Affiliation:
1. Department of Family and Community Medicine Penn State College of Medicine, The Pennsylvania State University Hershey Pennsylvania USA
2. Department of Public Health Sciences Penn State College of Medicine, The Pennsylvania State University Hershey Pennsylvania USA
3. Department of Surgery Penn State College of Medicine, The Pennsylvania State University Hershey Pennsylvania USA
Abstract
AbstractBackgroundHealthcare costs in the U.S. are high and variable, which can hinder access and impact health outcomes across communities. This study examined hospital‐ and county‐level characteristics to identify factors that explain geographic variation in prices for four cancer‐related procedures.MethodsData sources included Turquoise Health, which compiles publicly‐available price data from U.S. hospitals. We examined list prices for four procedures: abdominal ultrasound, diagnostic colonoscopy, brain MRI, and pelvis CT scan, which we linked to characteristics of hospitals (e.g., number of beds) and counties (e.g., metropolitan status). We used multilevel linear regression models to assess multivariable relationships between prices and hospital‐ and county‐level characteristics. Supplementary analyses repeated these models using procedures prices for commercial insurance plans.ResultsFor each procedure, list prices varied across counties (intraclass correlation: abdominal ultrasound = 23.2%; colonoscopy = 17.1%; brain MRI = 37.2%; pelvis CT = 50.9%). List prices for each procedure were associated with hospital ownership (all p < 0.001) and percent of population without health insurance (all p < 0.05). For example, list prices for abdominal ultrasound were higher for proprietary versus Government‐owned hospitals (β = 539.10, 95% confidence interval [CI]: 256.12, 822.08, p < 0.001) and for hospitals in counties with more uninsured residents (β = 23.44, 95% CI: 2.55, 44.33, p = 0.03). Commercial insurance prices were negatively associated with metropolitan status.ConclusionsPrices for cancer‐related healthcare procedures varied substantially, with considerable heterogeneity associated with county location as well as county‐level social determinants of health (e.g., health insurance coverage). Interventions and policy changes are needed to alleviate the financial burden of cancer care among patients, including geographic variation in prices for cancer‐related procedures.
Funder
National Institutes of Health
Subject
Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology
Reference35 articles.
1. Congress of the United States Congressional Budget Office.Geographic variation in health care spending.https://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/89xx/doc8972/02‐15‐geoghealth.pdf2008.
2. Large variations in hospital pricing for standard procedures revealed
3. Geographic Variation in Health Care Spending in the United States
4. Rural health care costs: are they higher and why might they differ from urban health care costs?;Williams D;N C Med J,2018