Most Americans — more than 65% — have private health insurance, but a new report has revealed a potentially very expensive drawback.

Patients who have private (commercial) coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare, according to recent data from RAND Corp. in Washington, D.C.

As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid.

HEALTH CARE COSTS UP TO 300% HIGHER FOR PRIVATELY INSURED PATIENTS THAN THOSE WITH MEDICARE

Several states — California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin — had medical costs that were more than 300% higher than Medicare prices, the report stated.

The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at over 4,000 hospitals across the country between 2020 and 2022.

The report also included the names and prices of each hospital.

“Calculating 4,000-plus U.S. hospitals’ overall relative prices has never been done before this study, because it’s so difficult to collect the requisite data and to get permissions to publish the hospital and health system names associated with each relative price,” said Brian Briscombe, a health care analyst at RAND and one of the study authors, to Fox News Digital.

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“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”

The report gives employers a tool they can use to become “better-informed purchasers” of health care services, Peter Hussey, director of RAND Health Care in Santa Monica, California, noted in a news release. 

“Hospitals account for the largest share of health care spending in the U.S., so this report also provides valuable information that may aid policymakers interested in curbing health care costs,” Hussey also said in the release.

The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at more than 4,000 hospitals across the country between 2020 and 2022. (iStock)

The wide variance of prices across hospitals is the most important takeaway, according to Briscombe.

“Within a single city, you can find a hospital that (on average across all its services) charges privately insured patients about twice as much as Medicare charges for those same services — but down the street, another hospital charges three times what Medicare charges,” he told Fox News Digital. 

The difference in prices cannot be explained by differences in quality, he added.

“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”

Dr. Brett Osborn, a Florida neurologist and longevity expert, was not involved in the RAND study but said the findings are “concerning.”

“Hospitals bill private insurers multiples of the Medicare allowable,” he told Fox News Digital.

“The elevated costs are passed onto patients, resulting in higher premiums and out-of-pocket expenses.”

As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid, according to a new study.  (iStock)

And these costs are on the rise, Osborn warned. 

“People accept job offers because the employer offers health insurance — otherwise, for many, the premiums would be unaffordable,” he added.

Osborn emphasized the significant price variations among states.

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“Hospitals in some states charge less than 200% of Medicare rates, while others exceed 300%,” he said.  

“Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”

“This discrepancy is due to some hospitals’ market power, making it hard for employers to avoid them. Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”

The doctor also called for greater price transparency from hospitals.

The new report published the names and pricing models of more than 4,000 U.S. hospitals. (iStock)

“Despite a federal rule for price transparency, only 24.5% of hospitals comply — highlighting the need for informed health care purchasing and policy changes to manage costs,” he said. 

“The system is fundamentally flawed, designed to profit from illness rather than promote health,” Osborn continued. 

“It clearly favors hospital systems, not the patients, reinforcing the harsh reality: There is money in the sick.”

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Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said the issue of price variations is complex.

“Sometimes these are hidden costs, and sometimes hospitals and other health organizations know they can get away with charging private insurers more while obscuring prices from both the insurer and the patient to help compensate for the shrinking reimbursements from public insurances,” Siegel told Fox News Digital. 

“At the same time, more out-of-pocket costs are transferred to the consumer in terms of copays and deductibles, as middlemen take the profits.”

“The system is fundamentally flawed, designed to profit from illness rather than promote health.”

With the lack of price transparency, there is no way to introduce competition, Siegel said, as the true costs and prices are hidden. 

The study did have some limitations, the researchers acknowledged. 

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“We didn’t have sufficient claims data to publish all U.S. hospitals’ relative prices,” Briscombe told Fox News Digital. 

“Some states in the U.S. don’t have All Payor Claims Databases (APCDs), so we have to collect claims from one data contributor at a time – usually from employers that operate in that location and whose employees and dependents use those hospitals.”

“Despite a federal rule for price transparency, only 24.5% of hospitals comply, highlighting the need for informed health care purchasing and policy changes to manage costs,” according to a doctor who spoke with Fox News Digital. (iStock)

Overall, he said, the researchers had a “sufficiently large sample of data” to estimate the overall relative price of each hospital and health system included in the report, Briscombe said, “but it would be nice to have even more claims data in order to publish the relative prices for all U.S. hospitals.”

Fox News Digital reached out to the Centers for Medicare & Medicaid Services and the American Hospital Association requesting comment.

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Many cat owners are rejoicing at the news that a drug used to treat an otherwise fatal illness for cats will be available in the United States as of June 1. 

“Stokes Pharmacy has formed an exclusive partnership with the Bova Group to offer a U.S.-made compounded oral treatment for feline infectious peritonitis (FIP),” according to a statement from Stokes Pharmacy, a New Jersey-based compounding pharmacy. 

Bova, a veterinary pharmaceuticals company based in the U.K. and Australia, began selling GS-441524, a drug compound to treat FIP, in 2021 — but the drug was not available for sale in the United States. 

