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Speaker 1: Bloomberg Audio Studios, podcasts, radio news.

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Speaker 2: Gen Villa lives in Salinas, California, and she told us

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Speaker 2: that a few years ago, when she went into labor

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Speaker 2: with her second child, things moved really quickly.

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Speaker 1: My water broke in the middle of the night and

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Speaker 1: I was like, okay, well, let me take a shour

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Speaker 1: and get ready, but my partner's like, no, we got

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Speaker 1: to go.

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Speaker 2: They got in the car and drove forty five minutes

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Speaker 2: north across county lines to a hospital in Santa Cruz.

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Speaker 1: My contractions were getting shorter and shorter, and then when

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Speaker 1: we arrived they asked how what would been timing them,

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Speaker 1: and it was like a couple of minutes. So they

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Speaker 1: rushed me into the room and as they were registering

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Speaker 1: me in my room, I was giving birth.

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Speaker 2: The reason the timing was so tight, the reason Jen

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Speaker 2: chose to go to a hospital almost an hour away.

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Speaker 2: It's not because it was the closest option. In fact,

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Speaker 2: the closest hospital to her home is only about half

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Speaker 2: a mile away.

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Speaker 1: Like I could probably drive there and get there maybe

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Speaker 1: in the same minute.

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Speaker 2: The reason Jen and her partner made that middle of

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Speaker 2: the night drive came down to money. When Jen gave

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Speaker 2: birth in Santa Cruz County. The tab was about eighty

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Speaker 2: three hundred dollars, but if she had given birth at

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Speaker 2: a hospital in the county where she lives, the cost

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Speaker 2: could have been more than forty thousand dollars. Today, on

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Speaker 2: the show Bloomberg News Crunch, the data on hospital pricing

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Speaker 2: around the country. What they found reveals a new picture

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Speaker 2: of just how much healthcare prices can vary, even just

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Speaker 2: a few miles apart. I'm Sarah Holder and this is

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Speaker 2: big take from Bloomberg News. Gen Via started thinking about

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Speaker 2: having a second child after she moved to Salinas.

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Speaker 1: Mind you, it was like planned, so I was kind

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Speaker 1: of like looking into like when's the beeth time.

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Speaker 2: Where's the doctor's She was thinking about who could deliver

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Speaker 2: the baby because the obgin she had wasn't in network,

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Speaker 2: and Jen knew having a baby with an out of

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Speaker 2: network doctor would be expensive. She needed some guidance. Jenn's

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Speaker 2: a special education teacher, and so she turned to the

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Speaker 2: head of her teachers' union for advice.

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Speaker 1: What do I do you know? Like, how do I

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Speaker 1: start this? Since I wasn't pregnant yet? She said, like,

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Speaker 1: you could you have time to just change your insurance

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Speaker 1: is just going to be a lot more if you

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Speaker 1: want to have your baby and keep your doctor. And

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Speaker 1: I said, okay, so how much more? And then when

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Speaker 1: it was like about a thousand more, it's like, I'll drive.

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Speaker 2: A thousand dollars more a month. That's how much more.

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Speaker 2: Jen says she would have to pay to get a

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Speaker 2: health insurance plan that would allow her to get care

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Speaker 2: from the hospital closest to her home, and not just

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Speaker 2: that hospital. Her insurance wouldn't cover her giving birth at

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Speaker 2: any of the three hospitals in her county, which are

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Speaker 2: among the most expensive in the country.

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Speaker 1: My first reactions like, you gotta be kidding me, are

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Speaker 1: you serious? Okay, well, financially, one makes way more sense

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Speaker 1: than the other, so I'm gonna do this, But like,

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Speaker 1: how dare them? Like how is this okay? Like how

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Speaker 1: is okay that I people that work in the hospital,

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Speaker 1: I'm teaching your kids, you know, like I'm working to

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Speaker 1: better our community as a whole, but I can't use

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Speaker 1: the hospital.

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Speaker 3: Gen's experience is sort of an extreme situation because of

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Speaker 3: the place she lives and the price levels there that

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Speaker 3: are so high.

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Speaker 2: That's my colleague John Tazzi. He covers all things related

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Speaker 2: to the cost of healthcare in the US.

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Speaker 3: But everyone in the United States who has commercial insurance

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Speaker 3: is sort of exposed to this problem, right.

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Speaker 2: John and his colleagues recently got an up close look

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Speaker 2: at this problem when they cunched some data on hospital

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Speaker 2: pricing collected by a research group called the Rand Corporation,

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Speaker 2: and they found pricing disparities like the one gen Via

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Speaker 2: described all over the country.

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Speaker 3: In New York City, in Texas, in Indiana, pretty much

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Speaker 3: everywhere you look where there are multiple hospitals, there are

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Speaker 3: lower cost or higher cost options within a certain range.

