title: National estimates of price variation by site of care.
abstract: OBJECTIVE
  Recently, researchers and policy makers have demonstrated growing interest in differences in payments across sites of care for the same healthcare service, such as in a hospital outpatient department (HOPD) versus a physician office (PO). Our objective was to examine the price differential for individuals with employer-sponsored insurance by site of care for 7 commonly performed services at the national and regional level.
  
  
  METHODS
  We analyzed 2008 to 2013 claims data from Truven Health MarketScan Commercial Claims and Encounters Database, containing administrative data for 44 to 53 million individuals covered by employer-sponsored health insurance.
  
  
  METHODS
  We selected 7 services based on total payments from different clinical categories-categories in which differences in clinical quality and patient morbidity are less likely to be sources of the price differential. We calculated payment amounts at the visit level for each healthcare service by site of care, then calculated the price differential by site of care as a ratio of average HOPD price to the average PO price or average ambulatory surgery center price for the same service.
  
  
  RESULTS
  Across all 7 services, prices at a HOPD were statistically significantly higher than payments to a PO, ranging in 2013 from 21% more for an office visit to 258% more for chest radiography. The increase in the price differentials, combined with a shift in volume in favor of hospital outpatient departments, was associated with a 44% increase in total spending between 2008 and 2013.
  
  
  CONCLUSIONS
  Our study shows that price differentials by site of care exist at a national level, and that they are increasing over time.
authors.affiliation: American's Health Insurance Plans, 601 Pennsylvania Ave, NW, South Building, Ste 500, Washington, DC 20004. E-mail: ahiggins@ahip.org.
authors.forename: Aparna
authors.initials: A
authors.lastname: Higgins
authors.forename: German
authors.initials: G
authors.lastname: Veselovskiy
authors.forename: Jill
authors.initials: J
authors.lastname: Schinkel
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States