JAMA Network July 22, 2019
Christopher F. Koller, MPPM, MAR; Dhruv Khullar, MD, MPP

The prices paid for hospital services have long had a strange dichotomy. For the 37% of the population insured by Medicare or Medicaid, prices are publicly available and generally increase slowly. By contrast, prices for the commercially insured population are privately negotiated, proprietary, and confidential. These rates are closely guarded by health plans, who are convinced that negotiating with clinicians and health care organizations on behalf of consumers is a source of competitive differentiation.

However, the black box of commercial insurer prices is slowly being pried open. Aggregated claims data have allowed for a deeper understanding of the size and variation in payments to hospitals, in particular, which represent the largest component of overall health care costs at approximately 40%....

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