University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Gen Intern Med. 2010 Feb;25(2):110-4. doi: 10.1007/s11606-009-1176-5.
The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer.
To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement.
We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy.
Three hundred and fifty-three hospitals in California.
Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures.
Only 28% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15%) did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p<0.001), cholecystectomy ($14,014 vs. $7,196; p<0.001) and colonoscopy ($2,017 vs. $216; p<0.001).
Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.
大多数州都颁布了价格透明度法，让患者能够选择医疗服务，并防止对未参保者的价格歧视。在加利福尼亚州，医院必须向请求无保险的患者提供价格估算，并且不能收取高于医院从政府支付方获得的报销金额的费用。
评估加利福尼亚州医院对患者价格请求的响应率，并将收到的价格估算与医疗保险报销进行比较。
我们从一个虚构的无保险患者向加利福尼亚州的急性护理医院发送了三封信件，要求估算三种常见的择期手术之一的费用：腹腔镜胆囊切除术、子宫切除术或常规筛查结肠镜检查。
加利福尼亚州的 353 家医院。
医院的响应率、收到的价格估算差异以及等效手术的医疗保险报销。
只有 28%（98/353）的医院做出了回应，而且它们的回应内容各不相同。在 98 个回应中，15 个（15%）没有提供报价，而是要求提供更多信息，例如计费代码；55 个（56%）仅提供了医院服务的价格估算；10 个（10%）包含医生和医院服务；18 个（18%）没有说明涵盖的内容。所有手术的折扣后价格估算中位数均高于医疗保险报销率：子宫切除术（$17,403 比 $5,569；p<0.001）、胆囊切除术（$14,014 比 $7,196；p<0.001）和结肠镜检查（$2,017 比 $216；p<0.001）。
加利福尼亚州现行立法未能实现让未参保患者能够比较医院为基础的医疗服务价格的目标。
