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Comparison Shopping for Emergency Care Is Virtually Impossible in California
Jun 2, 2014

WASHINGTON — Charges for emergency medical care in California vary widely from hospital to hospital, affecting hospital bills for millions of uninsured patients and insured patients seeking care out-of-network.  Researchers’ models were only able to account for 30 to 41 percent of the price variation among hospitals, leaving the majority of variation in charges unexplained. The study was published online Friday in Annals of Emergency Medicine (“Variation in Charges for Emergency Department Visits Across California”)

“The acute nature of most ER visits limits a patient’s ability to shop for lower cost or in-network emergency care, which makes the magnitude and variation in charges quite concerning,” said lead study author Renee Hsia, MD, MSc, of the University of California San Francisco, San Francisco, Calif.  “There is actually less variation in charges for consumer electronic goods than there is for emergency medical care.”

Dr. Hsia compared facility charges for emergency visits coded at level two, three or four (out of a total of five code levels).  (Codes are determined by the level of intensity of hospital services required for treatment, with level one representing the lowest risk and resource use.)  The range of charges for a level two emergency department visit was $156 to $1,422.  For a level three visit, hospitals charged from $266 to $3,130.  For a level four visit, the range was $275 to $6,662.

For all visit levels, government hospitals had significantly lower charges than non-profit hospitals.  There was little difference in charges between non-profit and for-profit hospitals.  All visit levels had significantly higher charges at hospitals treating higher proportions of Medicaid patients.

The study’s models accounted for hospital characteristics such as ownership, urbanicity, case-mix, capacity, payer mix, as well as market characteristics such as wage index and competition.  It did not account for less easily measured characteristics of each hospital, such as facility features, throughput efficiency and staffing levels.  Those factors could contribute somewhat to the variation in charges.

“The largely arbitrary chargemaster system in hospitals has a major bearing on the cost of medical care,” said Dr. Hsia.  “The lack of systematic charge setting can have especially devastating effects on uninsured or out-of-network patients facing the full bill for their care.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit

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