Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA.
Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
Urology. 2014 Mar;83(3):626-30. doi: 10.1016/j.urology.2013.09.066. Epub 2014 Jan 15.
To examine variation in the open market cost of a radical prostatectomy (RP) procedure in the US hospitals for an uninsured patient, as many proposals for health care reform highlight the importance of individuals actively participating in selecting care. However, reports suggest that obtaining procedure prices remains challenging and highly variable.
We used 2011-2012 US News and World Report rankings to identify a cohort of 100 hospitals making an effort to include an equal distribution of both academic and private centers, city size, and geographic region. Each hospital was called and the essence of the script included a caller stating he was a healthy, uninsured 55-year-old man recently diagnosed with Gleason 3 + 4 prostatic adenocarcinoma with no metastases. Facility, surgeon, and anesthesia fees were solicited.
Seventy hospitals provided facility prices. Facility estimates averaged $34,720 (±20,335; range, $10,100-$135,000), which was statistically higher at academics centers. No significant differences were seen by region, population, or hospital ranking. Surgeon and anesthesia fees were provided by 10%, averaging $8280 (±$4282; range, $4028-$18,720). Thirty-three hospitals provided discounted fees for prompt payment averaging 34% (±16%; range, 10%-80%).
There is wide variation in pricing for RP, with higher rates found in academic centers. Wide variation in facility costs were observed, and nearly all were unable to provide surgeon and/or anesthesia fees. Currently, it appears to be unacceptably difficult for men with prostate cancer without insurance to obtain prices for an RP procedure.
在美国医院中，为无保险患者检查根治性前列腺切除术（RP）手术的公开市场成本的变化，因为许多医疗保健改革提案都强调了个人积极参与选择护理的重要性。然而，报告表明，获得手术价格仍然具有挑战性且变化很大。
我们使用了 2011-2012 年美国新闻与世界报道的排名，确定了一个由 100 家医院组成的队列，这些医院努力平衡学术和私人中心、城市规模和地理位置。每个医院都被呼叫，脚本的核心内容包括一个呼叫者表示他是一位健康的、无保险的 55 岁男性，最近被诊断出患有 Gleason 3+4 前列腺腺癌，没有转移。征求了医院的设施、外科医生和麻醉师的费用。
70 家医院提供了设施价格。设施价格平均为$34720（±20335；范围，$10100-135000），在学术中心更高。区域、人口或医院排名均无显著差异。只有 10%的医院提供了外科医生和麻醉师的费用，平均为$8280（±$4282；范围，$4028-18720）。33 家医院提供即时付款的折扣费用，平均折扣率为 34%（±16%；范围，10%-80%）。
RP 的定价存在很大差异，学术中心的价格更高。观察到设施成本的广泛差异，几乎所有医院都无法提供外科医生和/或麻醉师的费用。目前，对于没有保险的前列腺癌患者来说，获得 RP 手术价格似乎是难以接受的。
