When it comes to health care in the United States, some medical procedures and surgeries come with hefty price tags — many easily reaching six or seven figures, leaving patients and insurers footing massive bills. While health insurance may cover a portion, there are still significant out-of-pocket expenses that often make getting treatment a financial challenge for patients.
There is a wide range in the comprehensiveness of health insurance plans in the U.S. Plans that have the lowest monthly premiums may have deductibles in the thousands of dollars, high out-of-pocket maximums or high out-of-pocket costs for care received from out-of-network providers.
“When you couple these less comprehensive plans with a high-cost medical procedure, the result can be a very high medical bill for the patient,” says Anna Sinaiko, associate professor of health economics and policy at Harvard T.H. Chan School of Public Health in Boston.
Health Care Spending in the U.S.
Health care spending in the United States is higher than in any other high-income country, and the U.S. is the only developed country without universal health care.
In the U.S., spending for health care comprises 17.6% of the entire U.S. economy. In 2023, the country spent $4.9 trillion, an increase of 7.5% from 2022, or an average of about $14,570 for every person in the country.
“The trends show that the cost of care generally increases every year, and it’s rare to see prices go down,” says John Hargraves, director of data strategy at the Health Care Cost Institute in Washington, D.C.
Hospital costs are influenced by the cost of living and demographics of areas. In New York City, for example, hospital costs are higher than in most areas of the country.
According to the Health Care Cost Institute, health care spending across metro areas range in cost depending on location:
— Bakersfield, California: $3,499 per person (43% below the national average)
— Charlestown, West Virginia: $11,296 per person (84% above the median average)
— Most metro areas: Between $5,218 and $7,060 per person a year
With a significant shortage of physicians and with few state-of-the art medical centers, it’s unlikely that a hospital in a rural area is performing any of the country’s most expensive health care procedures.
Medical procedure and treatment costs are determined by various factors, including the following:
— Complexity of procedure/treatment. Procedures that require complex techniques with high levels of expertise are expensive.
— Medical equipment. Procedures that require advanced and state-of-the-art medical equipment cost more than other procedures.
— Medical staff. Procedures that require highly skilled medical personnel and teams of specialists cost more than other procedures.
— Hospital facilities. Procedures formed in state-of-the-art facilities with advanced technologies will be more expensive than at other hospitals.
“The prices paid for procedures by commercial insurers depend somewhat on these costs, but a big driver of commercial prices is market competition and how much leverage a hospital system has when negotiating prices,” Sinaiko says.
For those on Medicare, she adds, prices are set by the Medicare program and then adjusted for geographical differences in costs, such as the cost of living.
Here are the six most expensive medical procedures and treatments in the U.S. in 2024, according to Resolve Medical Bills, a private online expert medical billing service:
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1. Heart Transplant ($1.3 million)
At an average cost of $1.3 million before insurance, a heart transplant is an operation in which a failing heart is replaced with a healthy donor heart. It’s a procedure reserved for people whose heart condition hasn’t improved with medications and other surgeries.
A heart transplant team is composed of highly trained and skilled medical professionals, including cardiovascular surgeons, heart failure specialists, interventional cardiologists, electrophysiologists, cardiovascular imaging specialists, transplant coordinators, social workers and nutritionists.
To be eligible for a heart transplant, you must undergo highly specialized testing and evaluation, including blood type and antibody testing, cancer screenings, bone density scans, kidney function assessment, pulmonary function assessment and a psychiatric evaluation to determine your eligibility to successfully undergo this complex procedure.
If it’s determined that you’re a good candidate, you will have to wait for a healthy donor heart. If one becomes available, it’s removed from a deceased donor and must be transplanted within a few hours.
Check out U.S. News’s Best Hospitals for Cardiology, Heart and Vascular Surgery.
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2. Liver Transplant ($1.1 million)
The second most expensive surgery in the country is a liver transplant at a cost of about $1.1 million without insurance. A liver transplant is a procedure that replaces a diseased or damaged liver with a healthy one from a living or deceased donor.
A liver transplant requires a great deal of planning, complex testing and assessment to determine your eligibility. It also requires a highly specialized team composed of hepatologists (doctors who specialize in liver diseases), transplant surgeons, transplant nurse coordinators, nurse practitioners, dietitians, psychiatrists and other specially trained team members.
More people are eligible for liver transplants than there are available donor livers. If you have acute or chronic liver failure, cancer that’s spread to your liver, are deemed to be well enough to endure the procedure and have no substance abuse disorders, you may be referred to a transplant hospital that will determine if you should be placed on the United Network for Organs (UNOS) waiting list, which is a long list with patients ranked by severity of need.
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3. Bone Marrow Transplant ($950,000)
At an approximate cost of $950,000, the third most costly medical procedure in the U.S. is a bone marrow transplant, a procedure that replaces diseased, defective or cancerous bone marrow (the soft spongy tissue found inside bones) with healthy, functioning bone marrow. This is also referred to as a stem cell transplant.
