HM820 - Class 9: Hospital Competition Flashcards
What is selective contracting
when payers only allow beneficiaries to be treated by certain providers.
The practice was an innovation in healthcare, introduced in the ≈1980s, and one that never went away.
This is a key way in which prices are set in the commercial market for healthcare.
Insurers do this through Preferred Provider Organization
Some facts about hospitals spending in the US
Hospital prices are a third of all healthcare spending. (Drugs are 10–15 percent.)
The biggest problem in healthcare today: high hospital prices.
What was the hip replacement pricing study and what did it find
Researcher called hospitals to see if she could get a price for fully out of pocket hip replacement.
Out of 102 hospitals, 16 could not provide a price at all.
Huge variation in quoted prices ($12,000-$125,000)
What did ECG study show (the follow up study to the hip-replacement study)
The ECG study demonstrated that even for a less complicated hospital service that most still wouldn’t quote a price AND the ones that did there was still huge variation.
“Among the 20 hospitals contacted, a price for an ECG could be obtained from only 3.
Two policy changes that have or could dramatically affect the hospital industry are: (1.) The ACA’s Medicaid Expansion and (2.) Medicare for All. How does the hospital industry feel about these two policy changes?
Supports the Medicaid expansion, does not support Medicare for All
