Most states have limited laws or no laws at all to guarantee patient access to information on hospital and clinic prices, according a newly released report that found poor disclosure and incomplete information in three dozen states.

The report, released by the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute, awarded an F to 29 states—including seven without any price laws whatsoever—and gave another seven states a D. State laws were graded on how easily disclosed prices could be seen by the public; whether laws required disclosure of prices or discounts paid by insurers; and how many providers and procedures were included.

Even among two states that earned an A, Massachusetts and New Hampshire, disclosure was lacking, the reports' authors said.

“We graded on a curve,” said Suzanne Delbanco, executive director of the Catalyst for Payment Reform, an employer group. “I think there's room for improvement, even among the As.”

Glenn Melnick, a healthcare finance professor at the University of Southern California, described the report as “pretty lenient” and said it underscored “how bad things are right now.” Melnick said he believed the report did not emphasize enough the value of the discounted prices paid by insurers instead of sticker prices, or charges. “Charges, unless they represent the real prices, are not useful information,” he said.

“The real challenge will be to combine detailed services into common bundles of services that consumers are likely to buy and then give actual prices,” Melnick said in an e-mail. “Right now, pricing is far too detailed and after the fact to be helpful to consumers.”

As households pay a larger share of the medical bill, pricing information is increasingly important, Delbanco said.

Francois de Brantes, executive director of the not-for-profit Health Care Incentives Improvement Institute, said he was saddened by the results “when you consider the weight of healthcare costs for the average family and what it has become, and while a lot of people are talking about it, nobody seems to be worried about concrete action.” Publishing prices would be one such action with the power to directly benefit consumers, he said. “If you're fumbling around without any pricing information, you're at the mercy of whoever is setting the prices.”

More laws are necessary, he said. Voluntary efforts have so far failed to significantly improve disclosure of prices. Without legislation, consumers have little hope of getting access to prices for the hospitals and doctors they visit.

He called for laws that require health plans to disclose more price information to patients. State health insurance exchanges, new markets scheduled to launch this year under the 2010 health reform law, can also develop regulations to require such disclosure, he said. States should also ban hospitals and clinics from including clauses in health plan contracts that prohibit health plans from publishing price information, he said.