Effects of Negotiated Price Transparency Regulations: Evidence from Hospital Prices

协商价格透明度法规的影响：来自医院价格的证据

• 批准号: 10733271
• 负责人: Christopher Behrer
• 金额: $ 4.29万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10733271
• 关键词: Effects; Negotiated; Price; Transparency; Regulations

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.

抽象的 医疗保健负担能力是一个主要的政策问题，是公平获得医疗服务的障碍，也是一个重要因素 患者的健康结果。医疗保健服务的价格是负担能力的重要决定因素，并且 美国私人保险个人的价格是由私人健康保险公司和 医疗保健提供者。从历史上看，医院与保险公司协商的价格不容易被参与者遵守 谈判之外。这种缺乏透明度对患者充分知情的选择、政策造成了障碍 反应和学术研究。 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协商的价格。这 该规则对价格的影响、这些影响的机制以及随之而来的后果尚未得到证实 经过严格研究。该政策的目标是增加信息并减少支出。然而，之前 证据和经济理论表明其影响尚不清楚。在已设定价格的集中市场 通过谈判，增加价格透明度可能会促进串通或以其他方式导致价格上涨。 此外，保险公司根据雇主所在的医院网络向雇主出售保险合同。 保险公司已协商好价格。这种雇主-保险公司关系可以建模为委托代理关系 在这种关系中，保险公司努力协商价格，而低价的好处归于保险公司。 雇主。 CMS 的政策本可以为雇主带来新的信息，改善雇主监控 保险公司在谈判中的努力并创建保单效果的另一种潜在机制。这项研究将 实证评估 CMS 价格透明度规则的效果。该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可观察保单变更之前和之后的协商价格。研究 还将使用医院公布的价格、经济处罚的变化以及信息变化的数据 关于在政策出台之前可用于估计因果影响的协商价格。该研究将利用变化 保险合同结构调查机制并将探讨对消费者的后续影响 研究雇主医疗费用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种假设 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。该研究将使用并尝试扩展结构经济模型 协商价格来探索这些机制并确定影响变化的决定因素。该研究将 生成关于近期一项重大医疗保健政策的影响的有用证据，并提高对这一政策的理解 医院定价的复杂过程。这些证据将使监管机构、政策制定者、卫生部门 系统、保险公司和消费者做出更明智的决定，以追求负担得起的医疗保健。