Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.
The quotes she received might surprise even hardened health care economists: Only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.
Rosenthal's grandmother was fictitious, created for a research project on health care costs. But the findings, which form the basis of a paper released Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of U.S. health care costs and an opaque system in which prices are often hidden from consumers.
"Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there's virtually no information," said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Rosenthal.
Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.
"We've been trying to help patients get good value, but it is really hard to get price commitments from hospitals," said Jeff Rice, the chief executive of Healthcare Blue Book, which collects data on medical procedures. "And even if they say $20,000, it often turns out $40,000 or 60,000."
In an accompanying commentary, Andrew Steinmetz and Ezekiel J. Emanuel of the University of Pennsylvania acknowledged that there was "no justification" for the inability to provide estimates or for the wide range of prices.
But they said that more rigorous data on quality such as infection rates and unexpected deaths were required to know when high prices were worth it.