Hospital Charges for Laparoscopic and Open Cholecystectomy

To the Editor. — I read with interest the Questions and Answers1inJAMAand felt compelled to respond to Dr Fitzgibbons' assertion that hospital charges for laparoscopic cholecystectomies are less than charges for open cholecystectomies. As the medical director at Blue Cross/ Blue Shield of South Carolina, I have been interested in the impact that new technology and new procedures have on claims costs. My staff and I have been involved in an ongoing analysis of our claims experience with laparoscopic cholecystectomies. Earlier this year, we compared claims for laparoscopic cholecystectomies performed in 1990 with open cholecystectomies performed in five South Carolina hospitals. We attempted to include only uncomplicated cases in our study and compared hospital charges, surgeon's fees, fees for the assistant at surgery, and the anesthesia professional charges. The results of our study of 22 of our earliest cases (ie, 11 open and 11 laparoscopic cholecystectomies)