As people covered by commercial health insurance become responsible for more health care costs through higher deductibles and copayments, understanding the price of a health care service and the difference in prices between providers is more important. ChangeHealthcare attempts to provide this data for consumers and issues a regular report on prices and variation. The latest report covers the 4th quarter of 2014. (ChangeHealthcare Report) The report focuses on high-cost services which also tend to have high variability in pricing across providers. These, according to the report, provide the greatest opportunity for reducing spending without likely affecting quality. While the report does not attempt to identify causes for the variation, it does note that setting seems to play a role, which is supported by other research showing, for example, that the same service in a hospital outpatient setting is more expensive than in a physician’s office. Among the high-cost, high variability services are C-section deliveries, with prices varying by 164%, from $6,680 to $17,619 around a median of just under $12,000. This variability has actually lessened from prior quarters. Vaginal delivery also shows high variance, from $4,359 to $12,613, a range of 189%. This variability also appears to be declining and the median price is trending downward. Colonoscopy prices varied 208% from $1,379 to $4,242. Mammograms ranged from $135 to $397, a 189% variance. The median price and variance has been steady. MRIs varied 451%, from $511 to $2,815, but the medians tend to be nearer the lower end. Other imaging services, such as ultrasounds and CT scans, also showed large variation. Even office visits had a large range of prices, for example, a women’s health visit went from $69 to $200 and primary care visits ranged 174% from $71 to $175. And the preventive services which must be provided without copay under the reform law had large price ranges, which must concern payers because they cannot use financial incentives to encourage members to use lower-priced providers. Payers may need to consider designated networks for these preventive services.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
NextGen, an electronic medical records firm, is being put out of its public company misery, as a PE firm will pay $1.6 billion for the one-time high-flier.
September 7, 2023
A number of companies which attracted large financing rounds during the epidemic have imploded when reality set in. The latest is Cano Health, which is a little surprising since it...
August 15, 2023
Another over-hyped digital health company screws shareholders who bought the hype, as Babylon Health has to bail itself out by going private, with nothing being returned to ordinary shareholders. The...
June 26, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace