I read with great interest the special report by Mary Chris Jaklevic titled "Price bundling packs pitfalls" (Feb. 27, p. 58). As she notes, package pricing is not a panacea. But there are many other problems she failed to mention. Based on my experience with organ transplant "centers of excellence," several are noteworthy.
First, the cost-shifting problem may be more real than is apparent. Are hospitals merely able to offer favorable prices through internal cost shifts? This is certainly true for transplants and cardiovascular procedures. In healthcare, manipulating the market for institutional gain, prestige and marketing advantage are common and accepted practices.
Second, package pricing is more reasonable and less risky if the procedures and services in question are acute and can be treated short term with definitive results. Cancer and mental health are less acute, more chronic and less predictable. Thus, the provider assumes a high level of unpredictable risk, while the payer achieves predictable payment.
Finally, in the case of transplants, payers have begun negotiating contracts that include before and after transplant services. For example, a package price often applies to a one-year period or longer and may include the services a patient requires even before a donor organ becomes available-an event over which a provider has virtually no control.
Clearly, if we are to understand the real economic impact and outcomes associated with package pricing, we must rely on broad-based analyses. The benefits we attribute to this pricing practice may be more apparent than real.
ROGER W. EVANS
Head, section of healthservices evaluation
Mayo Clinic, Rochester, Minn.