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“This treatment is supported by Bova’s unique drug formula, which has been used in clinical research studies across the globe and is currently in use in the U.K. and Australia,” said Stokes. 

Fox News Digital reached out to Stokes Pharmacy for further comment. 

In a May 10 statement, the U.S. Food and Drug Administration (FDA) said there are “certain conditions where the agency does not intend to take enforcement actions for compounded products for use in animals,” and that the drugs are still not technically FDA-approved. 

FIP is a “viral disease of cats caused by certain strains of a virus called the feline coronavirus,” according to the website for Cornell University’s Feline Health Center. 

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While most feline coronaviruses are relatively harmless and resolve on their own, the virus sometimes mutates into what is known as FIP. 

“Once a cat develops clinical FIP, the disease is usually progressive and almost always fatal,” the Cornell website states.

Until now, U.S. cat owners have had to turn to the “black market” to obtain a drug that was not yet approved in this country. 

While most feline coronaviruses are relatively harmless and resolve on their own, the virus sometimes mutates into what is known as FIP.  (iStock)

FIP Warriors, a group founded in March 2019 that helps connect cat owners with medications needed to treat their cats, told Fox News Digital that they are “cautiously optimistic” at the news that veterinarians will be able to prescribe treatment for cats with FIP. 

Still, the group noted, “We have very little factual information at this time and eagerly await more details from Bova and Stokes to become available. We are in direct contact with Bova and will be sharing all updates we receive with the entire FIP Warriors community.” 

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“Our sincere hope is that a safe, affordable and easily accessible medication option will help treat and cure as many FIP cats as possible and that this is a positive first step toward that goal,” the group added.

“We will continue our diligent work to educate both veterinarians and cat parents as the FIP landscape evolves.”

“Within 48 hours, I could see that my cat was starting to feel better, and within a week she was back to normal.”

One of the cat owners helped by the FIP Warriors organization told Fox News Digital about what she went through to save her cat. 

Jessica Guyette, a resident of Washington, D.C., told Fox News Digital that she returned home from a trip to discover that one of her two cats had lost a significant amount of weight and was acting strangely. 

Jessica Guyette of Washington, D.C., successfully treated her cat’s FIP with a drug regimen not yet legal in the United States. Above is her cat, pictured while sick, left, and after she was cured, right. (Jessica Guyette)

After several vet visits, Guyette was informed that her cat had FIP — and that there was nothing legally that could be done. 

A veterinarian “secretly suggested” that she turn to online groups to acquire the drugs that might save her cat, which is what led her to FIP Warriors. 

“At this point, there were no other options,” she said. “She was still losing weight, very lethargic, and I could tell that she was dying.” 

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Guyette, who works as a researcher for the National Institutes of Health, said she and her cat saw quick results.

“Within 48 hours, I could see that my cat was starting to feel better, and within a week she was back to normal,” she said — describing the overall experience of trying to save her as “terrifying.” 

She added, “I brought her in [to the vet] every month to run blood tests and the vet was astonished to find that she was back to normal, when she had been on the brink of death.”

Hannah Shaw, known on YouTube as the “Kitten Lady,” runs a nonprofit to rescue kittens and to educate others on how to care for vulnerable kittens. (Andrew Marttila)

Activist and author Hannah Shaw, founder of the nonprofit organization Kitten Lady, also treated her own cat, Coco, for FIP using black market drugs and documented the process on her YouTube channel, “Kitten Lady.” 

“It is a huge triumph that FIP — which has been considered a fatal disease for so long — is now able to be legally treated by veterinarians,” the California-based Shaw told Fox News Digital via email.

“This moment is the culmination of years of research, advocacy and activism from a movement that is sick of seeing cats die due to lacking access to lifesaving treatment.”

Shaw’s latest book, “Cats of the World,” will be released in October.

In the past, when veterinarians were told to “remain hands-off” when advising cat owners about treating FIP, it was “confusing and isolating for people who discover that their cats have been diagnosed with the disease,” she said.

Even more frustrating, said Shaw, was how “animal advocates have been successfully treating cats for FIP for a number of years, but navigating that care has been incredibly complicated for the average cat guardian.” 

Coco, one of Shaw’s cats, developed FIP while undergoing chemotherapy, she told Fox News Digital.

It was only due to “total strangers on the internet” that Shaw was able to obtain the medication and successfully treat Coco, she said.

“It is a huge triumph that FIP — which has been considered a fatal disease for so long — is now able to be legally treated by veterinarians,” an activist told Fox News Digital. (iStock)

“GS-441524 completely cured her of FIP, and thanks to the drug, I got another amazing two years with her,” she said. 

The ability for veterinarians to discuss FIP treatment with cat owners and for the drugs to be obtained through legal means is a “massive win,” Shaw said, “and is going to help so many people save their cats’ lives.” 

“This moment is the culmination of years of research, advocacy and activism from a movement that is sick of seeing cats die due to lacking access to lifesaving treatment, and it’s a huge cause for celebration,” she added.

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