Data Brief | | August 2023

Mississippi Residents Worry about High Hospitals Costs; Have Difficulty Estimating Quality/Cost of Care; Express Bipartisan Support for Government Action

Hospitals provide essential services and are vital to the well-being of our communities. However, a
survey of more than 1,300 Mississippi adults, conducted from May 3 to May 22, 2023, finds that
many Mississippi residents worry about hospital costs and support a variety of government-led
solutions across party lines.   

Hardship and Worry about Hospital Costs 

A substantial portion of Mississippi respondents worry about affording health care costs both now
and in the future, and many reported experiencing financial hardship resulting from hospital bills.
Over three in five (64% of) respondents reported being “worried” or “very worried” about
affording medical costs from a serious illness or accident. Mississippi respondents may have cause
to worry about affording hospital care—of the 31% of respondents who reported receiving an
unexpected medical bill in the past year, 53% say that at least one such bill came from a hospital. 

Hospital Consolidation

In addition to the above health care affordability burdens, the survey reveals that some Mississippi
residents have been negatively impacted by health system consolidation. Between April 1, 2018
and January 1, 2023, seven hospitals in the state have changed ownership through either a merger,
acquisition, or change of ownership (CHOW).^1,2

Relative to other states, Mississippi has few regulations surrounding hospital change of ownership;
the state does not have any provisions requiring notice, review or approval of any health care
acquisitions mergers or consolidations. Additionally, as of 2023, the state has passed legislation
that exempts hospital acquisitions and mergers from state anti-trust laws.^3,4

In the past year, 11% of respondents reported that they or a family member were unable to access
their preferred health care organization because of a merger that made their preferred
organization out-of-network. Respondents reported a variety of new burdens occurring due to
these mergers, including:

• 37%—Delaying or avoiding going to the doctor or having a procedure done;
• 41%—Skipped recommended follow-up visits;
• 27%—Skipped filling a prescription medication;
• 24%—Changed your preferred doctor or hospital;
• 24%—Changed your health plan coverage to include your preferred doctor or hospital;
• 15%—Switched to telehealth options to continue seeing your preferred doctor; and
• 14%—I have stayed with my preferred health care organization and now pay out-of-network or out-of-pocket costs.

Survey respondents were also asked to share their experiences following hospital consolidation. Selected
responses are listed below in Table 1.

Skills Navigating Hospital Care

Mississippi respondents reported fairly high confidence in their ability to know when to seek
emergency care, with 67% reporting that they are very or extremely confident about knowing
when to go to the emergency department versus a primary care provider. However, they are less
confident in their ability to find hospital costs and quality information. Forty-one percent of
respondents are NOT confident they can find out the cost of a procedure ahead of time, and 46%
are NOT confident they can find quality ratings for doctors or hospitals.

Mississippi respondents’ lack of confidence may be reflected in the low rates of searching for
hospital price and quality information. Out of all respondents, only 32% tried to find the COST of a
hospital stay ahead of time and 17% needed a hospital stay but did not search for cost information.
Out of those respondents who tried to find hospital cost information or needed a hospital stay
(but did not search for cost information), 42% reported finding the information they were looking
for, 23% reported they did not find the information they were looking for, and 35% did not
attempt to find information when they needed a hospital.

Thirty-nine percent of all respondents reported that they have tried to find QUALITY information
on hospitals and 17% needed a hospital but did not try to look for quality information. Out of those
respondents who tried to find hospital quality information or needed a hospital stay (but did not
search for quality information), 50% were successful at finding quality information, 20% were
unsuccessful and 30% did not attempt to find quality information when they needed a hospital
(see Figure 1). Figure 1 also captures other health care costs integral to hospital services, including
medical tests, primary care, and specialist doctor visits.

Among respondents who needed a hospital stay but did not seek out price or quality information,
the most frequently reported reasons for not seeking information were:

• 33%–Followed their doctors’ recommendations or referrals;
• 27%–Did not know where to look;
• 24%–The act of looking for information felt confusing or overwhelming; and
• 22%–Did not have time to look.

Notably, few of these respondents reported that out-of-pocket cost or quality were unimportant
to them (9% and 6%, respectively).

Respondents who attempted to find hospital cost or quality information but were unsuccessful
faced a variety of barriers. Among those who were unsuccessful searching for cost information,
respondents reported that resources available to search for price information were confusing
(31%), their insurance plan or their provider, doctor, or hospital would not give them a price
estimate (30% and 31%, respectively) and that price information was insufficient (27%). In
unsuccessful searches for hospital quality information, respondents reported that resources
available to search for quality information were confusing (23%) and that the quality information
available was not sufficient (23%).

Among those who were successful at finding the cost for a hospital stay or quality information,
roughly half reported not comparing prices or quality between providers (i.e. “shopping”) (see
Figure 2). Still, 39% successfully compared the cost of a hospital stay at multiple providers and
42% were successful in comparing quality across hospitals.

Among those that did compare cost or quality information for different services, many reported
that the cost or quality comparison ultimately influenced their choice of which provider to seek
care from. Eighty-one percent of those who compared primary care or specialist doctor visit costs,
81% of those who compared medical test costs, and 84% of those who compared hospital stay costs
said the comparison influenced their choice. Among those who looked for hospital quality
information, 89% had their choice influenced by the information.

Although many of the respondents who sought out hospital price and quality information were
ultimately successful, many respondents never attempted to find this information. Even among
those who were successful at finding hospital cost or quality information, roughly half did not
compare prices or quality between providers (i.e. “shopping”).

Respondents identified a variety of barriers to finding and comparing cost and quality information,
including following doctors’ recommendations, confusion over where or how to find cost or
quality information, and providers and insurers not providing cost estimates. These reasons could
also be influenced by this information not being accessible, despite federal price transparency
mandates for hospitals.⁵

It could also stem from the fact that some consumers don’t view health care as a shoppable
commodity, especially in emergency situations and settings that lack a selection of
treatments/providers. Lack of knowledge of hospital quality and potential costs impedes
Mississippi residents’ ability to plan for needed care and budget for the expense of a hospital stay,
which can be costly, particularly for residents who are un- or under-insured.⁶

Support for "Fixes" Across Party Lines 

Hospitals, along with drug manufacturers and insurance companies, are viewed as a primary
contributor to high health care costs. When given more than 20 options, those that Mississippi
respondents most frequently cited as being a “major reason” for high health care costs were:

• 70%–Drug companies charging too much money;
• 68%–Hospitals charging too much money;
• 65%–Insurance companies charging too much money; and
• 55%–Large hospitals or doctor groups using their influence to get higher payments from insurance companies.

Mississippi respondents strongly endorse several hospital-related strategies, including:

• 88%–Require hospitals and doctors to provide up-front cost estimates to consumers;
• 85%–Set standard payments to hospitals for specific procedures;
• 84%–Impose price controls on contracts between insurers and health care providers;
• 85%–Strengthen policies to drive more competition in health care markets to improve choice and access; and
• 85%–Set up an independent entity to rate doctor and hospital quality, such as patient outcomes and bedside manner.

What’s even more interesting is the level of support for some of these strategies across party lines
(see Table 2).

Conclusion

The findings from this poll suggest that Mississippi respondents are somewhat motivated when it
comes to searching for hospital cost and quality information to help inform purchasing decisions
and plan for a future medical expense. However, Mississippi respondents still faced challenges
finding hospital costs, despite recent action at the federal level to make hospital prices more
transparent.^7,8

It is not surprising that Mississippi respondents express strong support for government-led
solutions to make price and quality information more readily accessible and to help consumers
navigate hospital care. Many of the solutions that respondent’s support would take the burden of
research and guesswork off consumers - such as standardizing payments for specific hospital
procedures, requiring hospitals and doctors to provide consumers cost estimates for certain
procedures, and establishing an entity to conduct independent quality reviews. Policymakers
should investigate the evidence on these and other policy options to respond to Mississippi
respondents’ bipartisan call for government action.
  

Notes 

1. Centers for Medicare and Medicaid Services. (2023). Hospital Change of Ownership. Retrieved July 17, 2023, from https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-change-of-ownership
2.  A CHOW typically occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the old owner’s Medicare Identification Number and provider agreement (including any outstanding Medicare debt of the old owner) to the new owner. The regulatory citation for CHOWs can be found at 42 CFR § 489.18. If the purchaser (or lessee) elects not to accept a transfer of the provider agreement, then the old agreement should be terminated and the purchaser or lessee is considered a new applicant. Most changes of ownership fall into this category. (Centers for Medicare and Medicaid Services. (2022, September). Medicare Fee-For-Service Provider Enrollment – Hospital Change of Ownership: Data Guidance. Retrieved July 17, 2023, from https://data.cms.gov/sites/default/files/2023-01/Hospital_CHOW_Data_Guidance_2022.12.30.pdf)
3. S.B. 2323, 2023 Reg. Sess. (Mis. 2023). http://billstatus.ls.state.ms.us/2023/pdf/history/SB/SB2323.xml#addinfo
4. National Conference of State Legislatures. (2023, February 22). Health System Consolidation. Retrieved July 17, 2023, from https://www.ncsl.org/health/health-system-consolidation 
5. As of January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to make public a machine-readable file containing a list of standard charges for all items and services provided by the hospital, as well as a consumer-friendly display of at least 300 shoppable services that a patient can schedule in advance. See: https://www.cms.gov/hospital-price-transparency/hospitals
6. According to Health Forum, an affiliate of the American Hospital Association, hospital adjusted expenses per inpatient day in Missouri were $1,305 in 2021–the lowest in the country and significantly below the national average. See: Kaiser Family Foundation, State Health Facts Data: Hospital Adjusted Expenses per Inpatient Day. Accessed June 21, 2023. https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-
   day/currentTimeframe=0&sortModel=%7B%22colId%22:%22Expenses%20per%20Inpatient%20Day%22,%22sort%22:%22desc%22%7D
7. This survey was conducted after the Centers for Medicare and Medicaid Services’ rule requiring hospitals to publicly display all standard charges for all items and services, as well as shoppable services, in a consumer-friendly format went into effect. However, low compliance from large hospitals indicates that the rule has yet to demonstrate the desired effect. See: Kelly, Susan, “Hospitals Still Fall Short on Price Transparency, Consumer Group Says,” Healthcare Dive (Aug. 10, 2023). See also: Kurani, Nisha, et al., Early Results from Federal Price Transparency Rule Show Difficulty in Estimating the Cost of Care, Kaiser Family Foundation, (April 9, 2021).
8. Mississippi Residents Experience Difficulty Estimating the Cost and Quality of Care; Express Bipartisan Support for Government Action, Healthcare Value Hub, Data Brief No. XX (XX 2023).

Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ unbiased views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions.

This survey, conducted from May 3 to May 22, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,514 respondents who live in Mississippi. Information about Dynata’s recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,380 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.