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保险商市场竞争和可选医院手术的谈判价格

Mitchell Mead¹, Clifford Sheckter², Andrew M Ibrahim³

¹University of Michigan, School of Medicine, Ann Arbor, MI; University of Michigan, Department of Surgery, Ann Arbor, MI; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI.

|September 26, 2025

概括

增加的保险商市场竞争可能会减少手术手术价格波动和降低成本. 在竞争较低的市场上,占主导地位的保险公司会谈判降低价格,从而影响整体医疗费用.

科学领域:

卫生经济学卫生经济学
医疗保健政策医疗保健政策
医学经济学医学经济学

背景情况:

医疗保险公司之间的整合引发了人们对手术程序定价的潜在影响的担忧.
保险市场竞争的减少可能会影响医疗服务的谈判价格.

研究的目的:

调查保险公司市场竞争与医院手术手术价格波动之间的关系.
分析保险公司的市场份额如何影响特定医疗程序的谈判价格.

主要方法:

2024年的一项横截面研究利用了9项手术的医院价格透明度规则的强制性数据.
谈判程序价格与凯泽家族基金会保险公司市场份额数据联系在一起,以评估市场竞争.
主要结果包括风险调整后的保险公司价格变化和不同市场竞争水平的价格差异.

主要成果:

医院手术的价格在不同保险公司内部和不同保险公司之间都存在显著的价格差异.
联合更换程序在Aetna,Anthem,BCBS,Kaiser和United等保险公司之间表现出相当大的价格差异.
在竞争较低的市场上,占主导地位的保险公司与非领先的保险公司相比,谈判的程序价格要低得多 (21.1%低).
相反,竞争激烈的市场显示,领先和非领先保险公司之间的谈判价格差异较小.

结论:

在保险公司竞争激烈的市场上,程序的谈判价格往往相似.
在竞争力较低的市场上,占主导地位的保险公司获得了较低的谈判价格.
加强保险商市场竞争可能会减少价格波动,并降低特定市场的程序成本.

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