In California, the median cost of treating patients hospitalized for uncomplicated appendicitis ranged from $1,529 to a whopping $182,955, a finding that surprised investigators led by Dr. Renee Y. Hsia, of the emergency medicine department at the University of California, San Francisco.
"Given estimates that 60% of bankruptcies in the United States involve catastrophic medical expenses, these data should alarm those making decisions about our society’s ability to obtain medical care without financial catastrophe," Dr. Hsia and her associates wrote online April 23 in the Archives of Internal Medicine.
Courtesy UCSF News Center
Dr. Renee Y. Hsia
The investigators used demographic and financial data from the 2009 Discharge Database of California’s Office of Statewide Health Planning and Development to review 19,368 cases of routine appendicitis treated at 289 hospitals and medical centers throughout California. They limited the analysis to patients 18-59 years who were admitted for 3 or fewer days (Arch. Intern. Med. 2012 April 23 [doi:10.1001/archinternmed.2012.1173]). The main outcome of interest was total charges per visit.
"It has been well described that the actual cost of care and charges billed to the patient are not necessarily the same," the investigators wrote. "But for the uninsured or underinsured, these charges are what the patient ultimately sees and therefore represent the perceived cost of their care."
Dr. Hsia and her associates found that the median hospital charge among all patients was $33,611; the lowest observed charge was $1,529 and highest was $182,955. Factors associated with higher median charges included being on Medicaid, being insured, and being treated at a for-profit hospital.
"A patient with severe abdominal pain is in a poor position to determine whether his or her physician is ordering the appropriate blood work, imaging, or surgical procedure," the investigators commented. "Price shopping is improbable, if not impossible, because the services are complex, urgently needed, and no definitive diagnosis has yet been made. In our study, even if patients did have the luxury of time and clinical knowledge to ‘shop around,’ we found that California hospitals charge patients inconsistently for what should be similar services as defined by our relatively strict definition of uncomplicated appendicitis."
The study was funded by grant KL2 RR024130 and the Robert Wood Johnson Foundation Physician Faculty Scholars. The investigators stated that they had no relevant financial conflicts to disclose.