Facts about hospital-insurer contracting.

Abstract

Objectives: To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting.

Study design: Retrospective analysis of 10 price transparency data files from HCA Healthcare.

Methods: Cross-sectional qualitative analysis of 524 hospital-insurer contracts across 10 hospitals.

Results: We ascertain 4 empirical regularities in these files. First, hospitals contract with many payers, ranging from 35 to 82 across the hospitals in the sample. Second, contract structure varies significantly within and across hospitals: Of the 524 contracts in our sample, the median contract contained 9 contract elements, whereas the mean contract contained 1285 contract elements. Third, most of the contracts in our sample contained multiple contracting methodologies (eg, both fixed fee and percentage of charges). Fourth, these contracts indicated substantial variation for the same service within and across hospitals, validating findings from analyses based on claims data and hospital price transparency files.

Conclusions: Hospital-insurer contracts dictate the flow and structure of a significant portion of total health care expenditure in the US. Increased attention by both researchers and policy makers would lead to a greater understanding of this vital-yet understudied-element of the market for hospital services.