Insurer Size and Negotiated Hospital Prices: Insights From the Affordable Care Act in Arkansas

IF 2.4 3区 医学 Q2 ECONOMICS
Health economics Pub Date : 2025-08-01 DOI:10.1002/hec.70022
Jee-Hun Choi
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Abstract

This paper examines the role of insurer size in price negotiations between commercial health insurers and hospitals in the United States. The empirical analysis focuses on a dominant insurer in the Arkansas individual health insurance market that experienced a size increase due to a policy change. Under the Affordable Care Act (ACA), Arkansas expanded its Medicaid program, but unlike other expansion states, it used individual plans—a private insurance option generally not designed for Medicaid—to provide coverage to newly insured beneficiaries. This unique policy nearly doubled the insurer's individual plan enrollment after the ACA was implemented. Admission-level regression analysis reveals that the insurer's hospital inpatient prices for individual plans decreased by 16.7% following the expansion. Consistent with the predictions from bargaining models, the findings suggest that the insurer's increased bargaining leverage due to its larger size is the primary mechanism behind the price reduction.

Abstract Image

保险公司规模和协商医院价格:来自阿肯色州平价医疗法案的见解。
本文考察了保险公司规模在美国商业健康保险公司和医院之间的价格谈判中的作用。实证分析侧重于阿肯色州个人健康保险市场的一家主导保险公司,该公司因政策变化而经历了规模增长。根据《平价医疗法案》(ACA),阿肯色州扩大了其医疗补助计划,但与其他扩大计划的州不同,它使用个人计划——一种通常不是为医疗补助计划设计的私人保险选择——为新投保的受益人提供保险。在ACA实施后,这项独特的政策使保险公司的个人计划登记人数几乎翻了一番。入院水平回归分析显示,保险公司的个人计划住院价格在扩大后下降了16.7%。与议价模型的预测一致,研究结果表明,保险公司由于其规模较大而增加的议价杠杆是降价背后的主要机制。
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 economics
Health economics 医学-卫生保健
CiteScore
3.60
自引率
4.80%
发文量
177
审稿时长
4-8 weeks
期刊介绍: This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.
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