I. Finding and Using Healthcare Data

2. How can I use databases to find the cost of healthcare used by patients outside of the VA?

Extracting cost information from utilization databases can be difficult. If the database reports any cost information, it is usually inpatient charges (i.e., what the hospital charged the patient), rather than actual payments or costs. Note that charges are not equivalent to costs. Most health plans pay $.50-.70 on the dollar. Even private-pay patients are able to negotiate discounts if they pay cash.

If there is no cost or charge information with the utilization data, it is difficult to impute cost estimates. If you are only interested in obtaining charges for a certain inpatient procedure or diagnosis, a good resource is the Healthcare Utilization and Cost Project (HCUP) webpage. HCUP is one of the databases developed by the Agency for Healthcare Quality and Research. They have an interactive web page that allows one to enter criteria and see average charges.

Since inpatient charges are easier to obtain than costs, many people choose to cost adjust the charges. Cost-adjusting the charges takes time and some programming. To get the details for cost adjusting charges, see FAQ # I5.