There’s been lots of BS about how the price reductions in those ads for LASIK "prove" that cash based consumer payment works in health care. I always thought they were like the teaser prices in travel  adverts in the Sunday papers–only good if you were leaving Tuesday at midnight, staying 4 months, taking no luggage, and having to fly the plane yourself while the pilot takes a nap.

And now HSC shows that it’s not as advertised.

HSC president Paul Ginsburg, Ph.D., points out that current efforts to increase price transparency for health care services often downplay “the complexity of decisions about medical care, patients’ dependence on physicians for guidance about appropriate services, and the need for information on quality.”
Ginsburg cautions that simply giving consumers a price list of “a la carte” services does little to help them make informed choices about which providers will cost less for an episode of care, let alone which providers offer the best value — or the optimal combination of the lowest cost and highest quality.
The article also points out that insured people have different needs for price information than uninsured people. Insured people need to know what their costs will be under their insurance and benefit structure. And policymakers should be careful not to overlook the role of health plans in negotiating better prices and translating complex price and quality data into usable consumer information that can potentially help steer patients to lower-cost, higher-quality providers, the article notes. Researchers chose the LASIK market for in-depth analysis largely because the vision correction surgery is widely regarded as the self-pay market with the most favorable conditions for consumer shopping. LASIK is an elective, nonurgent, simple procedure, giving consumers time and ability to shop; screening exams are not required to obtain initial price quotes, keeping the dollar and time costs of shopping reasonable; and easy entry of providers (ophthalmologists) into the market has stimulated competition and kept prices down.
However, LASIK patients still face significant hurdles when shopping from inconsistent bundling of what’s included in the procedure price to misleading advertising to quality concerns.
— Inconsistent Bundling. The package of services included in LASIK procedure fees varies across providers. For example, one critical factor is whether the cost of enhancement surgery is included in the fee. A price quote that appears to be the best deal but does not include follow-up operations if needed might end up being the highest-price option.
— Misleading Advertising. Misleading offers for free consultations or for LASIK for $299 and promises that LASIK would eliminate the need for glasses and contacts for life have all come under scrutiny by state and federal regulators, resulting in enforcement actions and settlements to halt the misleading practices.
— Quality Issues. Many industry observers expressed concern that LASIK is regarded as a commodity by some consumers, leading them to shop only on price, when provider quality may vary considerably. Even when consumers are interested in obtaining quality information, the study finds that it is not easy; those wishing to compare provider quality must gather information on success and complication rates from each LASIK surgeon’s practice.

Which of course means that if we’re going to get to real consumer purchasing, we need to figure out a rational way to price for rational bundles of service–and we have to make sure that providers are showing apples to apples comparisons.