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 卫生保健负担能力是主要的政策问题，是公平获得护理的障碍，也是一个重要因素 在患者健康结果中。医疗服务的价格是负担能力的重要确定，并且 美国私人保险的私人保险人的价格在私人健康保险之间进行谈判 医疗保健提供者。从历史上看，演员们不容易观察到医院保险人谈判的价格 在谈判之外。这种缺乏透明度给患者选择，政策带来了障碍 回答和学术研究。 2021年，医疗保险和医疗补助服务中心（CMS）价格 透明规则要求医院系统通过所有确保公开发布其谈判的价格。这 该规则对价格，这些影响的机制以及确保后果的影响尚未 严格研究。该政策的目的是增加信息并降低支出。但是，先验 证据和经济理论表明，这种影响尚不清楚。在集中的市场中，价格设定 通过谈判，提高价格透明度可能会促进综合或以其他方式导致价格上涨。 此外，确保根据医院网络向雇主出售保险合同 保险公司已经谈判了价格。这种员工 - 保险公司的关系可以建模为主要代理 在其中确保努力谈判价格和低价收益的关系中， 雇主。 CMS的政策可能为雇主提供新信息，改善员工监控 保险人在谈判方面的努力并创造了政策影响的另一种潜在机制。这项研究会 经验评估CMS价格透明度规则的影响。该研究将使用科罗拉多州的数据 所有付款人都要求数据库在政策变更之前和之后观察谈判的价格。研究 还将使用有关医院发布价格的数据，经济罚款的变化以及信息差异 关于在政策之前可用的价格来估计因果关系的价格。该研究将使用变化 保险合同结构以调查机制，并将探讨对消费者的跟进影响 研究员工医疗保健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一些关于 预期效果。具体而言，医院和保险的市场能力和议价能力将 调解对价格的任何影响。该研究将使用并尝试扩展 协商价格以探索这些机制并确定效果变化的决定者。研究将 关于最近的主要医疗保健政策的影响，为有用的证据提高了对 设定医院价格的复杂过程。这些证据将允许监管机构，政策制定者，卫生 系统，确保和消费者以追求负担得起的医疗保健做出更明智的决定。