Michael Batty is an economist at the Federal Reserve Board, in Washington, D.C.
Benedic Ippolito (
Health Aff (Millwood). 2017 Apr 1;36(4):689-696. doi: 10.1377/hlthaff.2016.0986.
Hospitals in the United States maintain chargemasters that contain the official list prices for all billable services. The prices vary widely across hospitals and are more than three times what hospitals are paid for treating a patient, on average. From this it is tempting to conclude that list prices are a strange, yet ultimately inconsequential, quirk of US health care. However, using both state and national data sets covering the period 2002-14, we found considerable evidence suggesting that list prices reflect hospitals' strategic behavior and have meaningful effects on payments made by and on behalf of patients. Specifically, we found that list prices varied predominantly across hospitals and within markets, were well predicted by observable hospital characteristics, and were positively related to prices actually paid by patients and their insurers. Moreover, analyses of data before and after the implementation of California's Hospital Fair Pricing Act suggest that high list prices causally increased payments from the uninsured. However, list prices had at most a limited relationship with care quality.
美国的医院维护着 chargemasters，其中包含所有计费服务的官方定价。这些价格在医院之间差异很大，平均而言是医院为治疗患者所支付费用的三倍以上。由此人们很容易得出这样的结论：定价是美国医疗保健中一个奇怪但最终无关紧要的怪现象。然而，我们使用涵盖 2002 年至 2014 年期间的州和国家数据集，发现了相当多的证据表明，定价反映了医院的战略行为，并对患者及其保险人为代表的支付产生了有意义的影响。具体而言，我们发现定价主要在医院之间和市场内变化，可由可观察到的医院特征很好地预测，并且与患者实际支付的价格及其保险费率呈正相关。此外，对加利福尼亚州医院公平定价法案实施前后数据的分析表明，高定价导致了无保险患者支付的增加。然而，定价与护理质量最多只有有限的关系。
