Effects of Negotiated Price Transparency Regulations: Evidence from Hospital Prices

摘要 卫生保健负担能力是一个主要的政策问题，是公平获得保健的障碍，也是一个重要因素 患者健康状况的影响。保健服务价格是负担能力的一个重要决定因素， 在美国，私人投保人的价格是由私人健康保险公司和 卫生保健提供者。从历史上看，医院与保险公司协商的价格不容易被参与者观察到 在谈判之外。这种缺乏透明度的做法阻碍了患者充分知情的选择， 答案和学术研究。2021年，医疗保险和医疗补助服务中心（CMS）价格 透明度规则要求医院系统公开公布与所有保险公司谈判的价格。的 这一规则对价格的影响，这些影响的机制，以及随之而来的后果还没有被 严格研究。这项政策的目标是增加信息和降低开支。但是现有 证据和经济理论表明，影响并不明显。在集中的市场上， 通过谈判，提高价格透明度可能会助长串通，或以其他方式导致价格上涨。 此外，保险公司根据医院网络向雇主出售保险合同， 保险公司已经谈好了价格。这种雇主-保险公司关系可以被建模为委托-代理关系 保险公司努力谈判价格，低价格的好处归于 雇主CMS的政策本可以为雇主提供新的信息，改善雇主监测 保险人在谈判中的努力和创造另一个潜在的机制的政策的影响。本研究将 实证评估CMS的价格透明度规则的效果。这项研究将使用来自科罗拉多州的数据 所有付款人索赔数据库，以观察谈判价格之前和之后的政策变化。研究 还将使用医院公布的价格、罚款的变化以及信息的变化等数据 关于谈判价格之前，政策估计因果关系的影响。该研究将使用变化， 保险合同结构，以调查机制，并将探讨后续影响消费者， 研究雇主医疗保健成本和个人保险市场保费的变化。最后，研究 将检查医疗保健使用的变化。现有的经济理论提供了几个假设， 预期效果。具体来说，医院和保险公司的市场力量和议价能力将 调解对价格的任何影响。该研究将使用并试图扩展结构经济模型， 谈判价格，探索这些机制，并确定影响变化的决定因素。这项研究将 就最近一项重大医疗保健政策的影响提供有用的证据，并提高对 制定医院价格的复杂过程。这一证据将使监管机构、政策制定者、卫生 系统，保险公司和消费者在追求负担得起的医疗保健时做出更明智的决定。

ABSTRACT Health care affordability is a major policy concern, a barrier to equitable access to care, and an important factor in patient health outcomes. Prices for health care services are an important determinant of affordability, and prices for privately insured individuals in the United States are negotiated between private health insurers and health care providers. Historically, a hospital-insurer negotiated price was not easily observed by actors outside of the negotiation. This lack of transparency created a barrier to fully-informed patient choice, policy responses, and academic study. In 2021, the Centers for Medicare and Medicaid Services (CMS) Price Transparency Rule required hospital systems to publicly post their negotiated prices with all insurers. The effects of this rule on prices, mechanisms of these effects, and the ensuing consequences have not yet been rigorously studied. The goal of this policy was to increase information and drive down spending. However, prior evidence and economic theory suggest that the effects are not clear. In concentrated markets with prices set by negotiation, increased price transparency may facilitate collusion or lead to price increases in other ways. Further, insurers sell insurance contracts to employers based on the network of hospitals with which the insurer has negotiated prices. This employer-insurer relationship can be modelled as a principal-agent relationship in which insurers exert effort to negotiate prices and the benefits of low prices accrue to the employer. CMS’s policy could have resulted in new information for employers, improving employer monitoring of insurer effort in negotiation and creating another potential mechanism of the policy’s effects. This study will empirically evaluate the effects of CMS’s Price Transparency Rule. The study will use data from the Colorado All Payer Claims Database to observe negotiated prices both prior to and after the policy change. The study will also use data on the prices posted by hospitals, variation in financial penalties, and variation in information about negotiated prices available prior to the policy to estimate causal effects. The study will use variation in insurance contract structure to investigate mechanisms and will explore follow-on effects on consumers by studying changes in employer health care costs and individual insurance market premiums. Finally, the study will examine changes in health care use. Existing economic theory provides several hypotheses about expected effects. Specifically, that the market power and bargaining abilities of hospitals and insurers will mediate any effects on prices. The study will use and attempt to extend structural economic models of negotiated prices to explore these mechanisms and identify determinants of variation in effects. The study will generate useful evidence on the effects of a major recent health care policy and improve understanding of the complex process by which hospital prices are set. This evidence will allow regulators, policy makers, health systems, insurers, and consumers to make more informed decisions in pursuit of affordable health care.