1. Commercial insurers' market power and hospital prices in Medicaid managed care.
- Author
-
Wang, Yang, Marr, Jeffrey, Xu, Jianhui, and Meiselbach, Mark Katz
- Subjects
- *
PRICES , *BUSINESS insurance , *HOSPITALIZATION insurance , *COMMERCIAL markets , *HEALTH insurance - Abstract
Objective Data Sources Study Design Data Collection/Extraction Methods Principal Findings Conclusions To examine the relationship between insurers' commercial market power and negotiated prices in Medicaid Managed Care (MMC) plans for hospital care.MMC prices from hospital‐disclosed price transparency data as of July 2023 compiled by Turquoise Health, insurance enrollment information from the 2021 Clarivate InterStudy enrollment data.Log‐transformed linear regression with hospital and procedure fixed effects estimating the within‐hospital MMC price variation as a function of insurers' commercial market share quartile and MMC market share for 15 common outpatient hospital services.A total of 39,049 MMC price samples measured at hospital‐procedure‐MMC insurer level are merged with county‐insurer level market share data.Around 25% of price variation in MMC plans are driven by within‐hospital factors. Compared with MMC insurers from the lowest commercial market share quartile (<0.8%), those from the highest commercial market share quartile (>17%) are associated with negotiating 4.6% (95% confidence interval: [2.8%–6.4%], p < 0.001) lower MMC prices for outpatient hospital care, including 3.6% (p < 0.05) for medical/surgical procedures, 3.6% (p < 0.01) for radiology, and 6.7% (p < 0.001) for emergency department visits.MMC insurers with substantial commercial market share negotiate lower MMC prices for multiple outpatient hospital services. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF