Aggregate Annual Health Care Expenditures Associated with Heart Transplantation in the United States: 1980-2011

Abstract

Purpose No attempt has been made to estimate the aggregate annual health care expenditures associated with heart transplantation in the U.S. Methods and Materials The data required for this analysis were abstracted from previously published reports. Results The average billed charge for a heart transplant in 1983 was $96,538. This figure included hospital charges, physician fees, and organ procurement costs. Based on actuarial analyses, this figure has substantially increased.Furthermore, as shown, the actual average billed per procedure charge greatly exceeds the expected average charge, given inflation. There is no obvious explanation for the observed variation between actual and expected charges, other than inflated hospital markups intended to address substantial third party payer discounts, which are typically based on a percentage of billed charges. For example, one major insurer promotes its so-called “centers of excellence network” by claiming that “clients save an average of 51 percent per transplant episode.” National estimates of health care expenditures reflect billed charges, not actual reimbursement. This is misleading but, if the same logic is applied to heart transplantation, insurers were billed $1.9 billion for heart transplants in 2011, compared with $695.0 million in 1988, the year after Medicare began paying for heart transplantation and $10.4 million in 1980. Conclusions Third party reimbursement for heart transplantation is increasingly adverse. To cope, hospitals have increased their charges. Thus, in constant dollars, total health care expenditures associated with heart transplantation in the U.S continue to increase disproportionately relative to inflation. Heart Tranplantation Procedure Average Billed Charges ($) Year Actual Charge Expected Charge Difference 1983 96,538 96,538 0 1993 166,600 139,980 26,620 1996 202,800 152,530 50,270 1999 228,100 161,218 66,882 2002 296,700 174,734 121,966 2005 349,800 189,214 160,586 2006 370,600 195,007 175,593 2007 513,500 200,799 312,701 2008 631,500 208,522 422,978 2011 782,400 218,176 564,224