Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Room SE 618 GH, Iowa City, IA 52242, USA.
JAMA Intern Med. 2013 Mar 25;173(6):427-32. doi: 10.1001/jamainternmed.2013.460.
Many proposals for health care reform incentivize patients to play a more active role in selecting health care providers on the basis of quality and price. While data on quality are increasingly available, availability of pricing data is uncertain.
To examine whether we could obtain pricing data for a common elective surgical procedure, total hip arthroplasty (THA).
We randomly selected 2 hospitals from each state (plus Washington, DC) that perform THA, as well as the 20 top-ranked orthopedic hospitals according to US News and World Report rankings. We contacted each hospital by telephone between May 2011 and July 2012. Using a standardized script, we requested from each hospital the lowest complete "bundled price" (hospital plus physician fees) for an elective THA that was required by one of the author's 62-year-old grandmother. In our scenario, the grandmother did not have insurance but had the means to pay out of pocket. We explained that we were seeking the lowest complete price for the procedure. When we encountered hospitals that could provide the hospital fee only, we contacted a random hospital affiliated orthopedic surgery practice to obtain the physician fee. Each hospital was contacted up to 5 times in efforts to obtain pricing information.
SETTING/PARTICIPANTS: All top-ranked and a sample of non-top-ranked US hospitals performing THA.
Percentage of hospitals able to provide a complete price estimate for THA (physician and hospital fee) for top-ranked and non-top-ranked hospitals and range of prices quoted by each group.
Nine top-ranked hospitals (45%) and 10 non-top-ranked hospitals (10%) were able to provide a complete bundled price (P < .001). We were able to obtain a complete price estimate from an additional 3 top-ranked hospitals (15%) and 54 non-top-ranked hospitals (53%) (P = .002) by contacting the hospital and physician separately. The range of complete prices was wide for both top-ranked ($12,500-$105,000) and non-top-ranked hospitals ($11,100-$125,798).
We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates. Patients seeking elective THA may find considerable price savings through comparison shopping.
许多医疗改革方案都鼓励患者在选择医疗服务提供者时，更多地基于质量和价格因素发挥积极作用。虽然质量数据越来越多，但定价数据的可用性尚不确定。
检验我们是否可以获得常见的择期手术——全髋关节置换术（THA）的定价数据。
我们随机选取了每个州（包括华盛顿特区）进行 THA 的 2 家医院，以及根据《美国新闻与世界报道》排名的 20 家顶级骨科医院。我们在 2011 年 5 月至 2012 年 7 月之间通过电话联系了每家医院。我们使用标准化的脚本，向每家医院请求为作者 62 岁的祖母进行一次择期 THA 的最低完整“捆绑价格”（医院加医生费用）。在我们的方案中，祖母没有保险，但有支付现金的能力。我们解释说，我们正在为该手术寻求最低的完整价格。当我们遇到只能提供医院费用的医院时，我们联系了一家随机的附属骨科手术实践医院以获取医生费用。每家医院都联系了 5 次，以获取定价信息。
地点/参与者：所有排名靠前的医院和部分未排名的进行 THA 的美国医院。
能够为排名靠前和非排名靠前的医院提供 THA（医生和医院费用）完整价格估算的医院比例，以及每个组的报价范围。
9 家顶级医院（45%）和 10 家非顶级医院（10%）能够提供完整的捆绑价格（P<0.001）。通过分别联系医院和医生，我们还能够从另外 3 家顶级医院（15%）和 54 家非顶级医院（53%）获得完整的价格估算（P=0.002）。顶级医院（12500-105000 美元）和非顶级医院（11100-125798 美元）的完整价格范围都很广。
我们发现很难获得 THA 的价格信息，并且所报价格差异很大。许多医疗服务提供者无法提供合理的价格估算。寻求择期 THA 的患者可能会通过比较购物获得可观的价格节省。
