Association Between Availability of a Price Transparency Tool and Outpatient Spending

Desai, Sunita; Hatfield, Laura A.; Hicks, Andrew L.; Chernew, Michael E.; Mehrotra, Ateev

doi:10.1001/jama.2016.4288

Cited by 108 publications

(104 citation statements)

References 20 publications

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“…Despite the proliferation of these tools, however, most consumers do not use them and are not even aware of their existence (Gourevitch et al, 2017). Hence, Desai et al (2016) find that offering a price transparency tool to employees was not associated with lower health spending.…”

Section: Policy Implicationsmentioning

confidence: 85%

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

Douven

Burger

Schut

2019

HEPL

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In the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.

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Section: Policy Implicationsmentioning

confidence: 85%

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

Douven

Burger

Schut

2019

HEPL

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“…At the end of the day, the decoupling of the consumption of drugs versus its payment through insurance (for those with such coverage) mitigates the impact of pricing transparency on consumption decisions, among other factors. 23 Prescription Drug Delivery and Role of ''Middlemen''…”

Section: Diabetes Marketmentioning

confidence: 99%

The “Economic Health” of U.S. Health Care and Role of Middlemen

Garg

2020

Diabetes Technology & Therapeutics

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This article goes through the major components of the health care return-on-investment equation, from spending to outcomes, and attempts to identify major causes for its underperformance compared with other types of enterprise. It also explores the role of ''middlemen'' in prescription drug pricing (broadly defined as any market participant other than the drug manufacturer and the provider/patient, including-but not limited to-insurance companies, pharmacy benefit managers [PBMs], and health plans) and teases out the mechanisms by which PBMs, in particular, contribute to overall health care costs and the types of risks and returns they endure. Like any economic system, the health care system is a net zero-sum construct, whereby costs and benefits are traded off or exchanged between components of the value chain involuntarily (e.g., by regulatory or legal mandate) or voluntarily (e.g., by economic incentive). Ultimately, the question for policymakers as it relates to health care reform is to determine what combination of such exchanges leads to the best overall outcomes. This question of optimization, however, is undoubtedly challenging and complex, and can bring to bear economic, social, political, and moral dimensions. In light of these considerations, the article concludes by touching upon some perspectives for the future and ideas for reform, including payer reform, delivery disintermediation by technology, and consumer-driven health care.

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“…There is some encouraging evidence, but it is based on a small number of clinical areas and for the very small number of patients (about 10%) that use the tools (Whaley et al, 2014). Broader evidence suggests a minimal effect of transparency tools on spending, in part because so few patients use them (Desai et al, 2016).…”

Section: Transparencymentioning

confidence: 99%

Benefit Design to Promote Effective, Efficient, and Affordable Care: A Vital Direction for Health and Health Care

Chernew¹,

Fendrick²,

Glied³

et al. 2016

NAM Perspectives

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This publication is part of the National Academy of Medicine's Vital Directions for Health and Health Care Initiative, which called on more than 150 leading researchers, scientists, and policy makers from across the United States to assess and provide expert guidance on 19 priority issues for U.S. health policy. The views presented in this publication and others in the series are those of the authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors' organizations. Learn more: nam.edu/VitalDirections.

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Association Between Availability of a Price Transparency Tool and Outpatient Spending

Cited by 108 publications

References 20 publications

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

The “Economic Health” of U.S. Health Care and Role of Middlemen

Benefit Design to Promote Effective, Efficient, and Affordable Care: A Vital Direction for Health and Health Care

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