Does Insurance Status Influence a Patient’s Hospital Charge?
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There is obscurity regarding how US hospitals determine patients’ charges. Whether insurance status influences a patient’s hospital charge has not been explored.
The objective of this study was to determine whether hospitals charge patients differently based on their insurance status.
This was an analysis of the Florida Hospital Inpatient Data File for fiscal years 2011–2012 (N = 4.7 million). Multivariable regression analysis was used to adjust for patients’ age, sex, length of stay, priority of admission, principal ICD-9-CM diagnosis, and All Payer Refined Diagnosis-Related Group subdivided by Severity of Illness subclass. Hospital fixed effects were included to account for differences in hospitals’ markups.
Compared with those with no insurance, patients with private insurance received hospital bills that were an average of 10.7% higher and patients with Medicare received bills that were an average of 8.9% higher. The impact of Medicaid coverage was imprecisely estimated, but the magnitude of the point-estimate was consistent with 3.5% higher charges to Medicaid patients, relative to the uninsured.
Conditional on patient characteristics, length of stay, and expected intensity of resource utilization, patients with private insurance and patients with Medicare were charged more (before discounting) than their uninsured counterparts within the same hospital.
KeywordsPrivate Insurance Hospital Charge Fiscal Year Service Line Uninsured Patient
We thank the Florida Center for Health Information and Policy Analysis for assistance obtaining the data used in this study. The Florida Agency for Health Care Administration disclaims responsibility for any analysis, interpretations, or conclusions created as a result of the data they provided.
Woodworth contributed to the conception and design of the study, and performed all statistical analyses. All authors contributed to the interpretation of the results and assisted in the preparation of the manuscript.
Compliance with ethical standards
This study was supported by a Grant from the Agency for Healthcare Research and Quality (AHRQ) through the Quality, Safety, and Comparative Effectiveness Research Training (QSCERT) Program (T32HS022236).
Conflict of interest
Woodworth, Romano, and Holmes declare that they have no conflicts of interest.
- 1.NHE Fact Sheet. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Accessed Dec 28, 2015.
- 2.Muhlestein D. What types of hospitals have high charge-to-reimbursement ratios? Health Affairs Blog; 2013.Google Scholar
- 3.Ginsburg PB. Wide variation in hospital and physician payment rates evidence of provider market power. Center for Studying Health System Change; 2010.Google Scholar
- 4.Morrisey MA. Cost shifting in health care: separating evidence from rhetoric. American Enterprise Institute; 1994.Google Scholar
- 6.United States Government Accountability Office. Meaningful price information is difficult for consumers to obtain prior to receiving care. GAO-11-791. http://www.gao.gov/assets/590/585400.pdf. Accessed Dec 29, 2015.
- 8.Public Workshop: Examining Health Care Competition. http://www.justice.gov/atr/events/public-workshop-examining-health-care-competition. Accessed Dec 29, 2015.
- 9.Carter GM, David Rumpel J. Payment rates for unusual medicare hospital cases. RAND Corporation; 1992.Google Scholar
- 10.The value of health insurance: few of the uninsured have adequate resources to pay potential hospital bills: assistant secretary for planning and evaluation. U.S. Department of Health and Human Services; 2011.Google Scholar
- 13.Fowler RA, Lori-Anne Noyahr J, Thornton D, Pinto R, Kahn JM, Adhikari NKJ, Dodek PM, et al. An official American Thoracic Society systematic review: the association between health insurance status and access, care delivery, and outcomes for patients who are critically ill. Am J Respir Crit Care Med. 2010;181(9):1003–11.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Fact Sheet: Common Types of Health Care Fraud. Centers for Medicare and Medicaid Services, July 2016. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/fwa-factsheet.pdf. Accessed Nov 12, 2016.
- 15.3M™ APR DRG Classification System and 3M™ APR DRG Software. http://multimedia.3m.com/mws/media/478415O/3m-apr-drg-fact-sheet.pdf. Accessed Dec 29, 2015.
- 18.Fox W, Pickering J. Hospital and physician cost shift: payment level comparison of Medicare. Medicaid, and commercial payers, Milliman; 2008.Google Scholar
- 21.Ginsburg PB. Can hospitals and physicians shift the effects of cuts in Medicare reimbursement to private payers? Health Affairs. 2003;W3:472–9.Google Scholar
- 22.Maeda JL, Mosher HR, Marder WD, Karaca Z, Friedman BS, Wong HS. Variation in hospital inpatient prices across small geographic areas. Am J Manag Care. 2013;20(11):907–16.Google Scholar
- 25.Zammitti EP, Cohen RA, Martinez ME. Health insurance coverage: early release of estimates from the National Health Interview Survey, January–June 2016. National Center for Health Statistics; 2016. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf. Accessed Nov 21, 2016.