The DOI matches its Crossref record; 48 of the 48 references it cites were found in a registry or an index.
Prices Paid to Hospitals by Private Health Plans: Findings from Round 4 of an Employer-Led Transparency Initiative
Open accessAbstract
Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits the ability of employers to knowledgeably develop or implement benefit design decisions. This study uses medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, and allows an easy comparison of hospital prices using a single metric. An important innovation of this study is that our data use agreements allow reporting on prices paid to hospitals and hospital systems (hospitals under joint ownership) identified by name.
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“private insurances often adopt Medicare models, and our estimates may be conservative since private insurers typically reimburse more than Medicare.”
From Program cost and return on investment analysis of remote patient monitoring for hypertension management in the cardiology department of a large healthcare system (2026) · cites this paper as [38]
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“another study found that in 2020, employers and private insurers paid 224 percent of what Medicare would have paid for the same services.38”
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Citations
Cites
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Cited by
Sorted by citations
Bonner, S. N., Thumma, J. R., Dimick, J. B., & Sheetz, K. H. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.15052 · Cited by 27
Options for states to constrain pricing power of health care providers
Gudiksen, K. L., & Murray, R. B. (2022) · Frontiers in Health Services · doi:10.3389/frhs.2022.1020920 · Cited by 17
Large self-insured employers lack power to effectively negotiate hospital prices
Eisenberg, M. D. (2021) · The American Journal of Managed Care · doi:10.37765/ajmc.2021.88702 · Cited by 17
Hospital resource allocation decisions when market prices exceed Medicare prices
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Site‐based payment differentials for ambulatory services among individuals with commercial insurance
Sen, A. P., Singh, Y., & Anderson, G. F. (2022) · Health Services Research · doi:10.1111/1475-6773.13935 · Cited by 14
Metadata
- Authors
- Whaley, C., Briscombe, B., Kerber, R., O'Neill, B., & Kofner, A.
- Venue
- RAND Health Quarterly
- Publisher
- Rand Corporation
- Published
- 2022
- Volume
- 10
- Issue
- 1
- Pages
- 5-5
- ISSN
- 2162-8254 (ISSN-L)
- PMC
- PMC9718062
- OpenAlex
- W4285121137
- Cited by
- 28
- References
- 48
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 9 · 2023: 8 · 2022: 3
- FWCI
- 4.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Rand health quarterly (publishedVersion)
- RAND Corporation eBooks (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- hospital prices, private health plans, employer-sponsored health insurance, price transparency, fiduciary obligations, benefit design, hospital systems, hospital ownership, health insurance claims data, health care costs
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