I've spent years making medical decisions based on the out-of-pocket cost. I've passed on doctor-advised MRIs because they would cost me $1,000 (and don't even get me started on the myth of how patients can negotiate with providers--a notion propagated largely by people who've never had to try it), and just this week I had to decide whether to have a follow-up visit with a neurologist for vertigo or see a podiatrist about an ongoing running injury.If there was a robustly competitive market then maybe it would be different. But most people have insurance and there isn't really a whole lot of ability to bargain down prices. I found it to be surprisingly challenging to be allowed in to see a medical doctor, paying the full (very high) sticker price.
I don't want to say that it has never worked for anybody (the US is large), but most of the time you are happy to find a provider at all.