Charges for blood tests vary across California hospitals

August 15, 2014, University of California, San Francisco

New UC San Francisco research shows significant price differences for ten common blood tests in California hospitals, with some patients charged as little as $10 for one test while others were charged $10,169 for the identical test.

The analysis of at more than 150 California hospitals looked at blood tests that are often required of , such as lipid panel, basic metabolic panel, and complete blood cell count with differential white cell count.

Hospital ownership and teaching status help explain a portion of the variation – prices generally were lower at government and teaching hospitals. Factors such as location, labor costs, patient capacity and percentage of uninsured population generally did not account for the price differences, the authors said, making it difficult for patients to know their costs in advance and to "act as rational consumers."

The report will be published in BMJ Open on August 15, 2014.

Charges for a basic metabolic test ranged from $35 to $7,303, depending on the hospital; the median charge was $214. The most extreme price difference was found in charges for a lipid panel: the median charge was $220, but overall charges ranged from $10 to as much as $10,169.

The results are of particular concern, said the authors, since there isn't much room for variability in blood tests. Moreover, because the tests are identical across providers, consumers might be expected to think that hospital charges would be similar.

"You may hear people say that, 'Charges don't matter' or that 'No one pays full charges,'" said senior author Renee Y. Hsia, MD, an associate professor of emergency medicine at UCSF and director of health policy studies in the Department of Emergency Medicine. She is also an attending physician in the emergency department at San Francisco General Hospital and Trauma Center.

"However, uninsured patients certainly face the full brunt of raw charges, especially if they don't qualify for charity care discounts," Hsia said. "And as employers are switching to more consumer-directed health plans with higher deductibles and co-pays, the out-of-pocket costs of even insured patients can be affected by these charges."

The analysis was based on charges assessed in 2011 by general, acute care medical/surgical hospitals. The majority of the hospitals were not-for-profit, urban, non-teaching facilities. On average, 41 percent of their patient populations were on Medicare and 25 percent were on Medicaid.

The blood test charges were based on full rates before pre-payments or contractual adjustments.

The scientists noted that they were unable to quantify some factors which could help influence medical charges for blood tests: "For example, many quality hospitals may choose to invest in higher quality facilities, supplementary services and social services than others," they wrote in their report. "The costs of these differences, while of value to patients, are not easy to measure, However, they likely do trickle down into charges for all basic services, including blood tests."

Still, they wrote, few of these factors were significant predictors of the charges patients ultimately faced.

Price variation similarly occurs when patients are hospitalized, according to a separate study also led by Hsia and published in the August 2014 issue of PLOS ONE. In that analysis, for an average California patient admitted for uncomplicated percutaneous coronary intervention ranged from $22,047 to $165,386, with a median charge of $88,350. Charges were higher at California hospitals located in areas with higher costs of living, in rural hospitals, and in hospitals with higher proportions of Medicare patients. However, these factors accounted for less than half the price variation, said the authors.

"To expect patients to be rational consumers is unrealistic when the system itself is irrational," Hsia said. "There is very little that we are able to point to that explains the variation, suggesting that the variations are not predictable and therefore a sign of huge inefficiency within the health care pricing system."

Explore further: How much does it cost to have a baby in a hospital?

Related Stories

How much does it cost to have a baby in a hospital?

January 16, 2014
Women giving birth in California can face a huge cost difference in their hospital bills, according to a new UC San Francisco study.

Medical bills: Sticker shock and confused consumers

April 25, 2012
You're enjoying a quiet weekend at home when suddenly you double over in pain. You need emergency appendectomy surgery. How much should it cost? And how much price shopping are you able to do?

How much will I be charged? Study examines patient bills for top 10 visits to the emergency room

February 27, 2013
It's a basic, reasonable question: How much will this cost me? For patients in the emergency room, the answer all too often is a mystery.

Higher chance of hospital death found in areas where emergency departments have closed

August 4, 2014
In the first analysis of its kind, UC San Francisco research shows that emergency department closures can have a ripple effect on patient outcomes at nearby hospitals.

Surgery prices are elusive: 13-fold price difference among US hospitals for prostate cancer surgery

June 9, 2014
Let's say you're buying a car. You have a wealth of data at your fingertips, from safety information to performance, to guide your decision.

Appendix removal: Huge sticker shock in study

April 23, 2012
What do hospitals charge to remove an appendix? The startling answer is that it could be the same as the price of a refrigerator - or a house.

Recommended for you

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.