THE PRICE AIN'T RIGHT? HOSPITAL PRICES AND HEALTH SPENDING ON THE PRIVATELY INSURED
THE PRICE AIN'T RIGHT? HOSPITAL PRICES AND HEALTH SPENDING ON THE PRIVATELY INSURED
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DOI：
10.1093/qje/qjy020
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发表时间：
2019-02-01
影响因子：
13.7
通讯作者：
Van Reenen, John
中科院分区：
文献类型：
--
作者：
Cooper, Zack;Craig, Stuart V.;Van Reenen, John
我们使用的保险索赔数据涵盖了28%的个人雇主赞助的医疗保险在美国研究的变化在私人保险的医疗支出，检查保险公司的结构，医院合同，并分析全国各地的医院价格的变化。每个私人保险受益人的医疗支出在不同地理区域之间相差三倍，与医疗保险支出的相关性很低。对于私人保险，一半的支出变化是由地区之间的价格变化驱动的，一半是由数量变化驱动的。不同地区、不同地区内的医院、甚至医院内部的价格差异很大。例如，即使是下肢磁共振成像这样几乎同质的服务，也有大约五分之一的病例级价格变化发生在医院内部。医院市场结构与价格水平和合同结构密切相关。垄断医院的价格比有四个或更多竞争对手的市场高出12%。垄断医院也有合同，使保险公司承担更多风险（例如，他们有更多的案件，价格是他们收费的一部分）。在集中的保险公司市场中，情况恰恰相反--医院的价格较低，承担更多的财务风险。研究2007年至2011年发生的366起并购，我们发现，当合并医院地理位置接近时，价格上涨超过6%（例如，5英里或更少），但当医院在地理上相距较远时（例如，超过25英里）。JEL代码：I11、L10、L11。
We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across geographic areas and has a very low correlation with Medicare spending. For the privately insured, half of the spending variation is driven by price variation across regions, and half is driven by quantity variation. Prices vary substantially across regions, across hospitals within regions, and even within hospitals. For example, even for a nearly homogeneous service such as lower-limb magnetic resonance imaging, about a fifth of the total case-level price variation occurs within a hospital in the cross section. Hospital market structure is strongly associated with price levels and contract structure. Prices at monopoly hospitals are 12% higher than those in markets with four or more rivals. Monopoly hospitals also have contracts that load more risk on insurers (e.g., they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs-hospitals have lower prices and bear more financial risk. Examining the 366 mergers and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6% when the merging hospitals were geographically close (e.g., 5 miles or less apart), but not when the hospitals were geographically distant (e.g., over 25 miles apart). JEL Codes: I11, L10, L11.