The growing power of some providers to win steep payment increases from insurers suggests policy remedies may be needed

Health Affairs

Volumn 31, Issue 5, 2012, Pages 973-981

  Berenson, Robert A ^a,b   Ginsburg, Paul B ^a   Christianson, Jon B ^c   Yee, Tracy ^a  

^a CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^b URBAN INSTITUTE   (United States)

^c UNIVERSITY OF MINNESOTA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HUMAN; LONGITUDINAL STUDY; MEDICAID; MEDICARE; PHYSICIAN; UNITED STATES;

DELIVERY OF HEALTH CARE; INSURANCE, HEALTH, REIMBURSEMENT; NEGOTIATING; POLICY MAKING; UNITED STATES;

EID: 84862491283     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0920     Document Type: Article

References (17)

1. Berenson RA, Ginsburg PB, Kemper N. Unchecked provider clout in California foreshadows challenges to health reform. Health Aff (Millwood). 2010;29(4):699-705.
2. Chernew ME, Sabik LM, Chandra A, Gibson TB, Newhouse JP. Geographic correlation between largefirm commercial spending and Medicare spending. Am J Manag Care. 2010; 16(2):131-8.
3. Schoenman JA, Chockley N. Understanding US health care spending [Internet]. Washington (DC): National Institute for Health Care Management Foundation; 2011 Jul [cited 2012 Mar 13]. (Data Brief). Available from:http://nihcm.org/images/stories/NIHCM-CostBrief-Email.pdf
4. Data from the Medicare Payment Advisory Commission find that commercial rates are 25 percent higher than Medicare rates for physicians and about 40 percent higher for hospitals. Medicare Payment Advisory Commission. Physician and other health professional services. In: Report to the Congress: Medicare payment policy. Washington (DC): MedPAC; 2011. p. 69-98.
5. For more information about the Community Tracking Study site visit methodology, see Center for Studying Health System Change. CTS site visits [Internet]. Washington (DC): HSC; [last updated 2012 Apr 9; cited 2012 Apr 12]. Available from: http://www.hschange.org/index.cgi?data=06
6. Medicare Payment Advisory Commission. Variation in private sector payment rates. In: Report to the Congress: Medicare and the health care delivery system. Washington (DC): MedPAC; 2011.
7. Ginsburg PB. Wide variation in hospital and physician payment rates evidence of provider market power. Washington (DC): Center for Studying Health System Change; 2010 Nov. (Research Brief No. 16).
8. SUNY Upstate Medical University Hospital recently merged with Community General Hospital; respondents expected that the merger would increase provider clout for each of the three remaining hospitals.
9. Melnick G, Keeler E. The effects of multi-hospital systems on hospital prices. J Health Econ. 2007;26(2): 400-13.
10. Cuellar AE, Gertler PJ. How the expansion of hospital systems has affected consumers. Health. Aff (Millwood). 2005;24(1):213-9.
11. Some states, including California, have "corporate practice of medicine" statutes that generally preclude hospitals from directly employing physicians. Some California hospitals are establishing medical foundations to simulate the effects of direct employment, although this work-around comes with greater complexity and higher costs.
12. Berenson RA, Bodenheimer T, Pham HH. Specialty-service lines: salvos in the new medical arms race. Health Aff (Millwood). 2006;25(5):w337-43. DOI: 10.1377/hlthaff.25.w337.
13. Casalino LP. The Federal Trade Commission, clinical integration, and the organization of physician practice. J Health Policy Polit. 2006; 31(3):569-85.
14. Cutler D, Dafny L. Designing transparency systems for medical care prices. N Engl J Med. 2011;364(10): 894-5.
15. Christianson JB, Tu HT, Samuel DR. Employer-sponsored health insurance: down but not out. Washington (DC): Center for Studying Health System Change; 2011 Oct. (Issue Brief No. 137).
16. Murray R. Setting hospital rates to control costs and boost quality: the Maryland experience. Health Aff (Millwood). 2009;28(5):1395-405.
17. McDonough JE. Tracking the demise of state hospital rate setting. Health Aff (Millwood). 1997;16(1):142-9.