Why 79% of Hospitals Still Fail Price Transparency

Nearly four years after the federal Hospital Price Transparency Rule took effect, the vast majority of U.S. hospitals are still failing to provide patients with clear, actionable cost information. A review of 2,000 hospitals shows that only 21.1% are fully compliant. This means nearly four in five hospitals either fail to post complete pricing data or bury it in formats that are confusing and unusable.

The rule, introduced in 2021, mandates hospitals to publish both a machine-readable file with comprehensive rates for all services and a consumer-friendly display of shoppable services. Yet compliance has declined from earlier reports, when approximately 34.5% of hospitals were fully compliant. Only 16.8% disclosed meaningful dollar amounts, and a mere 6.7% met full compliance and clarity standards simultaneously.

This failure isn’t just a technical issue — it has significant implications. Patients struggle to compare costs, employers cannot benchmark prices for contracts, and hospitals risk reputational and regulatory consequences. Experts cite two primary factors behind the low compliance: legacy billing systems that are not designed to support transparency and limited enforcement, which has made penalties rare relative to the scale of noncompliance.

Hospitals that do meet compliance standards demonstrate what is possible: structured, accessible disclosures that allow patients to see negotiated rates, cash pricing, and itemized costs. For the rest, transparency remains aspirational.

For healthcare leaders, the message is clear: price transparency is no longer optional. It is a strategic requirement that affects patient trust, market credibility, and the ability to operate competitively in an increasingly cost-conscious environment.