保险公司的市场竞争和协商价格的选择性医院为基础的程序

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-09-25 DOI:10.1016/j.surg.2025.109714

Mitchell Mead BSA , Clifford Sheckter MD, MS , Andrew M. Ibrahim MD, MSc

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引用次数: 0

摘要

保险公司的快速整合和保险市场竞争力的下降引起了人们对手术价格潜在影响的担忧。方法：这是一项2024年的横断面研究，根据医院价格透明规则（Hospital Price Transparency Rule），使用强制报告的9个基于医院的程序数据，该规则记录了医院和保险公司之间的程序谈判价格。这些数据与凯撒家庭基金会保险公司市场份额数据集相关联，该数据集记录了保险公司的市场竞争情况。主要结果是风险调整后的(1)保险公司价格变化和(2)保险公司市场竞争的价格差异。结果保险公司内部和不同保险公司之间基于医院的程序的价格差异很大。例如，关节置换（髋关节或膝关节）的协商价格因保险公司而异：Aetna（四分位数范围：11,161 - 16,975美元；1.52倍差异）、Anthem（四分位数范围：13,003 - 19,346美元；1.49倍差异）、BCBS（四分位数范围：13,170 - 20,358美元；1.55倍差异）、Kaiser（四分位数范围：22,318 - 24,874美元；1.11倍差异）和United（四分位数范围：13,003 - 18,693美元；1.44倍差异）。由于一家保险公司主导了市场，它通过谈判降低了手术的价格。例如，在竞争较低的市场中，由领先的保险公司与非领先的保险公司谈判时，程序的平均谈判价格低6,683美元（21.1%）（24,882美元对31,565美元；P < 001）。相比之下，竞争激烈的保险公司市场显示，领先和非领先保险公司之间的议价差异相对较小（26,155美元对25,368美元；P < 0.001）。结论：在竞争激烈的保险公司市场，保险公司协商了类似的价格。然而，在竞争较低的市场，占主导地位的保险公司谈判的价格明显较低。这些发现表明，增加保险公司的市场竞争可能会减少价格变异性，并降低特定市场的价格。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Insurer market competition and negotiated prices for elective hospital-based procedures

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Insurer market competition and negotiated prices for elective hospital-based procedures

Background

Rapid consolidation of insurers and decreasing competitiveness of insurance markets has raised concerns for potential impacts on the prices for surgery.

Methods

This was a 2024 cross-sectional study using mandatory reported data for 9 hospital-based procedures under the Hospital Price Transparency Rule, which documents negotiated prices for procedures between a hospital and insurer. These data were linked to the Kaiser Family Foundation Insurer Market Share data set, which documents insurer market competition. The primary outcomes were risk-adjusted (1) insurer price variation and (2) price differences across insurer market competition.

Results

Prices varied significantly for hospital-based procedures within and across insurers. For example, negotiated prices for joint replacement (hip or knee) varied by insurer: Aetna (interquartile range: $11,161–$16,975; 1.52-fold variation), Anthem (interquartile range: $13,003–$19,346; 1.49-fold variation), BCBS (interquartile range: $13,170–$20,358; 1.55-fold variation), Kaiser (interquartile range: $22,318–$24,874; 1.11-fold variation), and United (interquartile range: $13,003–$18,693; 1.44-fold variation). As an insurer dominated a market, it negotiated lower prices for procedures. For example, in low-competition markets, the average negotiated price for procedures were $6,683 (21.1%) less when negotiated by the leading insurer versus nonleading insurers ($24,882 vs $31,565; P < .001). In contrast, high-competition insurer markets demonstrated a relatively smaller difference in negotiated prices between leading and nonleading insurers ($26,155 vs $25,368; P < .001).

Conclusion

In high-competition insurer markets, insurers negotiated similar prices for procedures. However, in low-competition markets, the dominant insurer negotiated significantly lower prices. These findings suggest increasing insurer market competition may decrease price variability and lower prices in particular markets.

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.