揭示了标准手术定价在医院间的巨大差异。
Large variations in hospital pricing for standard procedures revealed.
机构信息
Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
出版信息
BMC Res Notes. 2022 Apr 5;15(1):129. doi: 10.1186/s13104-022-06014-2.
OBJECTIVE
The CMS mandated hospital price transparency reporting on January 1, 2021 aiming to empower patients, enhance market competition, and curtail healthcare costs in the US. We aimed to characterize variability in hospital pricing reported by 1982 hospitals on six standard procedures (including abdominal ultrasound, diagnostic colonoscopy, kidney function blood test panel, knee arthroscopic cartilage removal, magnetic resonance imaging scan of brain, and pelvis computed tomography scan with contrast), with a particular focus on variations in pricing by insurance plan type.
RESULTS
We found substantial heterogeneity across insurance plan types. The minimum number of prices reported was 18,679 for knee arthroscopic cartilage removal (reported by 908 hospitals, average = 21 prices/hospital), while the maximum number of prices reported was 44,921 for abdominal ultrasound (reported by 1861 hospitals, average = 24 prices/hospital). In general, reported hospital pricing was highest for the list price, followed by cash price and prices negotiated with commercial insurance plans. Government insurance, including Medicare, Medicaid and Veterans/Tricare plans, had much lower prices. However, prices were very heterogeneous with substantial overlaps between pricing for all plan types. The coefficients of variation for all procedures exceeded 100%, ranging from 106% for knee arthroscopic cartilage removal to 397% for kidney function blood test panel.
目的
CMS 于 2021 年 1 月 1 日强制实施医院价格透明度报告，旨在赋予患者权力、增强市场竞争并控制美国的医疗保健成本。我们旨在描述 1982 家医院针对六种标准程序（包括腹部超声、诊断结肠镜检查、肾功能血液测试面板、膝关节镜下软骨切除术、脑部磁共振成像扫描和骨盆 CT 扫描）报告的医院定价的可变性，特别关注不同保险计划类型的定价差异。
结果
我们发现不同保险计划类型之间存在很大的异质性。膝关节镜下软骨切除术报告的最低价格数量为 18679 美元（由 908 家医院报告，平均每家医院报告 21 个价格），而腹部超声报告的最高价格数量为 44921 美元（由 1861 家医院报告，平均每家医院报告 24 个价格）。一般来说，报告的医院定价以标价最高，其次是现金价格和与商业保险计划协商的价格。政府保险，包括医疗保险、医疗补助和退伍军人/三军计划，价格要低得多。然而，价格差异很大，所有计划类型的定价之间存在很大的重叠。所有程序的变异系数均超过 100%，范围从膝关节镜下软骨切除术的 106%到肾功能血液测试面板的 397%。
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