Unlike other medical services or procedures that might vary by patient or doctor, these blood tests are common, simple and standard procedures. A technician draws blood from a patient, then walks the blood to a lab, where the blood sample is put into a machine that performs the analysis, she said. "In general, for most of these tests, nobody is doing hand assays or looking into a microscope," Hsia said.
Most consumers with health insurance won't pay those prices; most often, their health plans have negotiated a lower price with the hospital or provider. But patients without insurance face the full brunt of the charges, especially if they dont qualify for a hospitals charity care discounts, Hsia said.
In general, county hospitals and teaching hospitals had lower prices than non-teaching hospitals, not-for-profit and for-profit hospitals, she said.
But outside of that, one of the most concerning findings is the small degree to which any factors could explain the differences
This shows that the way we price health care is so irrational, Hsia said.
The researchers looked at data from California because the state's hospitals are required by law to submit their average charges for 25 of their most common outpatient procedures to state health planning officials. But the results, Hsia said, would be very similar across the rest of the country. The researchers werent able to do a national analysis because the data are so difficult to find, and many states and hospitals dont make their charges publicly accessible.
The study's main conclusion is that there is no clear explanation for the price differences, Hsia said. A hospitals case mix, labor costs and number of beds did not affect charges for these common procedures. Although teaching hospitals and county-run hospitals were generally lower in price, there were no other factors that could explain the differences. The majority of hospitals were not-for-profit, urban, non-teaching hospitals. On average, their patient mix included about 25 percent Medicaid and 41 percent Medicare patients.
One factor that researchers werent able to measure was a hospitals investment in higher quality facilities or supplementary services. The costs of these differences, while of value to patients, are not easy to measure and may not be reflected in variables, such as a wage index, the study found. However, they likely do trickle down into charges for all basic services, including blood tests.
The bottom line, according to the study, is that hospitals recoup losses in other areas from third party payers to cover overall costs. This often results in some services subsidizing others, with their charge increases generally unrelated to their value, the study concluded.
