By Sabrina Corlette, Megan Houston, Maanasa Kona, Rachel Schwab, and Nia Gooding from the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute.
High and rising health care costs are projected to consume 20 percent of the U.S. economy by 2027, squeezing workers’ wages, reducing our economic competitiveness, and forcing difficult budgeting decisions for federal and state policymakers. The primary reason health care costs disproportionately more in the United States than in other developed countries – without better health outcomes – is the prices we pay for health care goods and services. And in the commercial insurance market, which covers almost 180 million Americans under the age of 65, the biggest driver of health care costs is the price insurers pay for hospital-based services.
Knowing what providers, particularly hospitals, are being paid, and by whom, can be useful for those seeking to control costs and improve affordability, including health care services researchers, employers who purchase health coverage, and health insurance regulators. Recent federal regulations require hospitals and health plans to publicly post their prices. But before any researcher, purchaser, or regulator can act on them, these data need to be accessible and in a format that can be analyzed. However, many hospitals have yet to comply with the new transparency requirements, and the data they have posted has in some cases been hidden from web search engines or provided in a format that makes analysis difficult.
We wanted to gain insights into the potential for this data and generate ideas for how to optimize the information to help reduce health system costs. In June we convened a meeting of 21 of the smartest health care researchers, purchasers, and insurance regulators from around the country. The group generated several recommendations to enhance regulatory oversight and enforcement, improve data access and standardization, and enable connections to available data on clinical quality and Medicare and Medicaid rates. These ideas, if implemented, could help researchers more accurately measure price variation and inform innovations in public policy, empower employers to be smarter purchasers of health coverage, and enable regulators to enhance their oversight of proposed premium rates or enforce state-level caps on cost growth.
You can read the full report and the group’s recommendations here.