How hospital monopolies are driving up the cost of your health care
Peter Whoriskey , Special to The Washington Post
Mon, August 10, 2026 at 2:52 AM GMT+5:30
11 min read
More than a million times a year, a U.S. surgeon slices open a knee, strips out worn cartilage, caps the leg bones with metal and drops in a plastic spacer to allow the new joint to glide
But while these knee-replacement procedures have become standard, the prices charged have not
At Catawba Valley Medical Center in Hickory, North Carolina, for example, the cost of the procedure under a Blue Cross Blue Shield health plan this year was about $16,000, according to data from Serif Health, a San Francisco start-up that collects recently released data from hospitals and insurers. Little more than an hour’s drive west, however, at Mission Hospital in Asheville, the cost of the procedure under the same health plan was around $40,000, or more than double, the data showed
Formed by the merger of the two largest hospitals in the region, Mission has little competition and more power to demand the higher price
The comparison between these two hospitals illuminates how large hospital systems created by a wave of U.S. mergers in recent decades can dominate the competition and push up health care costs
While many factors affect the price of a medical procedure, hospitals with few competitors can charge more, health economists say
The hospital price hikes mean that patients and their insurers must pay more for an episode of health care. But there is an important side effect, too, even for people who don’t require medical care. When insurers are faced with higher hospital prices, they pass the costs on and raise the prices they charge for everyone’s health insurance
Using Serif Health’s pricing data, it is possible to see how mergers like the one that created Mission Hospital influence costs. For years, it was difficult to determine how much hospital monopolies boosted charges. But since 2021, the Centers for Medicare and Medicaid Services has required hospitals to disclose prices, making it possible to gather comprehensive data such as Serif Health’s
The connection between market power and prices exists across the country. In Melbourne, Florida, Holmes Regional Medical Center is part of a health system, Health First, that dominates surrounding Brevard County. The center has charged Cigna two times what a hospital two hours north did for a knee replacement this year, the Serif Health data shows
Banner North Colorado Medical Center, which ranks as the leading health care provider in Weld County, Colorado, charged a UnitedHealthcare patient $20,000 more for the surgery in Greeley than a health system an hour’s drive south in Denver
