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Variation in Health Care Prices Across Public and Large Private Payers
National Bureau of Economic Research [NBER]; purchase required for full document Link to more items from this source
Aug. 3, 2020

"[P]rivate insurers pay 37 percent more than [traditional Medicare (TM)], and [Medicare Advantage] pays 10 percent more than TM for the five most common inpatient diagnoses....Among the five largest US insurers, the most expensive insurer negotiates prices that are 5-26 percent higher than the mean price for the 20 most common inpatient diagnoses. Additionally, we find a 10 percent increase in insurer market share corresponds to a 7 percent decrease in inpatient negotiated prices and a 10 percent decrease in the standard deviation of prices. This finding suggests that increased insurer market power allows payers to negotiate prospective payment contracts -- rather than the more common fee-for-service payments -- thereby offloading financial risk to providers."

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