Roberts Eric T, Chernew Michael E, McWilliams J Michael
Eric T. Roberts is a postdoctoral fellow in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy in the Department of Health Care Policy, Harvard Medical School.
Health Aff (Millwood). 2017 Jan 1;36(1):141-148. doi: 10.1377/hlthaff.2016.0479.
Proposed mergers among large US health insurers and growing consolidation among providers have renewed concerns about the effects of market concentration on commercial health care prices. Using multipayer claims for physician services provided in office settings, we estimated that-within the same provider groups-insurers with market shares of 15 percent or more (average: 24.5 percent), for example, negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent. Analyses stratified by provider market share suggested that insurers require greater market shares to negotiate lower prices from large provider groups than they do when negotiating with smaller provider groups. For example, office visit prices for small practices were $88, $72, and $70, for insurers with market shares of <5 percent, ≥5 to <15 percent, and ≥15 percent, respectively, whereas prices for large provider groups were $97, $86, and $76, exhibiting a continued decrease across higher insurer-market-share categories. These results suggest that mergers of health insurers could lower the prices paid to providers, particularly providers large enough to obtain higher prices from insurers with modest market shares. Continued monitoring will be important for determining the net effects of the countervailing trends of insurer and provider consolidation on the affordability of health care.
美国大型健康保险公司之间拟议的合并以及医疗服务提供商之间日益加剧的整合，再次引发了人们对市场集中度对商业医疗保健价格影响的担忧。利用在门诊环境中提供的医生服务的多付款人索赔数据，我们估计，例如，在同一医疗服务提供商群体中，市场份额达到或超过15%（平均为24.5%）的保险公司，其门诊协商价格比市场份额低于5%的保险公司低21%。按医疗服务提供商市场份额分层的分析表明，与小型医疗服务提供商群体谈判时相比，保险公司需要更大的市场份额才能从大型医疗服务提供商群体那里协商到更低的价格。例如，对于小型医疗机构，市场份额<5%、≥5%至<15%以及≥15%的保险公司的门诊价格分别为88美元、72美元和70美元，而对于大型医疗服务提供商群体，价格分别为97美元、86美元和76美元，显示出随着保险公司市场份额类别升高价格持续下降。这些结果表明，健康保险公司的合并可能会降低支付给医疗服务提供商的价格，尤其是那些规模大到足以从市场份额适中的保险公司获得更高价格的医疗服务提供商。持续监测对于确定保险公司和医疗服务提供商整合这两种抵消趋势对医疗保健可负担性的净影响至关重要。
