For several years, a small number of leading employers and plan sponsors in Maine have encouraged their employees to get the best possible care by offering incentives to see the highest quality health care providers. This year, some employers are also encouraging their employees to get care at not only the safest and highest quality facilities, but those who offer great care at the best cost. To know which hospitals offered great care for lower cost, the State of Maine Office of Employee Health and Benefits recently hired Onpoint Health Data to produce a report showing cost differences at hospitals around the state.  They are now combining this information with the Maine Health Management Coalition’s quality and safety information to help their employees find the best quality, lowest cost care in Maine.

Hospital costs are difficult to calculate. Unlike most industries, hospital costs are determined by several different factors other than the cost of the product or service. Hospitals charge more for some services because they use the difference to subsidize the cost of other important services that are not paid for.  Sometimes hospital care costs more because others did not pay their fair share either because they could not afford it, they did not have insurance, or their insurance did not pay adequately. That means other people pick up the tab. Also, the amount of services people receive in a hospital or region can determine the real costs of healthcare. This report only looks at the average prices that hospitals were paid by people with private insurance coverage.

In producing the report, Onpoint Health Data took many precautions to be sure that the information they presented was fair and accurate.  Because there is a large variation in the services offered at Maine hospitals, the report’s cost comparison is presented in two separate groups – small and large hospitals.   Despite which group is being evaluated, however, it is clear that costs vary significantly.

In addition to comparing small and large hospitals in two separate groups, Onpoint also used the largest available data source, provided by the Maine Health Data Organization (MHDO), instead of information strictly from state employees.   The larger sample size helped to make the study more accurate.  

Several healthcare financial experts have reviewed the report and agree that the way the study was done is a fair way to compare hospital costs. Although the report is as accurate as Onpoint was able to make it, there were some limitations with the data.  Because the MHDO could only supply Onpoint with private claims information, differences in how insurers code procedures, process data and pay for care may have skewed the results.  The report is also based on data from 2009, and costs may have changed since this information was collected.

Even though this report on hospital cost is not perfect, and does not include important information about utilization, it is a huge step towards making health care in Maine more transparent.  We believe patients have a right to know about the quality, safety and costs of their care. By continuing to measure and report on issues like cost, we will continue to move towards better care.

Please note that the information contained in this report does not reflect what you will pay for services. Please contact your health insurance carrier for information regarding coverage and out of pocket costs of care. If you are uninsured, please contact the hospital directly.

Download the Report >