Tomorrow’s Routine Procedure and the Bigger Questions It Raises About the Cost of Healthcare in Rhode Island
Tomorrow morning, like thousands of Rhode Islanders each year, I’ll be heading in for a routine colonoscopy. It’s not exactly anyone’s favorite way to spend a morning, but it’s an important preventive screening that saves lives.
And as I’m preparing for it, I’ve also been thinking about something bigger, something the Providence Journal reported recently that stopped me in my tracks.
According to their analysis, the cost of a colonoscopy in Rhode Island can vary by nearly eightfold, depending on which hospital or facility you go to.
Same procedure. Same state. Same basic setup. Yet wildly different pricing.
As someone who is promoting common-sense policies that strengthen Rhode Island rather than push people away, this kind of variation raises real questions.
Not just for me as a patient, but for all of us as consumers, taxpayers, and community members.
How did we end up with a system where something so standard can cost so differently across institutions? And more importantly: What can we do about it?
Tomorrow’s procedure may be routine, but the conversation around healthcare costs in Rhode Island is anything but.
The Eye-Opening Reality of Healthcare Pricing in RI
The Providence Journal’s reporting laid this out clearly: Rhode Island hospitals are required under federal transparency rules to publish what they charge for common procedures. When those numbers were compared, the Journal found that a colonoscopy, something widely considered a basic, preventive service, can cost nearly eight times more at one hospital than at another.
The price you see online isn’t necessarily what you or your insurer ultimately pays, and these variations point to something deeper: a healthcare system where costs are not aligned with value, consistency, or transparency.
Why is this happening?
The Journal’s follow-up analysis outlined a few key drivers:
Insurance Negotiations – Every insurer negotiates individually with every hospital. That means Blue Cross may pay one amount for a colonoscopy at Hospital A and a very different amount at Hospital B. Each contract is a custom arrangement, and the differences add up.
Facility Type – A colonoscopy performed at a large hospital outpatient department often costs far more than one performed at an independent ambulatory surgery center (ASC), even though the procedure is clinically identical. Medicare data reflects similar trends.
List Prices vs. Actual Prices – Hospitals have “chargemasters,”which are essentially list prices, but these are not the real prices most people pay. They are starting points for negotiations. For uninsured patients, the list price (or a discounted version of it) may be what they actually face.
Market Power – Larger health systems can command higher reimbursement rates simply because they are larger and have more leverage when negotiating with insurers.
Bundled Services – A colonoscopy may include sedation, pathology, and facility fees. How each hospital bundles or itemizes those components will affect the final number.
In other words, healthcare pricing in Rhode Island is not based solely on cost of service or clinical complexity. It is shaped by a maze of contracts, structures, billing practices, and institutional leverage.
The end result?
A Rhode Islander doing the responsible thing, getting a screening that could detect early cancer, may unknowingly face a bill hundreds or even thousands of dollars higher depending on where they are scheduled.
My Own Experience Has Me Asking Questions
As I prepare for my procedure, I’m seeing how opaque the process can feel even for someone who is relatively engaged and detail-oriented.
What I realized is this: if someone like me, who is comfortable reading budgets and financial statements, finds this confusing, how does the average Rhode Islander navigate it?
Preventive care shouldn’t require a degree in finance.
This process has reminded me that affordability and transparency aren’t abstract policy concepts.
They’re real-world pressures that influence whether people delay necessary screenings and whether families feel safe or anxious about their healthcare decisions.
Good News: Transparency Is Improving Slowly
A bright spot in all this is that Rhode Island patients now have more tools than ever before to understand costs before receiving care.
The Providence Journal published a helpful guide on how Rhode Islanders can “shop around” using publicly posted hospital pricing data.
It’s not perfect, and it requires patience, but it is progress, and we need more of that.
The first step toward more accountability from our healthcare providers is awareness, and I believe Rhode Islanders deserve much more information in plain language, not buried in spreadsheets.
This Affects the Whole State… Economically and Personally
When healthcare is unpredictable, families face instability. Employers face higher premium costs. Retirees face greater financial pressure. Younger medical professionals weigh whether Rhode Island is a viable long-term career option.
And as we’ve discussed in other “From the 36” posts, the state’s declining healthcare workforce only magnifies these issues.
Everything is connected.
Healthcare costs aren’t just about medicine.
They’re also about affordability, workforce capacity, economic mobility, and quality of life.
People want to live where services are reliable and costs are predictable.
Rhode Island can get there, but we need to acknowledge the unevenness in our system and commit to addressing it.
A Final Thought Before Tomorrow
I’ll walk into my appointment hopeful for good results, of course, but also hopeful that Rhode Island will continue to push toward a healthcare system that is easier to understand, easier to access, and easier to afford.
A colonoscopy shouldn’t come with financial questions.
Preventive care should encourage people to stay healthy, not scare them away with uncertainty.
In District 36 and across our state, we deserve a system where routine procedures come with routine transparency.
