Commercial insurers' market power and hospital prices in Medicaid managed care.

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-11-09 DOI:10.1111/1475-6773.14407

Yang Wang, Jeffrey Marr, Jianhui Xu, Mark Katz Meiselbach

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引用次数: 0

Abstract

Objective: To examine the relationship between insurers' commercial market power and negotiated prices in Medicaid Managed Care (MMC) plans for hospital care.

Data sources: MMC prices from hospital-disclosed price transparency data as of July 2023 compiled by Turquoise Health, insurance enrollment information from the 2021 Clarivate InterStudy enrollment data.

Study design: Log-transformed linear regression with hospital and procedure fixed effects estimating the within-hospital MMC price variation as a function of insurers' commercial market share quartile and MMC market share for 15 common outpatient hospital services.

Data collection/extraction methods: A total of 39,049 MMC price samples measured at hospital-procedure-MMC insurer level are merged with county-insurer level market share data.

Principal findings: Around 25% of price variation in MMC plans are driven by within-hospital factors. Compared with MMC insurers from the lowest commercial market share quartile (<0.8%), those from the highest commercial market share quartile (>17%) are associated with negotiating 4.6% (95% confidence interval: [2.8%-6.4%], p < 0.001) lower MMC prices for outpatient hospital care, including 3.6% (p < 0.05) for medical/surgical procedures, 3.6% (p < 0.01) for radiology, and 6.7% (p < 0.001) for emergency department visits.

Conclusions: MMC insurers with substantial commercial market share negotiate lower MMC prices for multiple outpatient hospital services.

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医疗补助管理性医疗中商业保险公司的市场力量和医院价格。

目的研究保险公司的商业市场力量与医疗补助管理式护理（MMC）计划中医院护理谈判价格之间的关系：MMC 价格来自 Turquoise Health 编制的截至 2023 年 7 月医院披露的价格透明度数据，保险注册信息来自 2021 年 Clarivate InterStudy 注册数据：数据收集/提取方法：数据收集/提取方法：将医院-手术-MMC 保险公司层面的 39,049 个 MMC 价格样本与县级保险公司层面的市场份额数据合并：约 25% 的医保计划价格变动是由医院内部因素造成的。与来自最低商业市场份额四分位数（17%）的 MMC 保险公司相比，医院内部因素与谈判价格的相关性为 4.6%（95% 置信区间：[2.8%-6.4%]）：[2.8%-6.4%]，P 结论：拥有大量商业市场份额的 MMC 保险公司对多种医院门诊服务的 MMC 谈判价格较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.