-- Margaret Farley Steele
TUESDAY, April 24 (HealthDay News) -- Acute appendicitis is a
common medical condition, but the cost of treating it varies
enormously -- from about $1,500 to $180,000 -- researchers
The median charge in 2009 was nearly $34,000, according to a
California study that looked at more than 19,000 patients treated
for uncomplicated appendicitis. The disparity is typical of price
variations across the United States, the researchers added.
"Given estimates that 60 percent of bankruptcies in the United States involve catastrophic medical expenses, these data should alarm those making decisions about our society's ability to obtain medical care without financial catastrophe," the researchers wrote in a letter published online April 23 in the Archives of Internal Medicine.
For their study, they looked at patients aged 18 to 59 who were
hospitalized three days or less. Most had an appendectomy (surgical
removal of the infected appendix).
Individual patient considerations reflected some of the cost
differences, as did length of stay, severity of illness and
hospital type. The researchers said patient level and hospital
factors accounted for about two-thirds of the price disparities,
but about one-third -- 32 percent -- remain unexplained.
County hospitals tended to charge the least, while for-profit
hospitals charged the most, the study found.
A spokeswoman for the American Hospital Association said each
patient's course of care is different. And, "the costs also reflect
more than the cost of serving an individual patient," said Marie
Watteau, the association's director of media relations. "They
reflect the costs of maintaining essential health care services for
their community 24 hours a day, seven days a week."
Different types of hospitals incur different expenses, she
explained. "One hospital might have a large role in training health
care professionals or conducting research," Watteau said. "Another
may maintain the community's only trauma or burn unit. And still
another may provide a higher portion of its care to patients unable
to pay for their care."
In the new study, the figures only reflect what patients were
billed, not what the hospitals were actually paid. Many hospitals
negotiate with insurance companies to lower fees, while uninsured
patients often receive the total bill.
The highest reported charge -- $182,955 -- was for a woman who
also had cancer, but the bill didn't reflect any cancer treatment,
according to published reports.
These findings point out serious flaws in the health care
system, the researchers and other health-care experts said.
Well-insured patients are protected from charges, while
underinsured and uninsured patients get exorbitant bills "without
understanding what the charges mean," the researchers wrote. The
concept of market theory within the health care system doesn't
work, it appears, and more work is needed to help the patient
become a true "consumer."
Edward Howard, executive vice president of the Alliance for
Health Reform, said efforts to promote transparency can help. "At
the same time, we need to test out new ways to pay hospitals and
doctors that give them incentives to provide better quality care at
lower prices, as judged by the outcomes their services yield,"
That hasn't happened yet, because the third-party payers
(employers and insurers, mainly) fear that their employees or
insured groups will balk if familiar providers are excluded from
networks, he said.
Expecting patients themselves to compare prices is unrealistic,
Howard added. He found that out in 2003 when he was rushed to the
hospital because of sudden cardiac arrest. "Even had I been
conscious, I would not have been likely to ask the EMTs if they
could take me to the hospital where charges were lowest -- assuming
I had called around after the attack [or looked at the Internet] to
find that out," he said.
Dr. Anthony Shih, executive vice president for programs at The
Commonwealth Fund, called the findings important. "There is also a
growing body of evidence that not only do charges vary
significantly but the actual prices paid for a given service varies
significantly among insurance plans within a state [even sometimes
for a given provider]," he said. Within one state, prices paid for
the same service can be three to six times different, he added.
"This price variation is not only irrational, but is also inequitable and administratively complex," Shih said.
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