Seems hard to believe, but 20 percent of us make a visit to a hospital emergency department every year. In spite of that, we rarely have a clue what our bills will look like after we head home. Turns out, the cost of treating common conditions—while high everywhere—varies a lot in ERs around the country, according to a new study in the journal PLoS One.
Senior author Dr. Renee Hsia, an assistant professor of emergency medicine at the University of California, San Francisco, looked at the average charges to treat the ten most common conditions seen in the ER by examining data from more than 8,000 ER visits made by adults between 2006 and 2008. While you’d expect to see some variation in costs depending on the region of the country and the hospital’s level of expertise, the findings of this survey are still stunning.
Read on to find out how much these common reasons for an ER visit will set you back:
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Upper Respiratory Infections
AVERAGE COST: $740
You wouldn’t expect much variation here, right? Dr. Hsia and her colleagues found a range between $19 and—wait for it—$17,421. Patients aren’t the only ones in the dark about what something costs to be treated in the ER; the study also found that doctors are typically clueless about what charges will be racked up. “The majority of [physicians] are similarly inaccurate when asked by patients regarding billable charges of their visit,” the authors wrote. “Providers are often at a loss when their patient questions them about the charges for a certain procedure or treatment.” The docs also don’t usually know how their hospital’s prices compare to neighboring hospitals.
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AVERAGE COST: $871
The range? As low as $66—all the way up to $10,403 to deal with an aching back. Some variation may be due to the type of insurance people carry: The study found that Medicaid patients were charged the most overall, followed by private insurance patients and then uninsured patients.
“A lot of people want to push the healthcare market to more of a free-market system,” Hsia says. (A free market is one in which there is little economic intervention or regulation by the state). “They think the more transparency there is, the better the healthcare market will become. But right now the healthcare market doesn't act like a free market at all. There are a lot of different agreements between insurance companies and hospitals that aren't transparent, and that doesn't allow it to act like a free market.”
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Open Wounds on Extremities
AVERAGE COST: $979
To treat an open wound, such as a bad cut from a knife or a spill on a bike that requires stitches, ranges, according to the study, from $29 to $25,863. That’s no joke, of course, since accidents and injuries are the leading cause of disability (and death) for people up to age 44. And a five-figure bill from the ER can throw someone into bankruptcy without too much trouble.
Even bills in the four digits are crushing to many consumers, the authors of the study point out. “Although many people depend on the [emergency department], obtaining acute medical care is increasingly becoming a significant financial burden as total charges for emergency department services continue to rise,” Hsia and her colleagues wrote. “To the consumers with insurance coverage, these growing charges result in larger deductibles and co-payments as payers shift toward increased cost-sharing.”
And, for the growing numbers of uninsured people who rely on the emergency room for healthcare, the higher charges come directly out of their wallets.
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Sprains & Strains
AVERAGE COST: $1,051
Even if you don’t break something, you can break the bank: The range for treating sprains and strains at the ER was $4 to $24,100. Of course, some variation of costs is expected, Hsia points out. “There are probably two reasons for variety,” she says. “There's variation for what the hospitals are allowed to charge. Most people don't know that hospitals are allowed to charge whatever they want. There is no regulation for what hospitals charge for their services.
“The second reason for variation is [the variation in what a sprain or strain means]. A mild sprain walking down the on stairs is very different than a day laborer who falls two stories off a ladder to the ground.”
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AVERAGE COST: $1,151
With “other injuries” being a catch-all kind of category, it’s natural to expect the range here to be very broad, and it is—from a paltry $4 up to $24,110. An injury can mean everything from removal of a splinter to being crushed by an overturned tractor.
What’s tricky is that hospitals vary in what they charge for various tests and procedures—and consumers have no way of knowing that. “We weren’t able to tease out in our paper what percentage of the variation is attributed to normal or justifiable reasons and what proportion is attributable to just variation in what people charge for the same services,” Hsia says. However, the variation in what hospitals charge is a target for improvement. “That’s a fixable part of healthcare,” she says. “It’s not patient-specific. It’s related to how our healthcare system works.”
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Normal Pregnancy & Delivery
AVERAGE COST: $1,204
The range here was $19 to $18,320. Typically, pregnant women have some opportunity to shop around and find out what hospitals will charge for childbirth services. The problem is that when emergencies arrive, who has time for price-shopping? “With very elective procedures, like cosmetic procedures, there are areas where it’s easier to [find out] what your charge might be,” Hsia says. “But in other areas, such as ER care, it’s very difficult for consumers to obtain this type of information. The importance of knowing this is because we’re moving toward a more consumer-directed market and consumers need to have more information to make decisions with.”
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AVERAGE COST: $1,210
Now here's an eye-popping range of costs for people essentially coming into the ER for the same reason—a headache: You can pay $15, or you can pay up to nearly $18,000. Some of those people, of course, just have a stress-related headache that will go away with an aspirin, while others have a life-threatening aneurysm. But costs also vary because different hospitals have various levels of expertise and technology at their disposal. A person with a headache at one facility may not receive imaging, for example, while a patient at another facility may be sent for an expensive MRI scan.
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Urinary Tract Infections
AVERAGE COST: $1,312
The range for treating this common (and very easily treatable) condition was $50 all the way up to a staggering $73,000. Even shopping around before you come to the ER (if you can stand the pain or discomfort that long) may not help much, Hsia says. Medical office or ER administrative staff may tell a consumer that costs will depend on her insurance plan. A call to an insurance company representative about costs often leads to this non-answer: It depends on what your doctor says. “Almost everyone has had an experience like this,” Hsia says. “There is almost no way to find the information you need.”
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AVERAGE COST: $1,354
You might take food safety a little more seriously when you hear this: Costs for getting an intestinal infection like E. coli or salmonella ranged from $29 to more than $29,000.
Okay, so by now you're convinced that the ER charges are vary wildly, and too often for unjustifiable reasons. Is there anything you can do? Not much, says Hsia. "At this point, there isn't a lot an individual consumer can do. We need to get policymakers on board to realize we really need change in our healthcare system."
Americans frequently gripe about the U.S. healthcare system. And yet, she notes, we also seem paralyzed by the fear of doing something different. "People are very scared of changing the system because they don't know what else will happen," she says. "There is a lot of resistance to the idea that maybe the government needs to be more involved. It doesn't mean the government needs to take over healthcare, but perhaps government needs to be more involved."
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AVERAGE COST: $3,437
The pain of a kidney stone will cause most people to get help pronto, and that often means a trip to the hospital. But of the ten most common conditions treated in an ER, the average cost of treatment for a kidney stone was the highest. The span: from $128 all the way up to more than $39,000. (It's important to note that while this study focused on the ten most common conditions seen in the ER, these are not even the most expensive conditions to treat.)
A growing number of people don't have much of a choice about getting care in an ER, Hsia says. "There's a lot of discussion in the media about how people inappropriately use the ER. But a lot of people aren't able to find another care setting," she says. "This [variation in costs] is not specific to the ER. It's present in every single sector of the healthcare industry."