How much do hospitals charge to remove an appendix? The startling answer is that the cost could be the same as the price of a refrigerator — or a house.
It's a common, straightforward operation, so you might expect charges to be similar no matter where the surgery takes place. Yet a California study found huge disparities in patients' bills — $1,500 to $180,000, with an average of $33,000.
The researchers and other experts say the results aren't unique to California and illustrate a broken system.
"There's no method to the madness," said lead author Dr. Renee Hsia, an emergency room physician and researcher at the University of California, San Francisco. "There's no system at all to determine what is a rational price for this condition or this procedure."
The disparities are partly explained by differences among patients and where they were treated. For example, some had more costly procedures, including multiple imaging scans, or longer hospital stays.
But the researchers could find no explanation for about one-third of the cost differences.
Other developed countries have more government regulation that prevents these wild disparities. U.S. critics of that kind of system favor more market competition, yet the study illustrates that "the laws of supply and demand simply do not work well in health care," said Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston.
The study was published Monday in the journal Archives of Internal Medicine.
The researchers examined 2009 data that hospitals were required to submit to the state on 19,368 patients with appendicitis. To get the fairest comparisons, the researchers included only uncomplicated cases with hospital stays of less than four days. The patients were 18 to 59 years old.
The study looked at how much patients were billed, before contributions from their health insurance — if they had any. Uninsured and Medicaid patients had slightly higher bills than those with private insurance.
The lowest and highest bills were not freak occurrences; many cases involved charges well over $100,000 or under $2,000, Hsia said. Also, within geographic regions, the lowest and highest charges differed by tens of thousands of dollars.