Fleecing Patients: Hospitals Charge Patients More Than Four Times the Cost of Care

Summary of findings:

  • U.S. hospitals charge on average $417 for every $100 of their total costs, in statistical terms a 417 percent charge-to-cost ratio.
  • Over the last 20 years, hospital expenditures have grown faster than overall health care expenditures. Hospital expenditures as a percentage of national health expenditures have increased from 30.8 percent in 1999 to 32.7 percent in 2018. In 2018 hospital expenditures alone comprised close to 6 percent of the national GDP.
  • Of the 100 hospitals with the highest charges relative to their costs, for-profit corporations own or operate 95 of them. All of the top 100 hospitals are owned by hospital systems, as opposed to being independently operated community hospitals. The top system is HCA Healthcare, which owns 53 of these hospitals, including the hospital with the highest charge-to-cost ratio in the U.S. Community Health Systems was second with 18 hospitals in the top 100.
  • For the 100 hospitals with the lowest charge-to-cost ratios, nearly two-thirds do not belong to systems. Only two of the lowest 100 are operated by for-profit corporations, while 60 are owned by government agencies, including four hospitals whose charges do not exceed their costs.
  • Higher charge-to-cost ratios tend to be strongly associated with higher hospital profits.
  • U.S. hospital profits, pushed upward by high charges, hit a record $88 billion in 2017, and fell slightly in 2018 to $83.5 billion. Since 2013, hospital profits have increased by 21 percent. Over the last 20 years, hospital profits have increased by 411 percent.

Full report, National Nurses United, November 2020