Where are the most expensive hospitals?

Story highlights

  • Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions
  • 20 of these hospitals operate in Florida

Talk about sticker shock: Some U.S. hospitals charge patients more than 10 times the rates paid by Medicare.

Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, 20 operate in Florida, and half are owned by a single chain, according to a study published in the journal Health Affairs Monday.
That doesn't mean all or even most patients end up paying those charges. Private insurers are able to negotiate the sticker price down significantly. Patients paying out of pocket can often negotiate discounts or get charity care if they are low-income.
    The average U.S. hospital charges a somewhat less staggering sum: 3.4 times the rates paid by Medicare, the federal health care plan for the elderly and disabled which pays fixed rates for procedures.
    But for uninsured patients asked to pay full charges, insured patients who end up at an out-of-network hospital and patients whose treatment is covered by casualty or workers compensation insurance, these charges can matter a lot.
    "Hopefully this is a wake-up call for people to recognize there's a problem," said Gerard Anderson, a professor of health policy at Johns Hopkins Bloomberg School of Public Health, and one of the authors of the study, which analyzed 2012 Medicare cost reports.
    "There is no justification for these outrageous rates but no one tells hospitals they can't charge them," Anderson said. "For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates. They charge these prices simply because they can."
    Even after full expansion of coverage under the Affordable Care Act, 30 million Americans will remain uninsured and may face particularly high charges, the study said. The law requires nonprofit hospitals to offer reduced-cost or charity care to eligible patients, but the provision does not apply to for-profit hospitals.
    "Hospitals' high markups, therefore, subject many vulnerable patients to exceptionally high medical bills, which often leads to personal bankruptcy or the avoidance of needed medical services," the study said.
    Of the 50 highest chargers, half are owned by Community Health Systems, a for-profit chain with 199 hospitals. The company made $18 billion in profits in 2014 — 45 percent more than in 2013. The researchers looked at charges at nearly 4,500 Me