National Institute for Health Care Reform
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Payment Policy and Benefit Design
The Role of Competition
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The Role of Competition
High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power
HSC Research Brief No. 27
Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients--especially for outpatient care--are much higher than Medicare and vary widely within and across communities, according to a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, ...
Contrary to Cost-Shifting Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates
, Vol. 32, No. 5
Contrary to the notion that hospitals charge private payers higher payment rates to offset lower Medicare rates, it turns out the opposite is truelower Medicare payment rates lead to lower private rates for inpatient care, according to a study by the Center for Studying Health System Change (HSC) ...
Addressing Hospital Pricing Leverage through Regulation: State Rate Setting
NIHCR Policy Analysis No. 9
Amid growing evidence that rising prices—especially for hospital care—play a key role in rising premiums for privately insured people, policy makers may want to revisit a tool—rate setting—used decades ago by a number of states to constrain hospital costs, according to a new Policy ...
Limited Options to Manage Specialty Drug Spending
HSC Research Brief No. 22
Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change (HSC). The study was ...
Hospital Geographic Expansion: The New Medical Arms Race?
, Vol. 31, No. 4
Hospitals’ longstanding competitive focus on cutting-edge technology, niche specialty services and amenities to attract physicians and patients has set the stage for the next chapter in hospital competitiontargeted geographic expansion into new markets with well-insured people, according ...
State Benefit Mandates and National Health Reform
NIHCR Policy Analysis No. 8
While the national health reform law requires states to pay for health benefit mandates that exceed a minimum package of covered services, states' financial liability for mandates is likely to be relatively small, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for ...
Health Status and Hospital Prices Key to Regional Variation in Private Health Care Spending
NIHCR Research Brief No. 7
Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices--especially for hospital care--also play a key role, accordingto a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit ...
Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients
Community Report No. 12
Indianapolis’ major hospital systems continue to encroach on each other’s traditional territories, engaging in a battle of bricks and mortar in suburban areas to compete for well-insured patients, according to a new Community Report released today by the Center for Studying Health System ...
Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs
NIHCR Policy Analysis No. 6
While federal and state policy makers face many complex decisions about the design and operation of new state-based health insurance exchanges, the overarching goal of the exchanges is straightforward—promoting healthy competition among insurers to provide better health care at lower total cost, ...
Reforming Provider PaymentThe Price Side of the Equation
New England Journal of Medicine
, Vol. 365, No. 14
It’s pretty basic economics: spending equals price times quantity. For some time, public health care payers, such as Medicare and Medicaid, have focused much of their cost-containment effort on constraining the prices they pay for health care services, which they set administratively. The Affordable ...
Oct. 6, 2011
Economic Downturn Strains Miami Health Care System
Community Report No. 11
Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a new Community Report released today by the Center for ...
Health Care Provider Market Power
Statement of Paul B. Ginsburg, Ph.D. President, Center for Studying Health System Change Research Director, National Institute for Health Care Reform (NIHCR). Before the U.S. House of Representatives Ways and Means Committee, Subcommittee on Health. Hearing on "Health Care Industry Consolidation"
Sept. 9, 2011
Rising Hospital Employment of Physicians: Better Quality, Higher Costs?
HSC Issue Brief No. 136
While not new, the pace of hospital employment of physicians has quickened in many communities, driven largely by hospitals' quest to increase market share and revenue, according to a study released today by the Center for Studying Health System Change (HSC). The study was funded jointly by the Robert ...
Physicians Key to Health Maintenance Organization Popularity in Orange County
Community Report No. 10
The extent of health plan delegation of financial risk and utilization management to physicians caring for health maintenance organization (HMO) enrollees makes Orange County stand out from many health care markets, according to a new Community Report released by the Center for Studying Health System ...
Syracuse Health Care Market Works to Right-Size Hospital Capacity
Community Report No. 9
Largely stable over the last three years, the Syracuse health care market continues to grapple with the challenge of finding the right level and mix of hospital capacity, according to a new Community Report by the Center for Studying Health System Change (HSC). The study was funded jointly by the Robert ...
Economic Downturn Slows Phoenix’s Once-Booming Health Care Market
Community Report No. 8
After more than a decade of rapid population growth and a thriving economy, Phoenix’s once-booming health care market has adopted a more cautious outlook amid the lingering effects of the great recession, according to a new Community Report by the Center for Studying Health System Change (HSC). ...
Key Findings from HSC’s 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform
HSC Issue Brief No. 135
Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change’s ...
Health Care Certificate-of-Need (CON) Laws: Policy or Politics?
NIHCR Research Brief No. 4
Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a ...
Lansing’s Dominant Hospital, Health Plan Strengthen Market Positions
Community Report No. 7
In an insular market wary of outsiders, Lansing’s dominant hospital system—Sparrow Health System—and health plan—Blue Cross Blue Shield of Michigan—have reinforced their already-strong market positions, according to a Community Report by the Center for Studying Health System ...
Greenville & Spartanburg: Surging Hospital Employment of Physicians Poses Opportunities and Challenges
Community Report No. 6
In an area already notable for high rates of physician employment, the two largest hospital systems in Greenville and Spartanburg, S.C., have greatly increased employment of physicians with an eye toward capturing more referrals and admissions, according to a new Community Report released today by the ...
The National Institute for Health Care Reform contracts with the Center for Studying Health System Change (HSC) to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States.
© 2012 National Institute for Health Care Reform.
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