Buyers beware. Hospitals in California charged as little as $10 and as much as $10,169 for a lipid panel test, according to an analysis published Aug. 15 in BMJ Open.

Renee Y. Hsia, MD, of the University of California, San Francisco, and colleagues evaluated variation in charges for 10 common blood tests performed by hospitals in California in 2011. California requires hospitals to submit average charges for 25 outpatient procedures annually, and provides a sample list that many hospitals use. The list features the 10 blood tests, including lipid panels.  

Hsia et al analyzed the data submitted to the California system in 2011 by 166 to 189 hospitals, with the number of hospitals dependent on which of the 10 blood tests was under study. They were interested in average charges as well as hospital- and market-level characteristics that might influence pricing.

The median charge for a lipid panel was $220 with a high of $10,169 and a low of $10. It was not the only test showing significant swings. A basic metabolic panel, for instance, had a median charge of $214, but depending on the hospital, it could cost $35 or $7,303.

Hospital case mix, wage index, the competitiveness of the market, county poverty rate and percent of uninsured in the hospital’s county did not seem to effect charges in their analysis. For lipid panels, the proportion of patients on Medicaid explained some of the between-hospital variability, though.

Hsia et al acknowledged that “trickle-down” factors such as supplementary services or neighborhood characteristics that were not included in their analysis may influence charges, as well as the use of increased charges for some common services to subsidize others. Still, the findings underscore the opaqueness of pricing in healthcare.     

Efforts to make patients “informed consumers” require that they have some insight on prices for procedures. “To expect patients to be rational consumers is unrealistic when the system itself is irrational,” Hsia said in a release. “There is very little that we are able to point to that explains the variation, suggesting that the variations are not predictable and therefore a sign of huge inefficiency within the healthcare pricing system.”