Patient cost largely unrelated to procedure price or insurance coverage, study finds

Little correlation exists between what a patient pays for a service and the amount an insurer pays or the overall price of a procedure, according to a new study from right-leaning think tank Pioneer Institute.

The study, which examines data from the Massachusetts Center for Health Information and Analysis and its all-payer claims database, analyzes the cost of knee MRIs at 14 Massachusetts hospitals in May 2015.

Researchers found the total price of a knee MRI without contrast, which included insurance payment and patient contribution, ranged from $1,423 at Boston Children's Hospital to $476 at Worcester-based St. Vincent's Hospital.

At the same time, patient out-of-pocket prices ranged from $206 at South Shore Hospital in South Weymouth to $55 at Cambridge-based Mt. Auburn Hospital. Insurer payments varied from $1,236 at Children's to $352 at New England Baptist Hospital in Boston.

"Even though patients paid $55 for an MRI at Mt. Auburn Hospital and $206 at South Shore, the total price of the procedure was very similar at the two hospitals," the researchers said. "New England Baptist patients paid about 30 percent of the price of the MRI, while patients at Tufts New England Medical Center [in Boston] and Mt. Auburn paid less than 10 percent of the total."

The study authors suggested linking transparency with financial incentives for consumers to select high-value providers with the lowest cost.

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