Zack Cooper (
Stuart Craig is a PhD candidate in the Wharton School, University of Pennsylvania, in Philadelphia.
Health Aff (Millwood). 2019 Feb;38(2):184-189. doi: 10.1377/hlthaff.2018.05424.
Evidence suggests that growth in providers' prices drives growth in health care spending on the privately insured. However, existing work has not systematically differentiated between the growth rate of hospital prices and that of physician prices. We analyzed growth in both types of prices for inpatient and hospital-based outpatient services using actual negotiated prices paid by insurers. We found that in the period 2007-14 hospital prices grew substantially faster than physician prices. For inpatient care, hospital prices grew 42 percent, while physician prices grew 18 percent. Similarly, for hospital-based outpatient care, hospital prices grew 25 percent, while physician prices grew 6 percent. A majority of the growth in payments for inpatient and hospital-based outpatient care was driven by growth in hospital prices, not physician prices. Our work suggests that efforts to reduce health care spending should be primarily focused on addressing growth in hospital rather than physician prices. Policy makers should consider a range of options to address hospital price growth, including antitrust enforcement, administered pricing, the use of reference pricing, and incentivizing referring physicians to make more cost-efficient referrals.
有证据表明，提供者价格的增长推动了私人保险的医疗保健支出的增长。然而，现有研究尚未系统地区分医院价格和医师价格的增长率。我们使用保险公司实际协商支付的价格，分析了住院和住院门诊服务的这两种价格的增长。我们发现，在 2007-14 年期间，医院价格的增长速度大大超过了医师价格。对于住院治疗，医院价格增长了 42%，而医师价格增长了 18%。同样，对于住院门诊服务，医院价格增长了 25%，而医师价格增长了 6%。住院和住院门诊服务支付的大部分增长是由医院价格的增长推动的，而不是医师价格的增长。我们的工作表明，减少医疗保健支出的努力应主要集中在解决医院而非医师价格的增长上。政策制定者应考虑一系列选择来解决医院价格的增长，包括反垄断执法、管理定价、参考定价的使用以及激励转介医生进行更具成本效益的转介。
