Aon Plc, Chicago, Illinois, USA.
Popul Health Manag. 2024 Jun;27(5):320-326. doi: 10.1089/pop.2024.0085. Epub 2024 Jul 31.
This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.
本文介绍了美国和世界部分国家的医院、保险和药品价格透明度政策及应用。这些政策中有许多适用于自营保险公司。到目前为止,美国和其他国家的经验表明,联邦和州的价格透明度法规对员工或家属是否寻找低成本或高质量的供应商,以及他们的医疗保健成本和质量几乎没有影响。这是因为监管监督不力、联邦和州报告要求相互冲突,以及供应商和保险公司几乎没有提供易于阅读或分析的价格信息的经济激励。然而,价格透明度要求已经存在。因此,本文提出了一些建议,以通过雇主、供应商、商业保险公司或技术公司为员工和其他被保险人提供的价格透明度工具,最大程度地发挥其效用。从政策角度来看,将报告要求与更清晰的技术指导和更强有力的监管监督相结合,将提高价格透明度工作的效用。对于个别雇主而言,通过将价格透明度工具与健康计划网络和设计策略、行为经济学提示以及旨在改善健康、福利和护理质量的计划相结合,价格透明度工作的影响可能会增加。许多方案供应商合作伙伴、顾问、精算、技术和研究公司都可以帮助这些工作发挥作用。