Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Prostate Cancer Prostatic Dis. 2024 Jun;27(2):252-256. doi: 10.1038/s41391-023-00643-9. Epub 2023 Jan 30.
Starting January 1, 2021, Centers for Medicare and Medicaid Services required United States hospitals to publicly disclose prices of their services provided. We analyzed publicly-disclosed prices of prostate cancer-related services.
All United States hospitals were queried for publicly-disclosed prices of total and free prostate-specific antigen, prostate magnetic resonance imaging, prostate biopsy, radical prostatectomy, and intensity-modulated radiation therapy as of May 2022. Prices were adjusted by regional price parity. Hospitals disclosing prices were compared with non-disclosing hospitals.
Of 6013 hospitals, 3840 (64%) disclosed pricing for at least one prostate cancer-related service. Compared to non-disclosing hospitals, disclosing hospitals had higher median gross annual revenue ($318,502,426 vs. $62,930,436, p < 0.001) and were more likely to be non-profit (56% vs. 30%, p < 0.001), academic-affiliated (46% vs. 13%, p < 0.001), and in neighborhoods with low hospital density (68% vs 62%, p < 0.001). Self-pay prices were higher than insurance-negotiated prices for all services (p < 0.001) other than prostate biopsy. The range of pricing was widest for self-pay prostatectomy, with a 32-fold difference from 90 to 10 percentile ($47,445 to $1476). Self-pay prices of total prostate-specific antigen, magnetic resonance imaging, biopsy, intensity-modulated radiation therapy, and prostatectomy were higher at academic vs. non-academic, for-profit vs. non-profit hospitals, and hospitals in the top quartile of gross annual revenue vs. the third and fourth quartiles (p < 0.01). Self-pay prices of prostate biopsy and prostatectomy were higher in urban vs. rural neighborhoods and neighborhoods with high vs. low hospital density (p < 0.001).
Self-pay prices of prostate cancer services were generally higher than insurance-negotiated prices and were higher at for-profit hospitals, academic hospitals, and hospitals in the highest quartile of gross annual revenue. Higher neighborhood hospital density was not associated with higher likelihood of price disclosure nor lower pricing of services, suggesting that local competition does not lead to lower prices and may disincentivize disclosure of prices.
自 2021 年 1 月 1 日起，医疗保险和医疗补助服务中心要求美国医院公开公布其提供的服务价格。我们分析了公开公布的前列腺癌相关服务价格。
截至 2022 年 5 月，对所有美国医院进行了查询，以获取总前列腺特异性抗原、前列腺磁共振成像、前列腺活检、根治性前列腺切除术和调强放射治疗的公开价格。价格通过区域价格平价进行调整。比较了公布价格的医院和未公布价格的医院。
在 6013 家医院中，有 3840 家（64%）至少公布了一种前列腺癌相关服务的价格。与未公布价格的医院相比，公布价格的医院的年总收入中位数较高（318502426 美元与 62930436 美元，p<0.001），更有可能是非营利性（56%与 30%，p<0.001），是学术附属机构（46%与 13%，p<0.001），并且位于医院密度较低的社区（68%与 62%，p<0.001）。除前列腺活检外，所有服务的自付价格均高于保险协商价格（p<0.001）。前列腺切除术的定价范围最宽，自付价格从 90 到 10 分位数相差 32 倍（47445 美元至 1476 美元）。与非学术性、营利性与非营利性医院以及总收入排名前四分之一的医院相比，学术性医院的总前列腺特异性抗原、磁共振成像、活检、调强放射治疗和前列腺切除术的自付价格更高（p<0.01）。与农村地区相比，城市地区的前列腺活检和前列腺切除术的自付价格更高，医院密度较高的地区的自付价格更高（p<0.001）。
前列腺癌服务的自付价格普遍高于保险协商价格，并且在营利性医院、学术性医院和总收入最高的医院中更高。较高的社区医院密度与更高的价格披露可能性或服务价格降低无关，这表明当地竞争不会导致价格降低，并且可能会抑制价格披露。