A stem cell transplant can be used to treat blood and lymphatic system cancers, hereditary blood disorders (like sickle cell anemia) and autoimmune diseases (like multiple sclerosis). A transplant is only considered when other treatments have failed.
A bone marrow transplant team is a highly trained, highly specialized team that includes oncologists, hematologists and immunologists. It also consists of a nurse who organizes all aspects of care needed before and after transplant, patient education, diagnostic testing and care after the procedure.
Prior to transplant, a patient is treated with high doses of chemotherapy or radiation to destroy diseased bone marrow. Healthy stem cells are then infused into the patient’s blood stream, which travel to the bone marrow and begin to produce new blood cells.
Stem cells to replace damaged ones can come from your own healthy stem cells or from donated stem cells that match yours.
Post-transplant care is critical and includes close monitoring, the use of medications to prevent graft vs. host disease that can occur when your donor’s immune cells attack your body cells and regular follow-up assessments.
4. Double lung transplant ($850,000)
At a cost of approximately $850,000, a double lung transplant entails removing both diseased lungs and replacing them with donor lungs.
The procedure requires a highly skilled, specially trained team that includes lung transplant surgeons, pulmonologists, pulmonary vascular physicians, physicians trained in lung disease, transplant psychiatrists, nurse practitioners with advanced education and training, transplant nurse coordinators and social workers.
Most donor lungs come from deceased people. Because there’s a shortage of donors, your wait could be anywhere from three months to six months to a couple of years.
To be eligible, you must have lung disease that doesn’t respond to any other treatments and have less than one to three years to live if you don’t get a transplant. Your general health will be evaluated, and you will have to go through a rigorous prescreening process to ensure the transplant will be advantageous for you.
If you’re approved for the transplant, you’ll be registered on the UNOS national deceased donor waiting list. Your donor’s blood type and lung size must match yours.
Recovery requires long hospital stays, takes at least three months and requires lifelong management and monitoring.
Check out U.S. News’s Best Hospitals for Pulmonology and Lung Surgery.
5. Intestinal or Small Bowel Transplant ($750,000)
Costing approximately $750,000 without insurance, an intestinal transplant is the replacement of a diseased or malfunctioning small intestine with a healthy one from a deceased donor. This is a rare, complex procedure for patients with intestinal failure who are unable to absorb enough nutrients or fluids through the digestive system.
The surgery is complicated and requires a highly trained and skilled team that includes transplant surgeons, gastroenterologists, specially trained nurse coordinators, ethicists, specialized nutritionists and psychiatrists.
During the surgery, the new donated intestine and its vessels are connected to the recipient’s digestive tract to create an ileostomy, an opening in the abdominal wall that allows waste to exit the body.
An ileostomy makes it possible for your health care team to monitor the transplant and its functioning and to check for problems and complications. Eventually, the ileostomy can be closed.
Pre-and post-transplant requirements are complicated and comprehensive and require life-long close monitoring and medication to prevent organ rejection and infections. Frequent endoscopic tests will be performed to determine how well the intestine is functioning.
Eligibility for the procedure is determined through weeks of consultations, lab tests and evaluation, and the ability to wait for a donor intestine.
6. Pancreas Transplant ($600,000)
A pancreas transplant costs approximately $600,000, making it the sixth most expensive medical procedure. It’s the only treatment that may be a cure for Type 1 diabetes.
People with diabetes take insulin to replace what the pancreas isn’t producing. When the pancreas stops working, a transplant may be an option that replaces a diseased or nonfunctioning pancreas with a healthy pancreas from a deceased donor.
A pancreas transplant team consists of a highly skilled and trained group of medical specialists that include transplant surgeons, transplant nephrologists, specially trained nurse coordinators and social workers.
To be eligible for the transplant, you must be living with Type 1 diabetes that can’t be controlled, along with kidney damage, eye problems and other complications. Once you’ve been deemed eligible, you’ll have tests to ensure you are healthy enough to undergo surgery. You’ll also have to undergo an immunological study to help the transplant team match you with an appropriate donor, imaging tests to plan the surgery and a psychological evaluation.
Once you’re deemed eligible, you’ll be placed on the national waiting list for a pancreas. You could be waiting for months or years before a matching pancreas becomes available. The procedure works best for people who don’t have heart or blood vessel disease.
Unlike with other transplants, your own pancreas remains in the body while the donated pancreas is connected to intestines so its digestive juices can drain. Your new pancreas will create insulin and, if successful, you’ll no longer have to take insulin.
After surgery, for as long as the transplanted pancreas is in your body, you’ll have to take medication to suppress your immune system. Additionally, you’ll need to be tested for the rest of your life to make sure the new pancreas is working properly.
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6 Most Expensive Medical Procedures, Ranked originally appeared on usnews.com
