Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration

Per-enrollee spending varies dramatically across geographic markets for people with private health insurance coverage, and variation in prices accounts for about half of the observed spending variation. But what is driving this variation in private insurers’ prices? This Research Insights summarizes newly published findings from NIHCM grantee, Zack Cooper and colleagues, who took a comprehensive look at this question. Above all, their work points to the importance of provider market power and relative negotiating strength vis-à-vis insurers. Not only do market-dominating hospitals command much higher prices from private payers and obtain insurance contracts that expose them to less financial risk, when two hospitals in close proximity join forces through a merger their negotiated prices rise significantly.

This Research Insights summarizes findings from a new study showing that hospital market power drives higher negotiated prices for privately insured patients.

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Prior research has demonstrated that patients respond to the incentives of reference pricing by shifting their demand to lower-priced providers. Do providers then respond to this shift in demand by lowering their own prices in a bid to retain their patient base? This Research Insights highlights findings from a paper co-authored by Dr. Christopher Whaley, with support from a NIHCM Foundation research grant, showing that such provider-side price responses exist but appear to be modest. However, because providers negotiate prices with an insurer for its full enrollee population, any price reductions for enrollees whose benefit design incorporates reference pricing are also enjoyed by all others covered by the insurer.

This Research Insights summarizes a study showing that provider-side price responses exist but appear to be modest.

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One in five Americans say they feel lonely or socially isolated–and this lack of meaningful social connections can have life threatening consequences. This webinar explored strategies for addressing loneliness across age groups and considered its effect on health.

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