#332 2009 · Surgery Center of Oklahoma · Healthcare / outpatient surgery
In an industry where no patient can learn the price of surgery before agreeing to it, this surgeon-owned center just put every price on its website — and let customers shop.
问题
buyers in a market cannot compare prices before committing because sellers never disclose them upfront
背景
In US healthcare, prices for surgery were and largely remain invisible to patients before treatment: hospitals negotiate different rates with each insurer under confidentiality clauses, bills arrive itemized and inflated relative to what insurers actually pay, and a patient asking 'what will this cost me' before agreeing to a procedure typically could not get a straight answer. This opacity protected every incumbent hospital simultaneously — none had to compete on price because no patient could compare prices to begin with.
Dr. Keith Smith, an anesthesiologist and co-owner of the physician-run Surgery Center of Oklahoma, had watched this system from the inside for years and concluded the lack of price transparency was itself the reason the market showed none of the cost discipline of a normal market. Rather than lobby for regulation to force disclosure industry-wide, he decided a single surgery center could just publish its own real numbers and see what happened.
换别人会怎么做
The available approach was lobbying for regulation to force price disclosure industry-wide, since every incumbent hospital individually benefited from opacity and none had any competitive reason to unilaterally reveal what a procedure actually cost before a patient committed to it.
他们看到了什么
Dr. Keith Smith saw that the opacity itself, not any inherent complexity in healthcare pricing, was the reason the market showed none of the normal cost discipline a functioning market has, since a patient who couldn't compare prices had no way to reward a cheaper, better option even if one existed. Rather than waiting for industry-wide mandated disclosure, he concluded a single surgery center could simply publish its own real, all-inclusive numbers unilaterally and let transparency itself become the competitive move no incumbent protected by the same opacity could easily match.
那一手
Starting in 2009, the Surgery Center of Oklahoma posted a single, fixed, all-inclusive price for each procedure directly on its public website — surgeon's fee, anesthesia, facility fee and post-op care bundled into one number a patient could see and compare before ever calling the center, with no insurance billing, no negotiation and no surprise balance afterward.
为什么管用
Posting a single, fixed, all-inclusive price for each procedure directly on the public website, with no insurance billing, negotiation, or surprise balance afterward, let patients actually compare costs before committing for the first time in a market where that comparison had simply never been possible, converting healthcare pricing into something buyers could shop the way they would any normal purchase. Because every other hospital's pricing model depended on the same opacity that had always protected all of them simultaneously, none could easily match the Surgery Center's transparency without exposing their own negotiated rates and abandoning the confidentiality clauses their entire pricing structure depended on, giving the Center a durable advantage rooted in structural difference, not just marketing. This is why the posted prices ran routinely 6 to 10 times lower than comparable hospitals and stayed stable for over a decade rather than rising with the rest of the industry, and why self-funded employers began flying employees across state lines and international patients started arriving directly off the strength of the published prices alone.
值了多少
The posted prices ran routinely at a fraction of what comparable hospitals charged — often cited at 6 to 10 times lower — and stayed largely stable for over a decade rather than rising with the rest of the industry. Self-funded employers began flying employees across state lines for lower-cost surgery at the center, and international patients, including Canadians facing long domestic wait times, started showing up directly off the strength of the published prices alone.
什么时候会失灵
The mechanism depends on the seller genuinely being able to offer an all-inclusive, predictable price without the underlying variability that makes many complex services hard to price in advance, a procedure with genuinely unpredictable complications or highly variable individual circumstances would be harder to bundle into one fixed number the way routine outpatient surgery could. It also depends on the seller not depending on the same opaque negotiated-rate system that protects incumbents, a hospital deeply embedded in insurer network contracts and confidentiality clauses would face real structural and legal barriers unwinding that arrangement that a physician-owned, insurance-free center like Surgery Center of Oklahoma never had to contend with. And unilateral transparency only works as a competitive advantage as long as it remains genuinely differentiating, if price transparency became universal industry practice through eventual regulation or widespread voluntary adoption, the specific advantage of being the first and most visible transparent option would erode even though the underlying benefit to patients would remain.
后来呢
The Surgery Center of Oklahoma's price list became the reference case cited in US healthcare-price-transparency legislation and congressional testimony, and its model — physician-owned, insurance-free, prices published before treatment — has since been replicated by direct-pay surgery centers and clinics nationwide as evidence that voluntary transparency, not just mandated disclosure, can move an opaque market.
资料来源
- [1]Transparent Health Care Pricing: Keith Smith and the Surgery Center of OklahomaMercatus Center, 2024mercatus.org
- [2]Physicians Taking Back Medicine: Keith Smith, M.D., and the free market revolution in surgeryMedical Economics, 2023medicaleconomics.com