Policy options for controlling rising hospital prices and their outcomes: a framework-based analysis

Rising hospital prices drive healthcare spending and threaten access, fueled by consolidation, weak regulation, and inefficient procurement. This scoping review applied the "Control Knobs" framework to identify and compare policy options for controlling hospital prices.

Following PRISMA-ScR guidelines, PubMed, Web of Science, Scopus, Embase, and Google Scholar were searched for English-language studies (Jan 2013-Jun 2024). Studies without hospital-specific price outcomes were excluded. Two reviewers independently screened and extracted data on study characteristics, policy options, and outcomes, which were synthesized narratively across the five "Control Knobs" domains: financing, payment, organization, regulation, and behavior.

Of 5,196 records, 50 studies met inclusion criteria, mostly from the U.S. (n = 30), with others from China, Italy, France, and eight additional countries. Policy options covered all five "Control Knobs" domains. Financing tools including competitive tenders, centralized procurement, and national negotiations, consistently reduced prices, particularly in China, Denmark, and India. Payment reforms, including fixed-rate contracts, price caps, reference pricing, and outcome-based procurement, generally lowered prices, though discounted-charge contracts and regional health technology assessment (HTA) sometimes increased them. Organizational changes had mixed effects. Mergers, Accountable Care Organization (ACO) acquisitions, and trauma center monopolies raised prices, while competition from ambulatory surgery centers (ASCs) and group purchasing organizations (GPOs) reduced them. Regulatory measures including caps, most-favored-nation (MFN) bans, and transparency tools, showed modest to substantial price reductions, whereas Certificates of Public Advantage (COPAs) had variable outcomes. Behavioral approaches, including HTA, biosimilar and generic entry, and public reporting, were generally associated with price declines.

Hospital price control relies on the interplay of financing, payment, organizational, regulatory, and behavioral mechanisms, with financing and payment reforms exerting direct short-term effects and organizational and regulatory tools shaping long-term market dynamics. The most effective policy options enhanced competition and purchasing power, including competitive tendering, centralized procurement, and promotion of generics and biosimilars. National price negotiations and merger restrictions also contained prices, while transparency, HTA, and outcome-based contracting had modest or context-dependent effects. Some interventions, such as high-deductible health plans (HDHPs), consolidations, and poorly designed regulations, increased prices. Sustainable price control requires a coordinated, context-specific approach that ensures both affordability and equity.