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Speaker 2: In total, John and his team found more than three

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Speaker 2: hundred and fifty hospitals that had significantly lower cost competitors

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Speaker 2: within just five miles.

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Speaker 3: And if patients were willing to travel thirty miles, almost

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Speaker 3: half of US hospitals have a significantly less expensive competitor

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Speaker 3: within thirty miles.

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Speaker 2: So why would it cost thousands more dollars in one

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Speaker 2: county and then in another county thirty miles over it

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Speaker 2: would be a lot cheaper.

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Speaker 3: It's a very good question.

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Speaker 2: It's the question.

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Speaker 3: It's the question. It's the question of American healthcare.

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Speaker 2: Have you talked to hospitals where they're charging more than

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Speaker 2: other people nearby, what do they say about their prices?

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Speaker 3: Yeah, so, I mean in general, the hospital industry kind

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Speaker 3: of says that this variation in and of itself is

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Speaker 3: not a problem because hospitals do have different cost structures

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Speaker 3: in different of the patients they see. Some of the

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Speaker 3: hospitals say that they are financially at risk and that

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Speaker 3: they need to you know, they see other hospitals, particularly

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Speaker 3: in rural areas, closing, so that they need to make

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Speaker 3: sure they are charging a price that will sustain their operations.

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Speaker 3: But I think, you know, whenever we hear assertions from

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Speaker 3: the industry that they need higher reimbursements from ultimately it's

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Speaker 3: all paid for by patients or tax payers, I think

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Speaker 3: we should scrutinize claims that we need to pay more

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Speaker 3: for what we're getting.

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Speaker 2: Well, do the people who end up paying more get

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Speaker 2: better care?

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Speaker 3: So there is a lot of research trying to understand

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Speaker 3: the relationship between price and quality. We should say measuring

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Speaker 3: quality and healthcare is pretty challenging in some ways. Some

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Speaker 3: hospitals might have like really top quality cardiac care not

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Speaker 3: as good quality, or thepedic care, and so I think

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Speaker 3: you need to be really kind of clear and specific

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Speaker 3: about what you're comparing when you're trying to do that

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Speaker 3: sort of analysis. But in general, the answers know that

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Speaker 3: higher cost care is not better quality.

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Speaker 2: How clear is this to consumers? Do people generally know

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Speaker 2: they can get cheaper care as close as a couple

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Speaker 2: miles away.

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Speaker 3: I think most consumers are largely baffled and confused every

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Speaker 3: time they interact with the healthcare system, So as a baseline,

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Speaker 3: I would say no.

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Speaker 2: Part of the reason why the cost of healthcare can

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Speaker 2: be so confusing is that many people don't pay for

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Speaker 2: it directly. They pay their insurance company, and then their

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Speaker 2: insurance company negotiates the prices with the provider, And for

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Speaker 2: a long time, even if you wanted to look up

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Speaker 2: how much something would cost at different hospitals, it was

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Speaker 2: hard to do.

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Speaker 3: Until relatively recently, all these kind of prices and contracts

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Speaker 3: were private. They were hidden, they were secret, they were

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Speaker 3: not public by default.

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Speaker 2: That started to change in recent years due to new

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Speaker 2: regulations under the Trump and Biden administrations that require hospitals

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Speaker 2: to publish their prices. But John Say's compliance has been slow,

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Speaker 2: and we're still a long way off from a world

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Speaker 2: where it's easy for individual patients to find the most

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Speaker 2: affordable care.

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Speaker 3: For twenty odd years now, in the US, there's been

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Speaker 3: a movement toward trying to make consumers, you know, patients

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Speaker 3: people need healthcare into shoppers, consumers who will compare price

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Speaker 3: and quality and make the best decisions based on that information.

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Speaker 3: There are now various websites and places where you can

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Speaker 3: try to compare pricing. I would say it's still really hard,

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Speaker 3: and like, particularly for people who are maybe having a

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Speaker 3: medical crisis, maybe kind of overwhelmed by other things the time,

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Speaker 3: it's a high bar to kind of like ask people

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Speaker 3: to do complicated analysis and try to weigh trade offs

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Speaker 3: between price and quality, right and like figure out Like,

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Speaker 3: it's hard, it's really hard. So I would say, you know,

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Speaker 3: even if consumers know that there's potentially other options, trying

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Speaker 3: to do that decision making on your own is really challenging.

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Speaker 3: We're looking at a part of our economy and a

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Speaker 3: part of our lives that we have like designated to

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Speaker 3: the market, Unlike a lot of countries have decided that

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Speaker 3: we're going to use a market approach to commercial healthcare.

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Speaker 3: In the US, and it's not working.

