The pricing of U.S. hospital services: chaos behind a veil of secrecy.

@article{Reinhardt2006ThePO,
  title={The pricing of U.S. hospital services: chaos behind a veil of secrecy.},
  author={Uwe E. Reinhardt},
  journal={Health affairs},
  year={2006},
  volume={25 1},
  pages={
          57-69
        }
}
  • U. Reinhardt
  • Published 2006
  • Medicine, Political Science
  • Health affairs
Although Americans and foreigners alike tend to think of the U.S. health care system as being a "market-driven" system, the prices actually paid for health care goods and services in that system have remained remarkably opaque. This paper describes how U.S. hospitals now price their services to the various third-party payers and self-paying patients, and how that system would have to be changed to accommodate the increasingly popular concept of "consumer-directed health care." 
View on PubMed
doi.org
275 Citations
Highly Influential Citations
7
Background Citations
88
Methods Citations
8
Results Citations
1

275 Citations

From 'soak the rich' to 'soak the poor': recent trends in hospital pricing.

  • G. Anderson
  • Medicine, Political Science
    Health affairs
  • 2007
Three specific policy options that could lower the markups are a voluntary effort by hospitals, litigation, and legislation.

Pursuing cost containment in a pluralistic payer environment: from the aftermath of Clinton's failure at health care reform to the Balanced Budget Act of 1997

One of the primary arguments in this article is that managed care operated partly as a systematic suppression of price discrimination or differential pricing (often referred to as ‘cost shifting’), as managed care organizations qua purchasing agents prevented hospitals and physicians from summarily raising prices to private payers to meet their financial requirements.

Divide et impera: protecting the growth of health care incomes (COSTS).

The health care sectors in the USA and elsewhere tend to be staffed with millions of smart and highly trained professionals who sincerely seek to improve the quality of their patients’ lives, but their admirable clinical efforts are embedded in a ceaseless struggle over money.

Health Affairs Shifting : Is It Time For A More Rational All-Payer System ? The Many Different Prices Paid To Providers And The Flawed Theory Of Cost

This article proposes that this price-discriminatory system be replaced over time by an all-payer system as a means to better control costs and ensure equitable health care in developed nations.

Con: single-payer health care: why it's not the best answer.

  • M. Diamond
  • Medicine
    American journal of respiratory and critical care medicine
  • 2009
While there are major cost concerns regarding the proposed increased role for the private insurance industry in covering just some of the uninsured, a single payer system would cover all comprehensively at a cost no higher than the authors are currently spending, and potentially significantly less, if the experience of other industrialized nations is any guide.

The costs of operating under a veil of secrecy.

  • B. Anderson
  • Medicine, Political Science
    The Journal of thoracic and cardiovascular surgery
  • 2017

The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

This article shows how all-payer claims databases emerged as the dominant model for reforming health care prices, and how APCD advocates reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform.

The level of hospital charges and the income of the uninsured patient

There is in fact a substantial intersection of charges and incomes in which full payment from the uninsured, or at least substantial partial payment, is a reasonable commercial expectation and it is concluded that there is empirical support for current hospital collection practices.

MarketWatch From ‘ Soak The Rich ’ To ‘ Soak The Poor ’

This paper focuses on relative prices in the hospital industry because there are better cross-sectional and longitudinal data on hospitals, not because hospitals are any more likely than other providers to charge higher rates to the “uninsured” and other selfpay patients.

Physician Competition and the Provision of Care: Evidence from Heart Attacks

Findings suggest that changes in organizational structure, such as a merger of physician groups, influence not only the negotiated prices of services, but also service provision.
...

References

SHOWING 1-10 OF 19 REFERENCES

An "All-American" health reform proposal.

  • U. Reinhardt
  • Medicine, Economics
    The Journal of American health policy
  • 1993
The "All-American" Deal requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents.

An "All-American" health reform proposal.

  • R. Ue
  • Medicine, Economics
  • 1993
The "All-American" Deal requires individual households to be insured and allows businesses to voluntarily offer health insurance; relies on the federal income tax system to collect income-based premiums and transfer funds to states through risk-adjusted payments; and lets states manage the disbursement of funds for uninsured residents.

The cost-shift payment 'hydraulic': foundation, history, and implications.

This paper provides a series of examples of cost shifting and a historical profile of the cost shift in the hospital industry since 1980, noting that cost-shifting pressures seem to fluctuate over time and across health care markets.

The Medicare World From Both Sides: A Conversation With Tom Scully

Tom Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), the nation’s largest health insurer, discusses the Medicare program with Princeton University economist Uwe…

Redefining competition in health care.

Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care.

Price Discrimination in Medicine

M ANY disinguished economists have argued that the medical profession constitutes a monopoly, and some have produced evidence of the size of the monopoly gains that accrue to the members of this…

Costs of health care administration in the United States and Canada.

The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita, and a large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.

Competition and Other Factors Linked to Wide Variation in Health Care Prices, Pub

  • no. GASO-05-856, August 2005, http://www.gao.gov/new .items/d05856.pdf
  • 2005

HIPAA Implementation: the Case for a Rational Roll-out Plan

The Jackson Hole initiatives for a twenty-first century American health care system.