NCPA - National Center for Policy Analysis

Health Care Costs Vary Widely

July 1, 2011

Patients pay as much as 683 percent more for the same medical procedures, such as MRIs or CT scans, in the same town, depending on which doctor they choose, according to a new study by a national health care group, reports USA Today.

That means patients who pay for a percentage of their care, instead of a copayment, may end up spending hundreds of dollars more for a certain procedure than they would if they chose treatment somewhere else -- often within a few minutes' drive.

Change:healthcare looked at claims data from May 2010 to May 2011 for 82,000 employees of small businesses to determine price differences for several procedures: MRIs, CT scans, ultrasounds and PET scans.

  • For a pelvic CT scan, they found that within one town in the Southwest, a person could pay as little as $230 for the procedure, or as a much as $1,800.
  • For a brain MRI in a town in the Northeast, a person could pay $1,540 -- or $3,500.

Howard McClure, CEO of Change:healthcare says health plans are moving toward "reference-based pricing," in which they look at the average price of a procedure for a region, then say that's all they'll reimburse.  But if a patient does not know how much a procedure costs, he or she gets stuck with the remainder of the bill if it goes above that average price.

Providers, he said, often don't know real costs, either.  When asked by patients for the cost of a procedure, providers often say they need to check with the insurer.  The patient only learns the real cost when the bill arrives, McClure says.

Source: Kelly Kennedy, "Health Care Costs Vary Widely, Study Shows," USA Today, June 30, 2011.  "Healthcare Transparency Index," Change:healthcare, June 2011.

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