Imagine buying a house without any idea how much it costs until after the closing. Or buying a new SUV not knowing what or how many monthly payments you owe until you get the first bill.

It may sound crazy, but that's how it is when it comes to health-care services. Need a cholesterol test, chest X-ray or your gall bladder removed? Chances are, you won't know how much the procedure costs until after it has been performed.

If you have a Cadillac insurance plan, you might not care. After all, little, if any, will be coming out of your pocket.

But the issue of so-called price "transparency" -- knowing upfront what your medical treatment and tests will cost -- is growing in importance for many consumers as the ranks of the uninsured climb and as Americans everywhere are being asked to foot more of their health care bills through higher insurance premiums, deductibles and co-payments.

It also is crucial to the succes of the major thrust of the Bush administration's health-care initiatives.

In his State of the Union address two weeks ago, President Bush again called for expanding the use of Health Savings Account plans, which allow consumers to set aside money tax-free to pay out-of-pocket medical expenses and typically are coupled with high-deductible insurance coverage for catastrophic expenses.

Created in 2003, HSAs are the backbone of the administration's platform for stemming runaway health care costs. The theory is that when people are spending more of their own money on health care, it will prod them to be more judicious in their choices.

The problem is, it has been difficult, if not impossible for consumers to be savvy shoppers because doctors, hospitals and insurers generally aren't prepared to give them good information about the cost of services.

"It's very difficult for consumers to obtain prices, which makes it difficult to be informed shoppers of health care," said Stephanie Suran, spokeswoman for the Pennsylvania Health Care Cost Containment Council, which has issued some of the state's first and only public report cards on medical care, including landmark studies on hospital-acquired infections.

Fruitless search
Last month, the Post-Gazette contacted a handful of area hospitals asking for prices for several common medical procedures but didn't have much luck.

The newspaper was able to get estimates for a routine mammogram at four of six centers that were contacted. The prices ranged from $98 to $320, although several were partial quotes, which didn't include physician charges for reading the X-rays. (Because charges vary depending on the discounts negotiated by a patient's insurance carrier, the Post-Gazette asked for prices for a patient who was uninsured.)

The PG struck out when attempting to get quotes for more complicated procedures, including a colonoscopy and heart catheterization.

"That would be difficult to find," one patient billing representative said in a typical befuddled response.

"I couldn't pull that up because there are so many charges," said another.

The public relations department at one hospital provided partial estimates reflecting hospital charges for the procedures, but not for related physician, anesthesia or supply costs.

Last year, a consumer advocate in Pennsylvania tried a similar experiment, contacting a handful of pediatricians and asking for the cost of an office visit and some routine office services.

None were willing to divulge prices, although some said they would do so if she came in and completed some paperwork, according to Cindy Fillman, director for the Office of Consumer Liaison for the Pennsylvania Department of Insurance.

"Consumers look for this information if they have to pay out of pocket," she said. "It would be nice to be able to pick up the phone instead of schlepping to the pediatrician's office."

That doesn't mean the winds of change haven't begun to kick up.

In a bold initiative in New Hampshire, that state's insurance department plans to launch a Web site next month giving residents access to cost estimates for many common medical procedures and tests at health care facilities statewide so patients can compare prices.

Since 2003, New Hampshire insurance carriers and third party administrators have been required to submit claims data to the state. The new Web site uses that data to calculate the median charge for medical procedures at specific medical centers based on the discounts negotiated by a particular insurance carrier.

Let's say a patient wants to get a mammogram or knee surgery. "The site takes the allowed [covered] amount and says this is the best guess for what you will pay if you go to a particular provider based on your insurance," said Leslie Ludtke, health policy analyst for the insurance department.

Prices include all related costs, including physician and hospital charges. There also is a section for people not covered by insurance, taking into account average discounts offered to the uninsured.

Maine is the only other state in the country that requires insurers to submit claims reports, Ms. Ludtke said. New Hampshire is the first to make them public.

"If people are expected to pay for something, they should know how much it costs," she said.

The project met with considerable resistance from insurers arguing that their contractual rates were confidential. The department solved the problem by using the median allowance by a particular carrier, Ms. Ludtke said.

Changes in the works
In Pennsylvania, several initiatives intended to improve transparency of hospital and physician costs are under way.

The Health Care Cost Containment Council has begun compiling some pricing information from commercial insurers and the federal Medicare and state Medicaid programs and is studying ways to include it in future public reports, Ms. Suran said.

The Rendell administration also is working on a plan, details of which will be unveiled shortly after the governor's budget address on Tuesday, said Amy Kelchner, spokeswoman for the governor's office of health care reform.

Options are still being discussed, she said, but one thing the governor has settled on is launching a Web site listing prescription drug prices to help people comparison shop.

"Pharmaceuticals are a bigger and bigger cost for consumers," Ms. Kelchner said. "Unless you call around, you don't know what you'll be charged."

In Western Pennsylvania, patients covered by health plans operated by Aetna Inc. have online access to pricing information for visits to network physicians and up to 30 common office procedures, such as immunizations, throat cultures and electrocardiograms.

The information has been available to Aetna's roughly 87,000 Pittsburgh-area customers since August. Similar data are available in 15 other markets nationwide.

Aetna decided to provide the data so policyholders can make informed choices about their health care, said Walt Cherniak, spokesman for Aetna's Mid-Atlantic region.

"There are an increasing number of consumer-directed health plans, not only HSAs, but higher deductible plans where more of your money is at stake," he said.

Ms. Ludtke of the New Hampshire insurance department said she was not sure what effect publicly posting physician and hospital charges would have on health care costs.

Some providers who viewed the state's prototype site were shocked at how expensive their prices were compared to the rest of the pack, while others were astonished at how cheap they were, she said.

"Maybe [posting prices] will make things more expensive or make them cheaper. I don't know," she said.

Regardless, Ms. Ludtke said, she firmly believes patients should have cost estimates in advance so they will know how deeply the scalpel will cut -- not into their skin, but into their wallets.

"If we know people have a financial responsibility [for health care] and it's becoming more common, how can we say they shouldn't be able to know what their financial burden is going to be?" Ms. Ludtke said.

"This is information people are entitled to have," she said. "It's the fair and right thing to do."