Maximilian J. Pany (
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). 2021 Sep;40(9):1386-1394. doi: 10.1377/hlthaff.2021.00001.
Concern about high hospital prices for commercially insured patients has motivated several proposals to regulate these prices. Such proposals often limit regulations to highly concentrated hospital markets. Using a large sample of 2017 US commercial insurance claims, we demonstrate that under the market definition commonly used in these proposals, most high-price hospitals are in markets that would be deemed competitive or "moderately concentrated," using antitrust guidelines. Limiting policy actions to concentrated hospital markets, particularly when those markets are defined broadly, would likely result in poor targeting of high-price hospitals. Policies that target the undesired outcome of high price directly, whether as a trigger or as a screen for action, are likely to be more effective than those that limit action based on market concentration.
对商业保险患者高昂的医院价格的担忧，促使人们提出了几项规范这些价格的建议。这些提议通常将监管限制在高度集中的医院市场。利用 2017 年美国商业保险索赔的大型样本，我们证明，根据这些提议中常用的市场定义，使用反垄断指南，大多数高价医院所在的市场被认为是有竞争力的或“适度集中的”。将政策行动仅限于集中的医院市场，特别是当这些市场被广泛定义时，很可能导致对高价医院的目标定位不佳。直接针对高价这一不良结果的政策，无论是作为触发因素还是作为行动的筛选条件，都可能比那些基于市场集中程度限制行动的政策更有效。
