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Options for states to constrain pricing power of health care providers

Health care is becoming increasingly unaffordable for both individuals and employers and prices vary in nearly incomprehensible ways that do not correlate with quality. In many areas, consolidation of insurers and providers resulted in market failure that needs policy interventions. With federal gri...

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Detalles Bibliográficos
Autores principales: Gudiksen, Katherine L., Murray, Robert B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012805/
https://www.ncbi.nlm.nih.gov/pubmed/36925859
http://dx.doi.org/10.3389/frhs.2022.1020920
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author Gudiksen, Katherine L.
Murray, Robert B.
author_facet Gudiksen, Katherine L.
Murray, Robert B.
author_sort Gudiksen, Katherine L.
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description Health care is becoming increasingly unaffordable for both individuals and employers and prices vary in nearly incomprehensible ways that do not correlate with quality. In many areas, consolidation of insurers and providers resulted in market failure that needs policy interventions. With federal gridlock, state policymakers are seeking options for controlling health care costs in markets where competition has failed. In this article, we discuss a spectrum of options that policymakers have to more directly control healthcare prices: (1) establishing a cost-growth benchmark, (2) creating a public option, (3) capping or establishing a default out-of-network payment rate for health care services, (4) creating affordability standards that authorize the insurance commissioner to reject contracts with excessive rate increases, (5) creating global budgets for hospital-based care, (6) capping excessive prices and/or tiering allowed rate updates, and (7) creating a population-based payment model. We provide a roadmap for state policymakers to consider these options, review the experiences with states who have tried these models, and discuss additional design considerations that policymakers should consider with any of these models. In the 1970's and 1980's, during a time of rapid growth in health care prices and spending, states took a decisive leadership role in developing regulatory models to curb the growth in health care costs and improve affordability for their citizens. It is time for states to lead the nation once again in addressing the current health care cost and affordability crisis in the U.S.
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spelling pubmed-100128052023-03-15 Options for states to constrain pricing power of health care providers Gudiksen, Katherine L. Murray, Robert B. Front Health Serv Health Services Health care is becoming increasingly unaffordable for both individuals and employers and prices vary in nearly incomprehensible ways that do not correlate with quality. In many areas, consolidation of insurers and providers resulted in market failure that needs policy interventions. With federal gridlock, state policymakers are seeking options for controlling health care costs in markets where competition has failed. In this article, we discuss a spectrum of options that policymakers have to more directly control healthcare prices: (1) establishing a cost-growth benchmark, (2) creating a public option, (3) capping or establishing a default out-of-network payment rate for health care services, (4) creating affordability standards that authorize the insurance commissioner to reject contracts with excessive rate increases, (5) creating global budgets for hospital-based care, (6) capping excessive prices and/or tiering allowed rate updates, and (7) creating a population-based payment model. We provide a roadmap for state policymakers to consider these options, review the experiences with states who have tried these models, and discuss additional design considerations that policymakers should consider with any of these models. In the 1970's and 1980's, during a time of rapid growth in health care prices and spending, states took a decisive leadership role in developing regulatory models to curb the growth in health care costs and improve affordability for their citizens. It is time for states to lead the nation once again in addressing the current health care cost and affordability crisis in the U.S. Frontiers Media S.A. 2022-10-19 /pmc/articles/PMC10012805/ /pubmed/36925859 http://dx.doi.org/10.3389/frhs.2022.1020920 Text en Copyright © 2022 Gudiksen and Murray. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Services
Gudiksen, Katherine L.
Murray, Robert B.
Options for states to constrain pricing power of health care providers
title Options for states to constrain pricing power of health care providers
title_full Options for states to constrain pricing power of health care providers
title_fullStr Options for states to constrain pricing power of health care providers
title_full_unstemmed Options for states to constrain pricing power of health care providers
title_short Options for states to constrain pricing power of health care providers
title_sort options for states to constrain pricing power of health care providers
topic Health Services
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012805/
https://www.ncbi.nlm.nih.gov/pubmed/36925859
http://dx.doi.org/10.3389/frhs.2022.1020920
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