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Speaker 2: So we've got this big problem in pricing. What do

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Speaker 2: we do about it? After the break, we visit a

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Speaker 2: place that has taken steps to get hospital pricing disparities

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Speaker 2: under control. Out of all the data John and his

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Speaker 2: team analyze, he said, there was one state that's led

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Speaker 2: the way on addressing hospital pricing disparities.

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Speaker 3: So in some ways, the state of Indiana's kind of

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Speaker 3: ground zero for what we're talking about here.

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Speaker 2: Back in twenty sixteen, John says, an employer's group called

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Speaker 2: the Employer's Form of Indiana got concerned that hospital pricing

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Speaker 2: in their state was getting out of hand.

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Speaker 3: And they said to some economists that RAND, Hey, can

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Speaker 3: you help us understand this.

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Speaker 2: RAND that's the research group that collected data on hospital pricing.

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Speaker 2: RAND compared what hospitals in the state were charging patients

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Speaker 2: with commercial insurance versus what they were getting paid for

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Speaker 2: patients on Medicare, and they found that many of the

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Speaker 2: hospitals in Indiana were unusually expensive, including the state's largest

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Speaker 2: health system, Indiana University Health.

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Speaker 3: That kind of led employers in Indiana to be pretty

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Speaker 3: upset about what they were paying. They didn't understand why

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Speaker 3: they were paying so much, and people in other states

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Speaker 3: weren't necessarily paying as much.

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Speaker 2: How did prices at Indiana University Health get so high?

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Speaker 3: I don't think there's one clear answer. One thing they

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Speaker 3: did say is, you know, like a lot of big

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Speaker 3: hospital systems, they've made acquisitions in recent years, they've absorbed

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Speaker 3: smaller hospitals. Some of those hospitals had existing contracts with insurers,

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Speaker 3: so they sort of inherited different prices. But you know,

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Speaker 3: I think how they got so high. Again, that's sort

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Speaker 3: of the fundamental question of like all of this that

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Speaker 3: we don't really have a good answer to, except that

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Speaker 3: those are the prices that insurance companies agreed to pay.

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Speaker 2: Bloomberg News asked to interview executives from each of the

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Speaker 2: fifty hospital systems across the country that Rand identified as

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Speaker 2: the most expensive. Indiana University Health was the only one

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Speaker 2: that agreed.

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Speaker 3: When we talked to the hospital, they didn't dispute that

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Speaker 3: this was an issue. They actually said that they're trying

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Speaker 3: to make affordability part of their strategy, and they have

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Speaker 3: pledged to kind of get their prices in line at

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Speaker 3: least with national average is over a five year.

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Speaker 2: Period, Indiana University Health pledged to start cutting prices in

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Speaker 2: twenty twenty, and since then, ambulance charges have fallen twenty

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Speaker 2: four percent, pharmacy services are down by thirty percent, and

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Speaker 2: radiology prices are now almost half of what they used

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Speaker 2: to be. John says it's a rare example of a

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Speaker 2: hospital group responding to pressure to bring their prices down.

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Speaker 3: So I think in Indiana you have a story of

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Speaker 3: a really engaged group of employers that really put this

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Speaker 3: issue on the map with data, They brought it to legislators,

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Speaker 3: They kind of made a political issue over hospital prices,

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Speaker 3: and that has at least begun to kind of trickle

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Speaker 3: into both policy changes but on some market changes where

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Speaker 3: we see IU Health responding to some of these concerns.

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Speaker 3: So I think the question to watch over the next

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Speaker 3: few years is like, first of all, what happens in

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Speaker 3: Indiana to overall cops, But then do we start to

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Speaker 3: see that kind of nationally right, do more hospitals come

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Speaker 3: out and say, hey, we understand there's a problem here

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Speaker 3: and we're gonna try and shift some things to address it.

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Speaker 3: I think we are seeing this increasingly as a political issue,

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Speaker 3: but in terms of like the public pressure on hospitals.

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Speaker 3: It's nowhere near like you look at pharma. I mean,

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Speaker 3: every politician is talking about drug prices constantly, even though

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Speaker 3: we spend far more on hospital care. Right So, I

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Speaker 3: think it'll be interesting to watch how this plays out

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Speaker 3: nationally over the next few years. John, thanks so much,

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Speaker 3: Thanks so much for having me.

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Speaker 2: Thanks for listening to Big Take from Bloomberg News. I'm

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Speaker 2: Sarah Holder. This episode was produced by David Fox. It

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Speaker 2: was edited by Caitlin Kenny and Timinette. It was mixed

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Speaker 2: by Blake Maples. It was fact checked by Tiffany Choi.

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Speaker 2: Our senior producers are Naomi Shaven and Jilda Decarly. We

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Speaker 2: get editorial direction from Elizabeth Ponso. Nicole Beemster Bore is

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Speaker 2: our executive producer. Sage Bauman is Bloomberg's head of Podcasts.

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Speaker 2: Thanks for tuning in. We'll be back tomorrow.