HealthDay News — Some US hospitals might be charging private insurers twice as much for knee and hip replacements as the implants typically cost, according to a research letter published in the Journal of the American Medical Association.1
Yi-Ju Tseng, PhD, and Kenneth Mandl, MD, MPH, of the Computational Health Informatics Program at Boston Children’s Hospital, looked at statistics from a single private insurance plan from 2011 to 2015. They focused on 40,372 patients with knee replacements and 23,570 patients with hip replacements. They compared the costs paid by the insurers for the implants to the average costs of the implants, as disclosed by a group of 160 hospitals and another group of 1500 hospitals.
The researchers found that the insurer paid an average of $10,604.52 for knee implants and $11,751.25 for hip implants, along with related supplies. But the average cost of the implants and related supplies, as determined by the group of 160 hospitals, was $5,023.01 for knee and $5,619.75 for hip. The average prices for the other hospital group were similar.
The numbers suggest that insurers paid an average of $5,600 more for knee implants and $6,100 more for hip implants than the average prices, the study authors said. The authors noted that their research had limitations. It only looked at one insurer, and all the patients were under 65.
- Tseng Y, Mandl KD. Difference between estimated purchase price and insurance payments for knee and hip implants in privately insured patients younger than 65 years. JAMA. 2017;317(8):854-855. doi:10.1001/jama.2016.19579