US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues
US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues
复制标题
DOI：
10.1377/hlthaff.2016.0093
复制
发表时间：
2016-09-01
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.
许多医院高管和经济学家认为，自从医疗保险在1985年采用了医院预期支付系统以来，医院收费清单上的价格（所有医院程序和用品的详尽价格清单）已经变得无关紧要。然而，使用2013年医疗保险的全国代表性医院数据，我们发现收费成本比（收费主管价格除以医疗保险允许成本）每增加一个单位，每次调整后的出院患者护理收入就会增加64美元。此外，医院似乎系统地调整了收费成本比：病人护理部门的平均收费成本比在1.8到28.5之间，营利性医院的收费成本比分别比政府医院和非营利医院高2.30和2.07。我们还发现了未参保患者比例、医院系统隶属关系和地区权力与收费成本比之间的相关性。这些发现表明，医院仍然认为收费标准是增加收入的重要途径。决策者可以考虑开发额外的政策工具，提高加价透明度，以保护患者免受特定服务的意外高额收费。
Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with $64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospital's system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services.