Charges for medical care at different hospitals

Background: The United States has a high proportion of people without healt h insurance (15%) and a low proportion of people without employment (5%), r esulting in millions who lack insurance but have some ability to pay. We te sted whether hospitals charge similar prices for well-specified elective se rvices to individuals paying out-of-pocket for medical care. Methods; We surveyed the 2 largest general hospitals from every large city (population >500 000) in the United States and Canada. At each hospital we evaluated 5 diagnostic, 7 therapeutic, and 3 nonclinical services to determ ine the total charge to patients who pay directly. Results: Overall, 66 hospitals were included (average, 758 beds; not-for-pr ofit, 97% [n = 64]; teaching, 80% [n= 53]). The range in charges was substa ntial; for example, a screening mammogram was $40 at one hospital in Los An geles, Calif, and $346 at one hospital in Quebec City. Charges for a screen ing mammogram were relatively stable between 1996 and 1997 (r=0.79; 95% con fidence interval, 0.68-0.87) and unrelated to the hospital's location or ch arges for other services. The relative amount of variation in charges was s imilar for high-priced and low-priced services, similar for diagnostic and therapeutic services, and similar for the United States and Canada. Conclusions: Charges for the same hospital service vary substantially. Grea ter visibility might reduce some variation by bringing outliers into closer scrutiny. Patients seeking care and paying out-of-pocket could save financ ially by comparison shopping.