Estimating Inpatient Hospital Prices from State Administrative Data and Hospital Financial Reports
Article first published online: 13 MAY 2013
© Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Health Services Research
Volume 48, Issue 5, pages 1779–1797, October 2013
How to Cite
Levit, K. R., Friedman, B. and Wong, H. S. (2013), Estimating Inpatient Hospital Prices from State Administrative Data and Hospital Financial Reports. Health Services Research, 48: 1779–1797. doi: 10.1111/1475-6773.12065
- Issue published online: 16 SEP 2013
- Article first published online: 13 MAY 2013
- California Office of Statewide Health Planning and Development
- Florida Agency for Health Care Administration
- Massachusetts Division of Health Care Finance and Policy
- Nevada Department of Health and Human Services
- New Jersey Department of Health and Senior Services
- Virginia Health Information
- Washington State Department of Health
- West Virginia Health Care Authority
- Wisconsin Department of Health Services
- Inpatient hospital prices;
- private insurance
To develop a tool for estimating hospital-specific inpatient prices for major payers.
AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006.
Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources.
Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset.
Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers—an important asset as the payer mix changes with the implementation of the Affordable Care Act.