The variation in hospital charges: a problem in determining cost/benefit for cardiac surgery.

Based on 417 itemized bills from 45 American hospitals that responded to a randomized, geographically stratified survey covering January to June, 1976, the middle 50% of hospital charges for cardiac operations ranged between $5,914 and $10,315. Nonitemizing hospitals submitted lower, but less accurate, estimates. As 60% of the itemized bill consisted of high charge/cost items such as laboratory and pharmacy fees, total charges were not lowered merely by increasing case load or decreasing operating room times. Careful individualization of services in 1 hospital, however, reduced charges up to 16%. Charge per day was a poor index of efficiency because patients staying longer had lower average daily charges. The variation in hospital charges and lack of accounting uniformity preclude meaningful quantitation of either the "typical" charge or the numerator of the cost/benefit ratio for cardiac operations.