Center for Studying Health System Change, Washington, D.C., USA.
Health Aff (Millwood). 2012 May;31(5):973-81. doi: 10.1377/hlthaff.2011.0920.
In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large physician groups--providers that health plans must include in their networks so that they are attractive to employers and consumers--can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well. Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers. Although government intervention--through rate setting or antitrust enforcement--has its place, our findings suggest a range of market and regulatory approaches should be examined in any attempt to address the consequences of growing provider market clout.
在持续关注推动医疗保健成本的因素时，人们直到最近才开始审视某些医疗保健提供者（尤其是占主导地位的医院系统）所拥有的权力，这些医院系统通过与保险公司谈判获得更高的支付费率。对美国 12 个社区的采访表明，所谓的“必备”医院系统和大型医生集团——即健康计划必须将其纳入网络的提供者，以便对雇主和消费者具有吸引力——可以发挥相当大的市场力量，从保险公司那里获得高额的支付费率。其他因素，如在特定地理区域提供重要、独特的服务或获得服务的机会，也可以为提供者提供杠杆作用。即使在拥有主导性健康计划的市场中，保险公司通常也不会积极限制费率上涨，这也许是因为保险公司可以简单地将成本转嫁给雇主及其员工。尽管政府干预（通过定价或反垄断执法）有其作用，但我们的研究结果表明，在试图解决提供者市场影响力不断增强所带来的后果时，应该研究一系列市场和监管方法。
