Provider Pricing Behavior and Health Policy

在美国，医疗保健支出几乎占GDP的20%，而医院护理支出几乎占GDP的三分之一。尽管如此，人们对医院的定价行为知之甚少：直到最近，医院和保险公司之间就项目和服务谈判的价格基本上是保密的，因此大大限制了研究人员了解医院护理市场动态的能力。该项目将使用来自全国各地医院的新的、公开的医院价格透明度数据，以更好地了解卫生政策如何影响医院定价：具体而言，医疗补助计划的扩大如何与改变的医院定价做法相关联。医院通常与许多不同的付款人（包括公立和私立）签订合同，这些付款人具有不同程度的谈判能力；医疗补助计划的扩大改变了某家医院的付款人组合分布，因此可能对付款人能够协商的价格产生影响。这个项目不仅应该加深对医院定价实践的集体理解，而且还可以对医院定价行为进行额外的研究，并为关于公共保险扩张的成本和收益的国家政策讨论提供信息。该项目将收集来自全国各地医院的新颖、公开的医院定价数据集样本，并对这些数据进行清理、记录和综合。然后，利用此分析数据集，本项目将对医院定价的决定因素进行两项研究。这两项研究都采用了准实验性的州际研究设计，将估算支付者组合与医院定价行为之间的关系。第一项研究将检查医院通过在支付者之间转移成本来应对医疗补助扩张的程度；第二项研究将考察医院通过战略性地改变医院内服务价格来应对医疗补助扩张的程度。最后，该项目将在少数民族服务机构（MSI）的其他研究人员中宣传和推广该研究数据集，并将为寻求使用这一新的重要数据源的其他MSI研究人员提供积极的外展和支持。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Spending on health care comprises almost 20% of GDP in the United States, and spending on hospital care constitutes almost a third of that. Despite this cost, relatively little is known about the pricing behavior of hospitals: until recently, the rates negotiated between hospitals and insurers for items and services have been largely confidential, thus significantly limiting researchers’ abilities to understand the market dynamics for hospital care. This project will use new, publicly available hospital price transparency data from hospitals across the country to better understand how health policy affects hospital pricing: specifically, how Medicaid expansion is associated with altered hospital pricing practices. Hospitals typically contract with many different payers – both public and private – that have different degrees of negotiating power; Medicaid expansion changes the distribution of payer mix for a given hospital, and thus may have consequences for the prices that payers are able to negotiate. This project should not only deepen the collective understanding of hospital pricing practices, but also enable additional research into hospital pricing behavior and inform national policy discussions on the costs and benefits of public insurance expansion. This project will assemble a sample of novel, publicly available hospital pricing datasets from hospitals all over the country and clean, document, and synthesize this data. Then, using this analytic dataset, this project will conduct two studies on the determinants of hospital pricing. Using a quasi-experimental state-border research design, both studies will estimate the relationship between payer mix and hospital pricing behavior. The first study will examine the extent to which hospitals respond to Medicaid expansion by shifting costs between payers; the second study will examine the extent to which hospitals respond to Medicaid expansion by strategically altering prices across services within the hospital. Finally, this project will publicize and promote this research dataset among other researchers at minority-serving institutions (MSIs), and will provide proactive outreach to, and support for, other MSI researchers seeking to use this new, important data source.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.