Hospital- and county-level characteristics explain geographic variability in prices of cancer-related procedures: Implications for policy and interventions.
Hospital- and county-level characteristics explain geographic variability in prices of cancer-related procedures: Implications for policy and interventions.
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美国的医疗保健成本很高且变化不定，这可能会阻碍社区的获取并影响健康结果。这项研究检查了医院和县级特征，以确定解释四种癌症相关手术价格地理差异的因素。数据来源包括Turquoise Health，该公司汇编了美国医院的公开价格数据。我们检查了四种程序的标价：腹部超声、诊断性结肠镜检查、脑部MRI和骨盆CT扫描，我们将其与医院的特点联系起来（例如，床位数）和县（例如，都市地位）。我们使用多水平线性回归模型来评估价格与医院和县级特征之间的多变量关系。补充分析重复了这些模式，使用商业保险计划的程序价格。对于每种手术，不同国家的标价不同（组内相关性：腹部超声= 23.2%;结肠镜= 17.1%;脑MRI = 37.2%;骨盆CT = 50.9%）。每种手术的定价与医院所有权（所有p < 0.001）和没有医疗保险的人口百分比（所有p < 0.05）相关。例如，私立医院的腹部超声标价高于公立医院（β = 539.10，95%置信区间[CI]：256.12，822.08，p < 0.001），未参保居民较多的县的医院的腹部超声标价高于公立医院（β = 23.44，95% CI：2.55，44.33，p = 0.03）。商业保险价格与大都市地位呈负相关。癌症相关医疗程序的价格差异很大，与县的位置以及县一级的健康社会决定因素（例如，健康保险）。需要采取干预措施和政策变化来减轻患者癌症护理的经济负担，包括癌症相关手术价格的地理差异。
Healthcare costs in the U.S. are high and variable, which can hinder access and impact health outcomes across communities. This study examined hospital‐ and county‐level characteristics to identify factors that explain geographic variation in prices for four cancer‐related procedures. Data sources included Turquoise Health, which compiles publicly‐available price data from U.S. hospitals. We examined list prices for four procedures: abdominal ultrasound, diagnostic colonoscopy, brain MRI, and pelvis CT scan, which we linked to characteristics of hospitals (e.g., number of beds) and counties (e.g., metropolitan status). We used multilevel linear regression models to assess multivariable relationships between prices and hospital‐ and county‐level characteristics. Supplementary analyses repeated these models using procedures prices for commercial insurance plans. For each procedure, list prices varied across counties (intraclass correlation: abdominal ultrasound = 23.2%; colonoscopy = 17.1%; brain MRI = 37.2%; pelvis CT = 50.9%). List prices for each procedure were associated with hospital ownership (all p < 0.001) and percent of population without health insurance (all p < 0.05). For example, list prices for abdominal ultrasound were higher for proprietary versus Government‐owned hospitals (β = 539.10, 95% confidence interval [CI]: 256.12, 822.08, p < 0.001) and for hospitals in counties with more uninsured residents (β = 23.44, 95% CI: 2.55, 44.33, p = 0.03). Commercial insurance prices were negatively associated with metropolitan status. Prices for cancer‐related healthcare procedures varied substantially, with considerable heterogeneity associated with county location as well as county‐level social determinants of health (e.g., health insurance coverage). Interventions and policy changes are needed to alleviate the financial burden of cancer care among patients, including geographic variation in prices for cancer‐related procedures.
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