Out-of-Pocket Prices for Insured Patients Vary Widely, Analysis Finds
Insured U.S. residents' out-of-pocket costs for several common procedures vary widely, but the lack of price transparency makes it difficult for consumers to compare prices among providers, according to an analysis by the Health Care Cost Institute, Modern Healthcare reports.
For the analysis, researchers used HCCI's database on health insurance claims from four major insurers, representing about 50 million individuals.
Researchers calculated the average price variation of five common medical procedures in 2012 and 2013 (Evans, Modern Healthcare, 2/3). The procedures included:
- Cataract removal;
- Non-contrast MRI on the ankle/hip/knee;
- Obstetric ultrasound; and
- Office visits to evaluate new patients (HCCI analysis, February 2015).
The researchers then determined how much patients paid for those services as a percentage of the total bill.
According to Modern Healthcare, the data include the prices negotiated between insurers and providers, as well as what patients paid out-of-pocket. The analysis did not differentiate the findings by types of health plans, such as high-deductible health plans.
The analysis found that, across the U.S., the average variation in out-of-pocket prices for insured patients was:
- $19 for a first-time office visit;
- $342 for an MRI; and
- $444 for cataract removal.
Among the 10 states studied, the researchers found that Wisconsin consistently had the most out-of-pocket price variation, ranging from $35 for office visits to $989 for cataract removal. Meanwhile ,Arizona and Maryland had the least price variation, not varying by $100 or more for any of the five procedures (Modern Healthcare, 2/3).
The analysis also found that out-of-pocket spending per capita as a percentage of total spending increased from 14.8% in 2012 to 15.2% in 2013 (HCCI analysis, February 2015).
HCCI Executive Director David Newman said that price transparency has generally improved but that many patients have trouble finding information that is useful and could help them gain a more complete understanding of potential prices (Modern Healthcare, 2/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.