Who pays more for hospital and physician services: commercial payers, Medicare or Medicaid? And how much more?

Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…

Few Americans research hospital prices

New regulation is making hospital prices available to patients. The Kaiser Family Foundation (KFF) reports: As of January 1 of this year, hospitals are required to post prices of common health services on their websites via consumer-friendly tools for patient use. Prior to implementation of this rule, hospitals were only required to publish their gross,…

Trump Executive Order to Mandate Price Transparency for Providers

As the N.Y. Times reports, more transparency is coming to provider prices. The White House released an executive order Monday afternoon intended to require insurance companies, doctors and hospitals to give patients more information about precisely what their care will cost before they get it. More transparency is generally good and surprise billing for out-of-network costs has been a major…

Competition matters

While the high price of branded drugs often gets a lot of attention in the public, few realize that after patent expiration, prices often plunge dramatically and high quality treatments are available for extremely affordable prices.  Granlund and Bergman (2018) estimate the size of this price reduction using data from Sweden. In the long term,…

Do hospital purchases of physician practices increase or decrease prices?

The effect of health care industry consolidation on prices is a question argued about by many including researchers, economists, anti-trust, lawyers, regulators and more.  There is evidence that health plan consolidation increases premiums, and hospital consolidation increases price. For instance, Dafny et al. 2015 writes: The harsh reality is that it’s difficult to find well-documented…

Why are hospital prices crazy?

Sarah Kliff of Vox has an interesting article looking at hospital pricing.  She provides examples of $629 for a Band-Aid in an emergency department to over $3,000 to look at a bruised finger. Part of these high costs are not just physician time and treatment materials but a facility fee.  The facility fee is basically the…