Effects of Negotiated Price Transparency Regulations: Evidence from Hospital Prices

摘要 保健负担能力是一项主要的政策关切，是公平获得保健的障碍，也是一个重要因素 在病人的健康结果中。保健服务价格是可负担性的重要决定因素， 在美国，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。这种透明度的缺乏给完全知情的患者选择、政策造成了障碍 回应和学术研究。2021年，医疗保险和医疗补助服务中心(CMS)的价格 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。这个 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尚未得到 经过严格的研究。这项政策的目标是增加信息，压低支出。然而，之前 证据和经济理论表明，这些影响尚不清楚。在设定了价格的集中市场 通过谈判，提高价格透明度可能会促成串通或以其他方式导致价格上涨。 此外，保险公司根据与其建立的医院网络向雇主出售保险合同 保险公司已经就价格进行了谈判。这种雇主-保险公司的关系可以被建模为委托代理关系 一种关系，在这种关系中，保险公司努力协商价格，并从低价中获益 雇主。CMS的政策本可以为雇主带来新的信息，改善对雇主的监控 保险公司在谈判和创建另一种潜在的保单效果机制方面所做的努力。这项研究将 实证评估CMS价格透明度规则的效果。这项研究将使用科罗拉多州的数据 所有付款人索赔数据库，以观察政策变化之前和之后的谈判价格。这项研究 还将使用有关医院公布的价格、经济处罚变化和信息变化的数据 关于在制定政策之前可获得的谈判价格，以估计因果影响。这项研究将在 保险合同结构调查机制并将通过以下方式探索对消费者的后续影响 研究雇主医疗保健成本和个人保险市场保费的变化。最后，这项研究 将研究医疗保健使用的变化。现有的经济理论提供了几个关于 预期效果。具体地说，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。这项研究将使用并尝试扩展结构经济模型 谈判价格，以探索这些机制，并确定影响差异的决定因素。这项研究将 就近期一项主要医疗保健政策的效果提供有用的证据，并提高对 确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、 系统、保险公司和消费者在追求负担得起的医疗保健方面做出更明智的决定。

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.