Healthy Marketplace Index Volume I: Price Index

Health care prices have grown rapidly across the United States. But focusing on the national picture doesn’t capture how these rising prices have affected local areas differently. Over the last five years, price levels and growth rates varied widely for different types of health care services both across and within metro areas. In short, each locality had a different experience.

This report explores these differences.

Analyzing over 1.78 billion commercial claims, we compared the median prices paid for the same set of health care services in 112 metro areas across the country. This report presents the price level benchmarks for the U.S. health care system from 2012 to 2016 using a variety of interactive maps and charts to help consumers and stakeholders understand how the prices in their local area compare to others around the country.

How does your area stack up?

Find Out!

Health Care Cost Institute

Overall Health Care Prices in U.S. Metros Relative to National Median, 2016

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PERCENT DIFFERENCE FROM NATIONAL MEDIAN

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50%

the national median in 2016

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Metros Ranked by Price

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2

Health Care Prices Varied Widely by Metro

Most metros ranged from 25% below the national median to 30% above the national median. But several major outliers had dramatically higher prices than the national median: San Jose, CA (82% above the national median), Anchorage, AK (82%), and San Francisco, CA (64%).

Baltimore, MD had the lowest overall health care price level in 2016, at 26% below the national median. To put this in context, prices in the most expensive metro (San Jose) were nearly 2.5 times higher than in Baltimore.

Distribution of Overall Price Levels in Select U.S. Metros, 2016

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the national median in 2016

3

Within Metros, Price Levels Were Not Consistent Across Service Categories

To see whether prices were driven by a particular subset of services, we decomposed overall price levels in to three distinct service categories: inpatient, outpatient, and professional (clinician) services.

Some metros had consistently high or low prices across all service categories, such as Baltimore (below-median prices) and San Francisco (above-median prices).

Other metros had outlier price levels among the three service categories, like Dayton, OH (inpatient), El Paso, TX (professional), and Green Bay, WI (professional).

Price Levels by Type of Service in Select U.S. Metros, 2016

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Overall

Inpatient

Outpatient

Professional

Inpatient prices apply to services rendered to patients who are kept in a health care facility overnight for treatment but not for observation.

Outpatient prices apply to services rendered to patients by sections of a hospital that provide medical services not requiring an overnight stay or hospitalization (e.g., emergency room [ER], outpatient surgery, observation room).

Professional prices apply to services rendered to patients by a health care professional. Service claims with no valid revenue code are assumed to be professional services (e.g., office and preventative visits, administered drugs).

4

Growth and Price Level Were Not Always Related

One might expect that a metro with high price levels in 2016 experienced substantial price growth over time. Our analysis shows that was not always the case.

In the scatterplot below, each metro’s 2016 price level is shown along the x-axis, relative to the national median. The y-axis represents each metro’s cumulative price growth from 2012 to 2016. You’ll notice a weak correlation between the two indicators, across all service categories. Price growth did not necessarily come with high prices, and vice versa.

2016 Price Level vs. Five-Year Price Growth for Select U.S. Metros

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Overall

Inpatient

Outpatient

Professional

5

How Did Your Area Stack Up?

Interact with our Healthy Marketplace Index data to examine health care price trends in metro areas that you select. Or have us fill in metros similar to your selected area.

Compare Health Care Price Levels and Growth in Select U.S. Metros

Overall

Inpatient

Outpatient

Professional

Inpatient prices apply to services rendered to patients who are kept in a health care facility overnight for treatment but not for observation.

Outpatient prices apply to services rendered to patients by sections of a hospital that provide medical services not requiring an overnight stay or hospitalization (e.g., emergency room [ER], outpatient surgery, observation room).

Professional prices apply to services rendered to patients by a health care professional. Service claims with no valid revenue code are assumed to be professional services (e.g., office and preventative visits, administered drugs).

PERCENT DIFFERENCE FROM NATIONAL MEDIAN

-50%
50%

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the national median in 2016

Similar prices to ___ and ___

Selected Metros

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Health Care Cost Institute

Our HMI price index provides the following key takeaways, for the 112 U.S. metros we studied:

  1. Overall health care price levels varied dramatically across metro areas in 2016.
  2. Within metros, price levels also varied among certain categories of health care services.
  3. The metros with highest price levels in 2016 were not necessarily the ones with the largest 5-year price growth.

This report and price index is the first release in a multi-part Healthy Marketplace Index series examining variation in key health care spending and market indicators among U.S. metro areas. Upcoming releases will offer comparisons of service use, total spending, waste, and provider competition.