NCPA - National Center for Policy Analysis

Doctor Payments Vary Widely

October 8, 2013

Private insurance companies across the United States pay doctors dramatically different amounts for the same routine office visits and services, says Reuters.

Physicians at the high end of the reimbursement spectrum get more than twice as much as those at the low end for the same service, with little apparent reason for the difference, according to researchers.

Researchers analyzed more than 40 million claims filed in 2007 for nearly a dozen types of services ranging from five-minute check-ups to comprehensive exams.

  • The most common claim filed was for a "problem-focused" exam lasting about 15 minutes with a patient the physician already knew.
  • The lowest-paid 5 percent of doctors received $47 or less for the visit while the highest-paid 5 percent received $86 or more. The average reimbursement amount was $63.
  • For more complex, yet identical, office visits lasting longer and involving a new patient, the reimbursements ranged from $103 or less to $257 or more.

"The point is that (there is) very little that can explain these price differences, no matter what information you put into the model," Dr. Renee Hsia, professor of emergency medicine at the University of California at San Francisco, told Reuters Health.

"The take-away message is to get a quote before you go to the doctor's office and consider shopping around," said Chapin White, a senior health researcher at Center for Studying Health System Change in Washington, D.C.

Source: Kathleen Raven, "U.S. Physician Payments Vary Widely, Mysteriously," Reuters, September 27, 2013.


Browse more articles on Health Issues