Women giving birth in California face huge cost differences in their hospital bills, according to a University of California San Francisco (UCSF) study published Jan. 16 in BMJ Open.
“Childbirth is the most common reason for hospitalization, and even for an uncomplicated childbirth, we see a staggering difference in what hospitals charge, even for the same, average patient,” lead author Renee Y. Hsia, MD, an associate professor of emergency medicine at UCSF, said in a news release.
Hsai and her colleagues analyzed data on nearly 110,000 individual cases during 2011 involving women who had private medical insurance. Among the study cases, 76,766 had uncomplicated vaginal births and 32,660 were uncomplicated Caesarean section births.
The study considered billed charges and estimated how much hospitals were reimbursed by insurance companies for births. Researchers also looked at such variables as length of patient’s hospital stay, the competiveness of the market and whether the hospital was non-profit or for-profit.
The researchers found that women in California received bills that varied from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For C-sections, bills varied between $8,312 and 71,000.
Their findings also showed that for-profit hospitals in wealthier areas and facilities that treated a greater number of patients who were seriously ill tended to charge higher rates. However, those factors, along with private medical insurance reimbursement, only accounted for about 35 percent of the pricing variation.
The researchers pointed to the lack of regulation concerning medical charges and to the “opacity of healthcare pricing” as reasons for widely varying hospital charges.
“Hospitals can charge whatever they want. They can mark up their costs based on whatever they feel they should be and ‘should’ is a very subjective determination,” Hsai told HealthDay.
“Even though we talk about consumer empowerment, that can’t be a reality until patients are able to obtain information about what they will be charged,” said Hsai.
And the charges “affect not only the uninsured, but also the fee-for-service reimbursements by some private insurers, which can translate to out-of-pocket costs for patients,” added Hsia.
Steve Guterman, vice president for Medicare and cost control at the The Commonwealth Fund, agrees.
“The only people who get stuck with paying billed charges are people who don’t have health insurance, because they don’t have anyone negotiating down their rate,” said Guterman in HealthDay.
“It makes it very hard to understand what’s going on, and it is a symptom of a healthcare market that is out of control because there is no transparency about what hospitals charge and what they get paid for each service,” Guterman said.
Though the study focused on California, Hsai reported she fully expected that the wide variation in billing can be found in hospitals throughout the U.S.