A patient receiving health care services in one part of the United States could pay twice as much as a patient living elsewhere, according to a new study.
Prices were highest in San Jose and lowest in Baltimore in 2016 for privately insured patients, the Health Care Cost Institute found.
The Washington-based nonprofit group analyzed nearly 1.8 billion health insurance claims filed between 2012 and 2016. It then calculated a nationwide average for health care prices and ranked 112 metros against that average.
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Although prices generally were well above average on the West Coast and the Northeast, regional patterns broke down elsewhere.
Across the Midwest, prices were below the national average in most cities, including Chicago, Indianapolis and Cleveland. But Milwaukee and Green Bay, Wis., were the fourth and fifth most expensive areas nationwide, just behind San Francisco and ahead of San Diego.
“It reinforces this idea that all health care is local,” said Bill Johnson, a senior health researcher with the institute.
There is little logic to health care prices within regions. Metros with professional fees near the national average sometimes have very high hospital prices and vice versa.
In Los Angeles, professional fees are 5 percent below the national average while prices for inpatient (hospital) stays and outpatient services (emergency room and procedures such as colonoscopies) are 28 percent and 30 percent above the national average respectively.
Green Bay has the fifth highest health costs in the nation — 14 percent above the national average. But it’s too simple to say that health care is expensive in Green Bay. Inpatient and outpatient costs are below the national average there while professional fees are 43 percent above the national average.
Kevin Kennedy, a researcher at the institute, said that examples like this “help direct attention to what the right question is to ask.”
For example, in Dayton, Ohio (health care costs 11 percent below the national average), inpatient charges are 18 percent above average. In Boston (health care costs 3 percent above the national average), professional fees are 22 percent above average. In San Jose (health care costs 65 percent above the national average), outpatient charges are a whopping 117 percent above average.
“It seems like there’s a different reason (for high costs) for every area,” Kennedy said.
“Health care isn’t one big problem,” Johnson said. “It’s a series of little problems.”
The institute plans additional reports to see how usage and competition affect the price of health care.
The group analyzed health claims data from four major insurers — Aetna, Humana, UnitedHealthcare and Kaiser Permanente — representing more than 50 million individuals.