Sakowitz Sara, Bakhtiyar Syed Shahyan, Sanaiha Yas, Vadlakonda Amulya, Coaston Troy, Benharash Peyman
Department of Surgery, University of California, Los Angeles.
Department of Surgery, Massachusetts General Hospital, Boston.
JAMA Surg. 2025 Sep 24. doi: 10.1001/jamasurg.2025.3647.
Hospital prices are currently not subject to regulation, yet have profound financial implications for patients, taxpayers, and governments. While significant for the contemporary era of value-based care, US national variation in hospital price markup has not been delineated.
To characterize national variation in the hospital price markup for major elective operations and to assess the association of markup with perioperative outcomes and overall quality of care.
DESIGN, SETTING, AND PARTICIPANTS: This national cross-sectional study evaluated institutional markup ratios (MRs) across 1960 US hospitals performing 4 major elective operations (abdominal aortic aneurysm repair, colectomy, coronary artery bypass grafting, and hip replacement) among patients aged 18 years and older within the 2022 Nationwide Readmissions Database. MR was defined as the ratio of charges to costs. Centers with MRs in the top decile were considered high-markup hospitals (HMH), with others categorized as non-HMH. Data were analyzed from September 2024 to March 2025.
The primary outcome was institutional MR, with secondary consideration of perioperative outcomes.
Of 1960 unique institutions, 194 were HMH. The median (IQR) hospital price markup factor was 3.0 (1.9-4.4). Considering only HMH, the median (IQR) MR was 8.5 (7.1-10.8); the top 50 most expensive hospitals marked up the true costs of care by a median factor of 13. On average, HMH were more commonly investor-owned, for-profit hospitals located in metropolitan areas. Of 362 367 patients, 42 620 (11.8%) were treated at HMH. Overall mean (SD) patient age was 65.1 (12.7) years, and 174 067 patients (48.0%) were female. Following risk adjustment, care at HMH was associated with significantly greater odds of major morbidity (adjusted odds ratio [AOR], 1.45; 95% CI, 1.14-1.84), including higher adjusted risk of cardiac, respiratory, infectious, and kidney sequelae. Moreover, treatment at HMH was associated with increased likelihood of nonelective readmission within 30 days (AOR, 1.33; 95% CI, 1.24-1.42).
This cross-sectional study found that considerable variation in price markup exists across hospitals and that HMHs demonstrated both lower quality and value of care. These findings underscore that HMHs represent a key initial target for national policy efforts targeting pricing regulation, transparency, and quality improvement.
医院价格目前不受监管，但对患者、纳税人及政府有着深远的财务影响。尽管对于当代基于价值的医疗时代而言意义重大，但美国医院价格加成的全国性差异尚未明确界定。
描述主要择期手术的医院价格加成的全国性差异，并评估加成与围手术期结局及整体医疗质量之间的关联。
设计、设置与参与者：这项全国性横断面研究评估了2022年全国再入院数据库中1960家美国医院对18岁及以上患者进行4种主要择期手术（腹主动脉瘤修复术、结肠切除术、冠状动脉搭桥术和髋关节置换术）的机构加成率（MR）。MR定义为收费与成本之比。MR处于最高十分位数的中心被视为高加成医院（HMH），其他则归类为非HMH。数据于2024年9月至2025年3月进行分析。
主要结局为机构MR，次要考虑围手术期结局。
在1960家独特的机构中，有194家是HMH。医院价格加成因子的中位数（IQR）为3.0（1.9 - 4.4）。仅考虑HMH时，MR的中位数（IQR）为8.5（7.1 - 10.8）；最昂贵的50家医院将医疗的实际成本加成的中位数因子为13。平均而言，HMH更常见于位于大都市地区的投资者所有的营利性医院。在362367名患者中，42620名（11.8%）在HMH接受治疗。患者总体平均（SD）年龄为65.1（12.7）岁，174067名患者（48.0%）为女性。经过风险调整后，在HMH接受治疗与发生严重并发症的几率显著更高相关（调整后的优势比[AOR]，1.45；95%CI，1.14 - 1.84），包括心脏、呼吸、感染和肾脏后遗症的调整后风险更高。此外，在HMH接受治疗与30天内非择期再入院的可能性增加相关（AOR，1.33；95%CI，1.24 - 1.42）。
这项横断面研究发现，不同医院之间存在相当大的价格加成差异，并且HMH的医疗质量和价值较低。这些发现强调，HMH是针对定价监管、透明度和质量改进的国家政策努力的关键初始目标。
