 |
|
Charges for Medical Care at Different Hospitals
Donald A. Redelmeier, MD;
Chaim M. Bell, MD;
Allan S. Detsky, MD, PhD;
Gary K. Pansegrau, MD, BSc
Arch Intern Med. 2000;160:1417-1422.
Background The United States has a high proportion of people without health insurance (15%) and a low proportion of people without employment (5%), resulting in millions who lack insurance but have some ability to pay. We tested whether hospitals charge similar prices for well-specified elective services to individuals paying out-of-pocket for medical care.
Methods We surveyed the 2 largest general hospitals from every large city (population >500,000) in the United States and Canada. At each hospital we evaluated 5 diagnostic, 7 therapeutic, and 3 nonclinical services to determine the total charge to patients who pay directly.
Results Overall, 66 hospitals were included (average, 758 beds; not-for-profit, 97% [n=64]; teaching, 80% [n=53]). The range in charges was substantial; for example, a screening mammogram was $40 at one hospital in Los Angeles, Calif, and $346 at one hospital in Quebec City. Charges for a screening mammogram were relatively stable between 1996 and 1997 (r=0.79; 95% confidence interval, 0.68-0.87) and unrelated to the hospital's location or charges for other services. The relative amount of variation in charges was similar for high-priced and low-priced services, similar for diagnostic and therapeutic services, and similar for the United States and Canada.
Conclusions Charges for the same hospital service vary substantially. Greater visibility might reduce some variation by bringing outliers into closer scrutiny. Patients seeking care and paying out-of-pocket could save financially by comparison shopping.
From the Program in Clinical Epidemiology and Health Care Research (Drs Redelmeier, Bell, Detsky, and Pansegrau) and the Departments of Medicine (Drs Redelmeier, Bell, Detsky, and Pansegrau) and Health Administration (Drs Redelmeier and Detsky), University of Toronto, and the Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre (Drs Redelmeier and Bell), Toronto, Ontario.
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(10):1543.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Screening for Colon Cancer -- Can We Afford Colonoscopy?
Detsky
NEJM 2001;345:607-608.
FULL TEXT
|
