending. Therefore, it would be in employers’ interests to become trusted sources of or trusted guides to price information for more of their employees. • ew Hampshire should consider a range of ways to make price information more N transparent. Despite finding that fewer people would trust local, state and federal governments as sources of price information than would trust other potential sources and that few people in New Hampshire have heard of their state’s price information website so far, this research also found most New Hampshire residents think it is important for their state government to provide comparative price information. What can states like New Hampshire reasonably do to fulfill people’s interest in price information? Besides providing information themselves, how can states encourage insurers and providers to be more transparent about prices and help state residents understand the extent of price variation? How New Hampshire Residents Use Health Care Price Information 17 METHODOLOGY IN BRIEF This brief summarizes findings from a nationally representative survey of 2,062 U.S. adults ages 18 and older and a representative survey of 826 adults in New Hampshire. Interviews were conducted from July through September 2016. These surveys were conducted in conjunction with representative surveys in three additional states: a survey of 802 adults in New York, one of 808 adults in Texas and one of 819 adults in Florida. Respondents could choose to complete the survey in English or Spanish. Data for both surveys were collected through 40 percent phone interviews, including cell phones, and 60 percent online surveys. The phone response rate for the national survey was 12.8 percent and for the New Hampshire survey was 10.0 percent, using the American Association for Public Opinion Research’s Response Rate Three (RR3) formula. Response rates did not differ between landline and cell phone interviews. For both surveys, the phone sample was weighted to correct for variance in the likelihood of selection for a given case. Phone and online samples were combined using propensity score matching and were weighted to general population demographics. The weight-adjusted margin of error is +/–2.6 percentage points for the national survey and +/– 3.9 percentage points for the New Hampshire survey. Differences reported between subgroups are statistically significant at the p < .05 level unless otherwise stated. The surveys were designed by Public Agenda and fielded by Social Science Research Solutions, Inc. Public Agenda conducted this research with support from the Robert Wood Johnson Foundation. For research briefs on the other three states and for the full national research report, including topline findings, full question wordings and sample characteristics, please go to http://www.publicagenda.org/pages/still-searching. 18 How New Hampshire Residents Use Health Care Price Information ENDNOTES 1 A gency for Healthcare Research and Quality, “Table II.F.1, Table II.F.2, Table II.F.3, Table II.F.4, Table II.F.5 and Table II.F.6,” Medical Expenditure Panel Survey Insurance Component Tables, 1996–2015, generated using MEPSnet/IC on January 31, 2017, https://meps.ahrq.gov/mepsweb/data_stats/MEPSnetIC/startup. 2 C atalyst for Payment Reform and Health Care Incentives Improvement Institute, “Report Card on State Price Transparency Laws” (Oakland CA: Catalyst for Payment Reform, 2016), http://www.hci3.org/wp-content/uploads/2016/07/reportcard2016.pdf. 3 N ational Conference of State Legislatures, “Transparency and Disclosure of Health Costs and Provider Payments: State Actions” (Denver, CO: National Conference of State Legislatures, 2015), http://www.ncsl.org/research/health/transparency-and-disclosure -health-costs.aspx. 4 ew Hampshire Insurance Department, “NH Healthcost” [website], https://nhhealthcost.nh.gov/, accessed 2017. N 5 T elephone and online samples were combined using propensity score matching techniques and weighted to the general U.S. population. See the methodology at the end of “Still Searching” for a detailed description of how this research was conducted. 6 T his percentage includes those who say they have ever tried to find out how much they would have to pay out of pocket, not including a copay, in any one or more of the following four situations: before visiting a primary care doctor, before visiting a specialist doctor, before a hospital stay or before getting a medical test. It also includes those who say they have ever tried to find out before getting care what a doctor or medical facility would charge their insurance companies. 7 A teev Mehrotra, Peter S. Hussey, Arnold Milstein and Judith H. Hibbard, “Consumers’ and Providers’ Responses to Public Cost Reports, and How to Raise the Likelihood of Achieving Desired Results,” Health Affairs 31, no. 4 (2012): 843–51; Anna D. Sinaiko and Meredith B. Rosenthal, “Increased Price Transparency in Health Care—Challenges and Potential Effects,” New England Journal of Medicine 364, no. 10 (2011): 891–94. 8 K athryn A. Phillips, David Schleifer and Carolin Hagelskamp, “Most Americans Do Not Believe that There Is an Association Between Health Care Prices and Quality of Care,” Health Affairs 35, no. 4 (2016): 647–53; David Schleifer, Rebecca Silliman and Chloe Rinehart, “Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas and New Hampshire” (Brooklyn, NY: Public Agenda, 2017), http://www.publicagenda.org/pages/still-searching. 9 S unita Desai, Laura A. Hatfield, Andrew L. Hicks, Michael E. Chernew and Ateev Mehrotra, “Association Between Availability of a Price Transparency Tool and Outpatient Spending,” JAMA 315, no. 17 (2016): 1874–81; Anna D. Sinaiko, Karen E. Joynt and Meredith B. Rosenthal, “Association Between Viewing Health Care Price Information and Choice of Health Care Facility,” JAMA Internal Medicine 176, no. 12 (2016): 1868–70; Aparna Higgins, Nicole Brainard and German Veselovskiy, “Characterizing Health Plan Price Estimator Tools: Findings from a National Survey,” American Journal of Managed Care 22, no. 2 (2016): 126–31. 10 A ustin Frakt, “Price Transparency Is Nice. Just Don’t Expect It to Cut Health Costs,” New York Times, December 19, 2016, https://www.nytimes.com/2016/12/19/upshot/price-transparency-is-nice-just-dont-expect-it-to-cut-health-costs.html?_r=0. 11 A n analysis of web analytics for New Hampshire Health Cost found that about 1 percent of the state’s population had actually visited the site during a three-year period from January 2011 to December 2013. See Ateev Mehrotra, Tyler Brannen and Anna D. Sinaiko, “Use Patterns of a State Health Care Price Transparency Web Site,” INQUIRY: The Journal of Health Care Organization, Provision, and Financing 51 (2014): 1–3. 12 T his includes residents of Arkansas, California, Colorado, Florida, Illinois, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Nevada, New Hampshire, North Carolina, Ohio, Oregon, South Dakota, Utah, Vermont, Virginia and Wisconsin. How New Hampshire Residents Use Health Care Price Information 19 About Public Agenda About the Robert Wood Johnson Foundation Public Agenda helps build a democracy that works for For more than 40 years the Robert Wood Johnson Foundation everyone. By elevating a diversity of voices, forging common (RWJF) has worked to improve health and health care. RWJF ground and improving dialogue and collaboration among is working with others to build a national Culture of Health leaders and communities, Public Agenda fuels progress on enabling everyone in America to live longer, healthier lives. critical issues, including education, health care and community engagement. Founded in 1975, Public Agenda is a nonpartisan, For more information, visit www.rwjf.org. Follow the nonprofit organization based in New York City. Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook. Find Public Agenda online at PublicAgenda.org, on Facebook at facebook.com/PublicAgenda and on Twitter at @PublicAgenda. For more information about this study, visit: http://www.publicagenda.org/pages/still-searching Or contact research@publicagenda.org, tel: 212.686.6610. How New Hampshire Residents Use Health Care Price Information 20