Market Power: Price Variation Among Commercial Insurers For Hospital Services
Market Power: Price Variation Among Commercial Insurers For Hospital Services
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DOI：
10.1377/hlthaff.2018.0567
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发表时间：
2018-10-01
期刊：
影响因子：
9.7
通讯作者：
Anderson, Gerard F.
中科院分区：
文献类型：
--
作者：
Bai, Ge;Anderson, Gerard F.
许多研究都集中在私人（商业）与公共（医疗保险和医疗补助）健康保险公司支付的医院价格差异上。人们对商业支付者（健康维护组织（HMO）或首选提供者组织（PPO））与其他支付者（例如伤亡（汽车）、工人赔偿和旅行保险公司）之间的价格差异知之甚少。我们发现，其他保险公司与医院的谈判能力远远低于商业HMO/PPO保险公司。在2010-16年期间，HMO/PPO保险公司为佛罗里达的医院服务支付的中位数价格分别从医疗保险价格的1.9倍增加到2.5倍，而其他保险公司支付的中位数价格从医疗保险价格的2.8倍增加到3.8倍。商业HMO/PPO保险公司的价格在主要医院系统中相似，无论所有权如何，而其他保险公司的价格在系统中差异很大。2016年，佛罗里达其他保险公司价格最高的20家医院（医疗保险费率的7.8-14.1倍）都隶属于美国医院公司。这些医院的商业净收入（中位数）的24%来自其他支付者，尽管这些支付者治疗的患者比例相对较小。保护有其他保险的患者免受高昂的医院价格的影响需要政策制定者、医院和保险公司的努力。
Much research has focused on differences in hospital prices paid by private (commercial) versus public (Medicare and Medicaid) health insurers. Far less is known about price differences across commercial payers-health maintenance organizations (HMOs) or preferred provider organizations (PPOs) versus other payers, such as casualty (automobile), workers' compensation, and travel insurers. We found that other insurers had far less negotiating power with hospitals than commercial HMO/PPO insurers did. In the period 2010-16, the median price paid by HMO/PPO insurers for hospital services in Florida increased from 1.9 times to 2.5 times the Medicare price, respectively, while the median price paid by other insurers increased from 2.8 times to 3.8 times the Medicare price. Commercial HMO/PPO insurers' prices were similar across major hospital systems, regardless of ownership, while other insurers' prices differed substantially across systems. In 2016 the twenty hospitals with the highest prices (7.8-14.1 times the Medicare rate) for other insurers in Florida were all affiliated with the Hospital Corporation of America. These hospitals generated 24 percent of their commercial net revenue (median) from other payers, despite treating a relatively small proportion of patients covered by these payers. Protecting patients with other insurance from high hospital prices requires efforts by policy makers, hospitals, and insurers.