School of Public Health, University of California, Berkeley.
UC Hastings College of Law.
Milbank Q. 2022 Jun;100(2):589-615. doi: 10.1111/1468-0009.12568. Epub 2022 May 10.
Policy Points Looking for a way to curtail market power abuses in health care and rein in prices, 20 states have restricted most-favored-nation (MFN) clauses in some health care contracts. Little is known as to whether restrictions on MFN clauses slow health care price growth. Banning MFN clauses between insurers and hospitals in highly concentrated insurer markets seems to improve competition and lead to lower hospital prices.
Most-favored-nation (MFN) contract clauses have recently garnered attention from both Congress and state legislatures looking for ways to curtail market power abuses in health care and rein in prices. In health care, a typical MFN contract clause is stipulated by the insurer and requires a health care provider to grant the insurer the lowest (i.e., the most-favored) price among the insurers it contracts with. As of August 2020, 20 states restrict the use of MFN clauses in health care contracts (19 states ban their use in at least some health care contracts), with 8 states prohibiting their use between 2010 and 2016.
Using event study and difference-in-differences research designs, we compared prices for a standardized hospital admission in states that banned MFN clauses between 2010 and 2016 with standardized hospital admission prices in states without MFN bans.
Our results show that bans on MFN clauses reduced hospital price growth in metropolitan statistical areas (MSAs) with highly concentrated insurer markets. Specifically, we found that mean hospital prices in MSAs with highly concentrated insurer markets would have been $472 (2.8%) lower in 2016 had the MSAs been in states that banned MFN clauses in 2010. In 2016, the population in our sample that resided in MSAs with highly concentrated insurer markets was just under 75 million (23% of the US population). Hence, banning MFN clauses in all MSAs in our sample with highly concentrated insurer markets in 2010 would have generated savings on hospital expenditures in the range of $2.4 billion per year.
Our empirical findings suggest banning MFN clauses between insurers and providers in highly concentrated insurer markets would improve competition and lead to lower prices and expenditures.
政策要点为了遏制医疗保健市场力量的滥用并控制价格，20 个州已经在某些医疗保健合同中限制了最惠国（MFN）条款。对于限制 MFN 条款是否会减缓医疗保健价格增长，人们知之甚少。在高度集中的保险公司市场中，禁止保险公司与医院之间的 MFN 条款似乎会促进竞争并导致医院价格下降。
最惠国（MFN）合同条款最近引起了国会和州立法机构的关注，他们正在寻找遏制医疗保健市场力量滥用和控制价格的方法。在医疗保健领域，典型的 MFN 合同条款是由保险公司规定的，要求医疗保健提供者向与其签订合同的保险公司授予最低（即最优惠）价格。截至 2020 年 8 月，20 个州限制了医疗保健合同中 MFN 条款的使用（19 个州在至少某些医疗保健合同中禁止使用），其中 8 个州在 2010 年至 2016 年期间禁止使用。
我们使用事件研究和差分差异研究设计，将 2010 年至 2016 年间禁止 MFN 条款的州与没有 MFN 禁令的州的标准化住院价格进行了比较。
我们的结果表明，禁止 MFN 条款减少了保险公司市场高度集中的大都市统计区（MSA）的医院价格增长。具体来说，我们发现，如果 MSA 所在的州在 2010 年禁止 MFN 条款，那么 2016 年 MSA 中高度集中的保险公司市场的医院价格平均将降低 472 美元（2.8%）。2016 年，我们样本中居住在高度集中的保险公司市场的大都市统计区的人口略低于 7500 万（占美国人口的 23%）。因此，2010 年在我们样本中所有高度集中的保险公司市场的大都市统计区禁止 MFN 条款，每年将节省约 24 亿美元的医院支出。
我们的实证结果表明，在高度集中的保险公司市场中，禁止保险公司与供应商之间的 MFN 条款将提高竞争力并降低价格和支出。
