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Understanding Healthcare Prices: A Consumer Guide

If you’re like many Americans, you don’t know what an emergency department visit or
an operation costs until a bill from a health care provider or a letter from your health
insurance plan comes in the mail. This uncertainty can be stressful and can
make it hard to plan your personal or household finances.
This guide can help you if:

  • You want to know where to get answers to your questions about health care prices.
  • You would like to compare prices for a particular service among providers.
  • You want to better understand, plan and manage your out-of-pocket health care costs.
  • You are covered by a high-deductible health plan.

(Healthcare Financial Management Association)

Understanding Your Medical Bill

After you visit a provider, you’ll typically receive a bill telling you how much you have to pay. Providers can include healthcare professionals, hospitals and other types of healthcare facilities. The amount you owe will depend on a number of factors—whether you have insurance, your type of plan and its cost-sharing features, and whether you received services in or out of your plan’s network.  It’s important to look at your bill carefully and understand all the items on it to make sure you’re being charged the correct amount. (FAIR Health Consumer Cost Lookup)

The True Cost of Healthcare

When people talk about U.S. health care, they often say that it’s a free market system. When David Belk, MD, began researching why U.S. health care costs so much, nothing he found looked very much like a market at all; either free or regulated. No one seemed to know the cost of anything—not the people buying (the patients) and not the people selling (the doctors and hospitals).  Cost is a central feature to any market system, but if no one knows what these costs are, Dr. Belk asks, how can this so-called free market be free?  Using anecdotes gleaned from his medical practice, Dr. Belk takes an in-depth look at health care costs and the many factors that make our system needlessly complicated and expensive.  (


Medical costs up to 20% higher at hospital-owned physician groups, study finds

Raising fresh questions about healthcare consolidation, a new study shows hospital ownership of physician groups in California led to 10% to 20% higher costs overall for patient care.  Health insurers typically pass along these increased costs in the form of higher premiums for employers and workers. Consumers also face higher prices with insurance deductibles rising. (Los Angeles Times, 10/21/2014)

Fewer Preventable Admissions with Smaller Medical Practices

Small primary care physician practices have lower rates of preventable hospital admissions, compared to larger practices, according to a study published online Aug. 13 in Health Affairs.  The researchers found that practices with one to two physicians had 33% fewer preventable admissions, and practices with three to nine physicians had 27% fewer, both compared to practices with 10–19 physicians. Preventable admissions were lower in physician-owned practices compared to hospital-owned practices. (Health Day News, 8/18/2014)

The Odd Math of Medical Tests: One Scan, Two Prices, Both High

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue — especially because the equipment to perform them has generally become far cheaper, smaller and more highly mechanized in the past two decades. (New York Times, 12/15/2014)

Hospitals With Pricing Power Don’t Necessarily Provide High-Quality Care

Large urban hospitals can have tremendous pricing power in their markets, with the ability to drive up healthcare prices. These hospitals are typically the area’s largest employer, and can include teaching facilities, sprawling “healthcare campuses” and Level I Trauma Centers. But do the high prices they demand from their patients and communities equate to higher quality care? As discussed in this article, the answer is NO. (, 2/20/2014)

Medicine’s Top Earners Are Not the M.D.s

As part of her ground breaking series on the costs of healthcare in the New York Times, Elizabeth Rosenthal examines the pay structures of healthcare professionals. Interesting, it’s not the actual providers of such care, including those most responsible – physicians and surgeons – who are on the top of the salary scale. It is insurance company and hospital executives. (New York Times, 5/18/2014)

A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care

According to a study published in the Sept. 2013 issue of Journal of Patient Safety the number of premature deaths associated with preventable harm to hospital patients was estimated at more than 400,000 per year. And it found “serious harm” seems to be 10- to 20-fold more common than lethal harm.  (Journal of Patient Safety, 09/2013)

See how you local hospital stacks up in the safety department:

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