Mark Katz Meiselbach (
Yang Wang, Johns Hopkins University.
Health Aff (Millwood). 2023 Aug;42(8):1110-1118. doi: 10.1377/hlthaff.2023.00039.
Most major insurers operate in both the commercial health insurance and Medicare Advantage (MA) markets. We investigated the ratio of commercial-to-MA prices negotiated by the same insurer, in the same hospital and for the same services, using 2022 price information disclosed by hospitals in compliance with the hospital price transparency rule. Insurers negotiated median hospital prices for commercial plans that were two to three times higher than their MA prices in the same hospital for the same service. The median commercial-to-MA price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services. In multivariable Poisson regression analysis, higher ratios were associated with system-affiliated, nonprofit, and teaching hospitals, as well as with large national insurers. These findings reflect the differences in financial incentives and regulatory policies in the commercial and MA markets. Because insurers respond to differing incentives by obtaining different negotiated prices across markets, policy and practice efforts that alter incentives for insurers may have the potential to lower commercial prices.
大多数主要保险公司都在商业健康保险和医疗保险优势（MA）市场运营。我们利用医院根据医院价格透明度规则披露的 2022 年价格信息，调查了同一家保险公司在同一家医院为同一服务协商的商业保险与 MA 价格之比。保险公司为商业计划协商的医院价格中位数是其在同一家医院为同一服务协商的 MA 价格的两到三倍。同一医院的商业保险与 MA 价格之比中位数从手术和内科服务的 1.8 到实验室检查和急诊就诊的 2.2 不等，再到影像学服务的 2.4。在多变量泊松回归分析中，更高的比值与系统附属的、非营利性和教学医院以及大型全国性保险公司有关。这些发现反映了商业和 MA 市场中财务激励和监管政策的差异。由于保险公司通过在不同市场获得不同的协商价格来应对不同的激励措施，因此改变保险公司激励措施的政策和实践努力有可能降低商业价格。
