New data released by National Nurses United revealed that not only do a handful of hospitals charge patients more than 10 times the actual cost of treatment but that prices have been steadily increasing for nearly two decades.

Skimping on care, patients often pay for it with their health, said Joan Ross, co-president of National Nurses United.

“If you are presented with a bill, and you know that bill is something you can’t afford, you’re not going to go in,” Ross said. “You’re just not going to.”

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Fourteen hospitals charged more than $1,000 for every $100 of their total costs, according to the union’s analysis.

The union compiled Medicare Cost Reports from 4,328 short-term acute care hospitals of the 4,655 that filed mandatory annual cost reports with Medicare, according to National Nurses United spokesman Chuck Idelson.  Criteria included that the hospitals’ revenue  be greater than zero, and that the hospitals have discharged at least 100 patients.

The union has analyzed these reports for the past 16 years, and it saw the biggest overall jump between fiscal year 2011 and fiscal year 2012, when hospitals charged 7 percent more than they had the previous year

Ross, who’s been a registered nurse in Minnesota for 40 years, said she’s watched as rising hospital prices have played a larger and larger role in patient care decisions.

“The first question — instead of triaging their physical and mental state — is not how ill you are but what kind of insurance you have,” Ross said. “That never was asked before, not when I started nursing. That didn’t come up as a question, nor should it.” 

Ross said steep hospital prices often drive patients to put their pocketbook before their health when it comes time to make medical decisions. She remembers a terminal cancer patient whose lack of insurance pushed her toward a cheaper option at first, but ultimately cost her family more money by the time she died.

Ross said the patient needed an intravenous catheter to deliver medications because the usable veins in her arm would eventually close up. But because the patient didn’t have insurance, and having the catheter put in would be expensive, Ross said, the patient decided not to get it. She hoped that she’d die before doctors could no longer find usable veins in her arms.

The patient endured extra pain, but didn’t want to burden her family with extra costs, Ross said.

But she didn’t die, and soon doctors found that they could no longer find a usable vein. They needed to give her the catheter anyway to deliver the drugs that would keep her comfortable.

“They ended up putting in the line that she should have had months ago,” Ross said. “Decisions are not made by what is best for the patients. They’re made on what costs the least and what they can afford [at the time]. But in long run, it ends up costing everybody more.”

The American Hospital Association said bills were higher than the cost of treatment because the hospital has to cover the cost of patients who can’t pay, and other expenses. 

“Today’s hospital bill is a symptom of a broken payment system,” the association said in a statement to ABCNews.com. ”It’s an example of the fragmented nature of our delivery system in which hospital bills often reflect just one aspect of care. In addition, hospitals deal with more than 1,300 insurers; each insurer has different plans with multiple requirements for hospital bills.  Add to that decades of federal regulations and it becomes even more complex and frustrating for everyone.”

Although the American Hospital Association lists 5,723 registered hospitals in the country, these include specialty facilities, such as rehab centers, which the nurses’ union left out in its study.

The American Hospital Association said it was committed to improving transparency so consumers can know what they’ll be expected to pay and compare prices. It has supported legislation requiring the states to publicize different service costs.

By Sydney Lupkin