The University of Texas Medical Branch John Sealy School of Medicine, Galveston.
Department of Biostatistics and Data Science, School of Public and Population Health, The University of Texas Medical Branch at Galveston, Galveston.
JAMA Intern Med. 2023 Nov 1;183(11):1214-1220. doi: 10.1001/jamainternmed.2023.4753.
US hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital's prices posted online correlate with the prices they give to a telephone caller is unknown.
To compare hospitals' online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included cash online prices from each hospital's website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures.
We calculated the difference between each hospital's online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices.
A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non-top-ranked, non-safety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non-top-ranked, non-safety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non-top-ranked, non-safety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55 221 (mean, $23 040), from $4361 to $14 377 (mean $10 925) for safety-net hospitals, and from $1183 to $30 299 (mean $15 861) for non-top-ranked, non-safety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r = 0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n = 12) had differences of 50% or more (Pearson r = -0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals.
Findings of this cross-sectional study suggest that there was poor correlation between hospitals' self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals' continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.
美国的医院被要求在网上公开公布其指定可购买服务的价格。然而，医院在网上公布的价格与他们通过电话向秘密购物者提供的价格之间的相关性尚不清楚。
将医院在线现金价的阴道分娩和脑部磁共振成像（MRI）与通过电话向要求价格估算的秘密购物者提供的价格进行比较。
设计、地点和参与者：这项横断面研究包括 2022 年 8 月至 10 月间从美国代表性医院的网站上收集的阴道分娩和脑部 MRI 的现金在线价格。此后，同样在 2022 年 8 月至 10 月间，模拟的秘密购物患者打电话给每家医院，要求提供这些程序的最低现金价格。
我们计算了每家医院阴道分娩和脑部 MRI 的在线和电话价格之间的差异，以及每个程序的在线和电话价格之间的 Pearson 相关系数（r），对于能够提供两种价格的医院。
共有 60 家有代表性的美国医院（20 家顶级医院、20 家安全网医院和 20 家非顶级、非安全网医院）被纳入分析。对于阴道分娩，19 家顶级医院中有 63%（12 家）、20 家安全网医院中有 30%（6 家）和 19 家非顶级、非安全网医院中有 21%（4 家）提供了在线和电话价格。对于脑部 MRI，20 家顶级医院中有 85%（17 家）、20 家安全网医院中有 50%（10 家）和 20 家非顶级、非安全网医院中有 100%（20 家）提供了在线和电话价格。两种程序的在线价格和电话价格差异很大。例如，顶级医院公布的阴道分娩在线价格从 0 美元到 55221 美元（平均 23040 美元）不等，安全网医院的价格从 4361 美元到 14377 美元（平均 10925 美元）不等，而非顶级、非安全网医院的价格从 1183 美元到 30299 美元（平均 15861 美元）不等。在 22 家提供阴道分娩在线和电话价格的医院中，有 45%（10 家）的医院价格相差在 25%以内，而 41%（9 家）的医院价格相差在 50%或以上（Pearson r=0.118）。在提供脑部 MRI 在线和电话价格的 47 家医院中，有 66%（31 家）的医院价格相差在 25%以内，而 26%（n=12）的医院价格相差在 50%或以上（Pearson r=-0.169）。在提供在线和电话价格的医院中，有 14%（3 家）的医院阴道分娩价格完全匹配，有 19%（9 家）的医院脑部 MRI 价格完全匹配。
这项横断面研究的结果表明，医院自行公布的在线价格与他们通过电话向秘密购物者提供的价格之间相关性较差。这些结果表明，医院在了解和沟通特定服务的价格方面仍然存在问题。这些发现还突出了无保险患者和其他试图比较医疗保健的患者持续面临的挑战。
