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The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured

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  • Zack Cooper
  • Stuart Craig
  • Martin Gaynor
  • John Van Reenen

Abstract

We use insurance claims data covering 28 percent of individuals with employer-sponsored health insurance in the US to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across geographic areas and has a very low correlation with Medicare spending. For the privately insured, half of the spending variation is driven by price variation across regions and half is driven by quantity variation. Prices vary substantially across regions, across hospitals within regions, and even within hospitals. For example, even for a near homogenous service such as lower-limb MRIs, about a fifth of the total case-level price variation occurs within a hospital in the cross-section. Hospital market structure is strongly associated with price levels and contract structure. Prices at monopoly hospitals are 12 percent higher than those in markets with four or more rivals. Monopoly hospitals also have contracts that load more risk on insurers (e.g. they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs - hospitals have lower prices and bear more financial risk. Examining the 366 merger and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6 percent when the merging hospitals were geographically close (e.g. 5 miles or less apart), but not when the hospitals were geographically distant (e.g. over 25 miles apart).

Suggested Citation

  • Zack Cooper & Stuart Craig & Martin Gaynor & John Van Reenen, 2015. "The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured," CEP Discussion Papers dp1395, Centre for Economic Performance, LSE.
  • Handle: RePEc:cep:cepdps:dp1395
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    Cited by:

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    2. Carril, Rodrigo & Duggan, Mark, 2020. "The impact of industry consolidation on government procurement: Evidence from Department of Defense contracting," Journal of Public Economics, Elsevier, vol. 184(C).
    3. Whaley, Christopher M., 2019. "Provider responses to online price transparency," Journal of Health Economics, Elsevier, vol. 66(C), pages 241-259.
    4. Keith Marzilli Ericson & Justin Sydnor, 2017. "The Questionable Value of Having a Choice of Levels of Health Insurance Coverage," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 51-72, Fall.
    5. Kevin Callison & Robert Kaestner & Jason Ward, 2018. "A Test of Supply-side Explanations of Geographic Variation in Health Care Use," NBER Working Papers 25037, National Bureau of Economic Research, Inc.
    6. Laurence Baker & M. Kate Bundorf & Aileen Devlin & Daniel P. Kessler, 2016. "Why Don’t Commercial Health Plans Use Prospective Payment?," NBER Working Papers 22709, National Bureau of Economic Research, Inc.
    7. Laurence C. Baker & M. Kate Bundorf & Daniel P. Kessler, 2017. "Does Multispecialty Practice Enhance Physician Market Power?," NBER Working Papers 23871, National Bureau of Economic Research, Inc.
    8. Mak, Henry Y., 2018. "Managing imperfect competition by pay for performance and reference pricing," Journal of Health Economics, Elsevier, vol. 57(C), pages 131-146.
    9. Yu, Serena & van Gool, Kees & Hall, Jane & Fiebig, Denzil G., 2019. "Physician pricing behavior: Evidence from an Australian experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 161(C), pages 20-34.
    10. Zack Cooper & Fiona Scott Morton & Nathan Shekita, 2017. "Surprise! Out-of-Network Billing for Emergency Care in the United States," NBER Working Papers 23623, National Bureau of Economic Research, Inc.
    11. Kate Ho & Robin S. Lee, 2019. "Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets," American Economic Review, American Economic Association, vol. 109(2), pages 473-522, February.
    12. Thomas M. Selden & Zeynal Karaca & Sandra Decker, 2018. "Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?," International Journal of Health Economics and Management, Springer, vol. 18(4), pages 409-423, December.
    13. Mark Shepard, 2016. "Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange," NBER Working Papers 22600, National Bureau of Economic Research, Inc.
    14. Boyle, Seán & Petch, Jeremy & Batt, Kathy & Durand-Zaleski, Isabelle & Thomson, Sarah, 2018. "How much do cancer specialists earn? A comparison of physician fees and remuneration in oncology and radiology in high-income countries," Health Policy, Elsevier, vol. 122(2), pages 94-101.
    15. Chiara Brouns & Rudy Douven & Ron Kemp, 2021. "Prices and market power in mental health care: Evidence from a major policy change in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 803-819, April.
    16. Cook, Amanda & Averett, Susan, 2020. "Do hospitals respond to changing incentive structures? Evidence from Medicare’s 2007 DRG restructuring," Journal of Health Economics, Elsevier, vol. 73(C).
    17. Saxell, Tanja & Nurminen, Mikko, 2020. "Physician Prices and Competition: Evidence from Acquisitions in the Private Health Care Sector," Working Papers 130, VATT Institute for Economic Research.
    18. Steven Berry & Martin Gaynor & Fiona Scott Morton, 2019. "Do Increasing Markups Matter? Lessons from Empirical Industrial Organization," Journal of Economic Perspectives, American Economic Association, vol. 33(3), pages 44-68, Summer.
    19. Caitlin Carroll & Michael Chernew & A. Mark Fendrick & Joe Thompson & Sherri Rose, 2017. "Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas," NBER Working Papers 23926, National Bureau of Economic Research, Inc.
    20. Mohajan, Haradhan, 2016. "An Analysis of Knowledge Management for the Development of Global Health," MPRA Paper 82959, University Library of Munich, Germany, revised 16 Aug 2016.

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    More about this item

    Keywords

    health care; health spending; hospitals; prices; price dispersion; competition; market structure; mergers;
    All these keywords.

    JEL classification:

    • L10 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - General
    • L11 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Production, Pricing, and Market Structure; Size Distribution of Firms

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