THURSDAY, June 19, 2014 (HealthDay News) -- For an uninsured man
with prostate cancer, the price of surgery could range from $10,000
to $135,000, depending on the hospital, a U.S. study finds.
What's more, that wide range in charges -- a 13-fold difference
-- has nothing to do with quality, researchers said.
"Consumers are used to higher prices meaning higher quality. But that's not true in medicine," said Dr. Bradley Erickson, the senior researcher on the study. "Prices are not attached to any kind of quality information."
What does determine hospital charges for prostate cancer
surgery? "We really don't know," said Erickson, an assistant
professor of urology at the University of Iowa in Iowa City.
What's clear, Erickson said, is that a man with no health
insurance -- or insurance with high copays -- would have a tough
time "shopping" for the best hospital for prostate cancer
For the study, recently published in the journal
Urology, one of Erickson's colleagues pretended to be an
uninsured man in need of prostate cancer surgery. He called 100
American hospitals, following the same "script" each time: He was
an otherwise healthy man with the means to pay out-of-pocket, and
he wanted an estimate of the total charge for surgery -- hospital
and surgeon fees included.
Thirty percent of hospitals said they couldn't offer an
estimate. Among the rest, the price ranged from $10,100 to $135,000
-- though only three hospitals were willing to put a quote in
The average price was almost $35,000, more than twice the
Medicare reimbursement, the researchers said.
Geography mattered. Hospitals in the Northeast quoted higher
prices, on average, than hospitals in the South -- about $40,800
versus $30,300, Erickson said.
But in other ways, there was little rhyme or reason. Big-city
hospitals, for example, charged no more than those in small cities,
on average. And there was no relationship between hospital charges
and their ranking by
U.S. News and World Report, which publishes a list of the
nation's "best" hospitals.
Experts who reviewed the study weren't surprised.
Other U.S. studies have shown wide-ranging prices for health
care, said Dr. Ezekiel Emanuel, chair of medical ethics and health
policy at the University of Pennsylvania in Philadelphia.
He pointed to a study last year -- by the same researchers --
showing that the price of hip-replacement surgeries at U.S.
hospitals ranged from roughly $11,000 to $126,000.
There are some reasons that hospital charges could legitimately
vary. For example, their costs for equipment differ to some degree,
"But mostly, it's a mystery," he said. "I don't think the hospitals even know why they charge what they charge."
The American Hospital Association declined a request to comment
on the study.
The "good news," Erickson said, is that 70 percent of hospitals
did provide a price estimate, which is a larger response than some
past studies have seen.
The not-so-good news: The "patient" here was a researcher who
could ask savvy questions. Even so, a typical inquiry involved
talking to four or five people, for up to 69 minutes, Erickson
said. It's not clear how a real patient would fare on the phone, he
And even if you get price information, "that's only half the
story," Emanuel said. "You also need to know if you're getting a
Yugo or a Mercedes."
Uwe Reinhardt, a health care economics expert at Princeton
University in New Jersey, agreed.
"Telling Americans to 'shop' for health care is like pushing someone into Macy's blindfolded, then saying, 'OK, go shopping,'" Reinhardt said.
Not only does price have little relation to quality, he said,
but the estimates hospitals give are just that. The actual charges
could be greater.
The study did uncover one way for patients to get a financial
break. One-third of hospitals said they would give a discount if
the "patient" paid up front. On average, that meant one-third off
the quoted price -- but some hospitals went as high as 80
For patients who can pay in advance, Erickson said, it might be
worthwhile to call different hospitals and ask about a
To Reinhardt, the findings spotlight a convoluted system. "This
study points up the sheer absurdity of our health care system,
which most of the public isn't even aware of," he said.
Erickson noted that these issues will continue under Obamacare,
even though fewer Americans will lack health insurance. Many
people, he said, will either remain uninsured or have high
deductibles or copays -- and, presumably, care about prices.
The Kaiser Family Foundation has more on
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