Open Access Journal Article

Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area

by Sebastian van Baal a,* orcid  and  Jordan M. Strang a
a
CBS International Business School, Cologne, Germany
*
Author to whom correspondence should be addressed.
Received: 8 February 2024 / Accepted: 30 March 2024 / Published Online: 24 April 2024

Abstract

The Hospital Price Transparency Final Rule aims at reducing the cost of healthcare in the United States by making information about the prices of medical services more readily available to market participants. The economic rationale is that higher price transparency should reduce the level and the dispersion of prices by disincentivizing hospitals from charging higher prices than possible. Using data on 3789 prices for three diagnostic imaging procedures and on the compliance with the rule for 86 acute care hospitals in the Greater Los Angeles area, we test the hypothesis that price levels and price dispersion are lower among hospitals that are more compliant. We do not reject this hypothesis, although we do not observe strictly decreasing relationships in all analyses. Prices are lower at hospitals with high or medium compliance than at hospitals with low compliance, but there is not a clear difference between hospitals with high and hospitals with medium compliance. Prices are less dispersed among hospitals with high compliance than among hospitals with low compliance, but the evidence for hospitals with medium compliance is less clear. We conclude that high compliance with the Hospital Price Transparency Final Rule implies lower prices and less price dispersion among hospitals.


Copyright: © 2024 by van Baal and Strang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor 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.

Share and Cite

ACS Style
van Baal, S.; Strang, J. M. Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area. Journal of Information Economics, 2024, 2, 24. https://doi.org/10.58567/jie02010003
AMA Style
van Baal S, Strang J M. Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area. Journal of Information Economics; 2024, 2(1):24. https://doi.org/10.58567/jie02010003
Chicago/Turabian Style
van Baal, Sebastian; Strang, Jordan M. 2024. "Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area" Journal of Information Economics 2, no.1:24. https://doi.org/10.58567/jie02010003
APA style
van Baal, S., & Strang, J. M. (2024). Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area. Journal of Information Economics, 2(1), 24. https://doi.org/10.58567/jie02010003

Article Metrics

Article Access Statistics

References

  1. Albæk, S., Møllgaard, P., and Overgaard, P. B. (1997). Government-assisted oligopoly coordination? A concrete case. The Journal of Industrial Economics, 45(4), 429–443. https://doi.org/10.1111/1467-6451.00057
  2. American Medical Association. (2021). Competition in health insurance: A comprehensive study of U.S. markets (2021 update). Retrieved April 18, 2022, from https://www.ama-assn.org/health-care-advocacy/advocacy-update/oct-8-2021-advocacy-update-spotlight-health-insurance
  3. American Medical Association. (2022). Competition in health insurance: A comprehensive study of U.S. markets (2022 update). Retrieved July 4, 2023, from https://www.ama-assn.org/delivering-care/patient-support-advocacy/competition-health-care-research
  4. Araich, H., Tran, J., Jung, J., Horný, M., and Sadigh, G. (2023). Healthcare price transparency in North America and Europe. British Journal of Radiology, 96(1151). https://doi.org/10.1259/bjr.20230236
  5. Babcock, P. (2019). Paralyzed by prices: An analysis of price theory within the context of health care. The Linacre Quarterly, 86(1), 89–102. https://doi.org/10.1177/0024363919837861
  6. Baye, M. R., Morgan, J., and Scholten, P. (2006). Information, search, and price dispersion. In T. Hendershott (Ed.), Handbooks in information systems, Vol. 1: Economics and information systems (pp. 323–375). Elsevier.
  7. Brown, Z. Y. (2019). Equilibrium effects of health care price information. The Review of Economics and Statistics, 101(4), 699–712. https://doi.org/10.1162/rest_a_00765
  8. Centers for Medicare and Medicaid Services. (2019). Medicare and Medicaid programs: CY 2020 hospital outpatient PPS policy changes and payment rates and ambulatory surgical center payment system policy changes and payment rates. Price transparency requirements for hospitals to make standard charges public. Federal Register, 84(229), 65524–65606. https://www.govinfo.gov/content/pkg/FR-2019-11-27/pdf/2019-24931.pdf
  9. Centers for Medicare and Medicaid Services. (2023). NHE fact sheet. National Health Expenditure Data. Retrieved July 12, 2023, from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet
  10. Chen, J., and Miraldo, M. (2022). The impact of hospital price and quality transparency tools on healthcare spending: A systematic review. Health Economics Review, 12, Article 62. https://doi.org/10.1186/s13561-022-00409-4
  11. Comanor, W. S., Frech, H. E., III, and Miller, R. D., Jr. (2006). Is the United States an outlier in health care and health outcomes? A preliminary analysis. International Journal of Health Care Finance and Economics, 6, 3–23. https://doi.org/10.1007/s10754-006-6863-8
  12. Cooper, Z., Craig, S. V., Gaynor, M., and Van Reenen, J. (2019). The price ain't right? Hospital prices and health spending on the privately insured. The Quarterly Journal of Economics, 134(1), 51–107. https://doi.org/10.1093/qje/qjy020
  13. Council for Community and Economic Research. (2016). Cost of living index. Retrieved May 2, 2022, from https://www.coli.org
  14. Desai, S. M., Hatfield, L. A., Hicks, A. L., Sinaiko, A. D., Chernew, M. E., Cowling, D., Gautam, S., Wu, S, and Mehrotra, A. (2017). Offering a price transparency tool did not reduce overall spending among California public employees and retirees. Health Affairs, 36(8), 1401–1407. https://doi.org/10.1377/hlthaff.2016.1636
  15. Desai, S. M., Shambhu, S., and Mehrotra, A. (2021). Online advertising increased New Hampshire residents’ use of provider price tool but not use of lower-price providers. Health Affairs, 40(3), 521–528. https://doi.org/10.1377/hlthaff.2020.01039
  16. Emanuel, E. J., and Diana, A. (2021). Considering the future of price transparency initiatives – Information alone is not sufficient. JAMA Network Open, 4(12). https://doi.org/10.1001/jamanetworkopen.2021.37566
  17. Frost, A., and Newman, D. (2016). Spending on shoppable services in health care (Issue Brief No. 11). Health Care Cost Institute. https://healthcostinstitute.org/images/easyblog_articles/110/Shoppable-Services-IB-3.2.16_0.pdf
  18. Glied, S. A., and Zhu, B. (2020). Catastrophic out-of-pocket health care costs: A problem mainly for middle-income Americans with employer coverage (Issue Brief). The Commonwealth Fund. https://doi.org/10.26099/x0cx-cp48
  19. Gourevitch, R. A., Desai, S., Hicks, A. L., Hatfield, L. A., Chernew, M. E., and Mehrotra, A. (2017). Who uses a price transparency tool? Implications for increasing consumer engagement. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 1–5. https://doi.org/10.1177/0046958017709104
  20. Graboyes, R. F., and McBirney, J. (2020). Price transparency in healthcare: Apply with caution. Mercatus Research, Mercatus Center at George Mason University. http://dx.doi.org/10.2139/ssrn.3684790
  21. Gul, Z. G., Sharbaugh, D. R., Guercio, C. J., Pelzman, D. L., Jones, C. A., Hacker, E. C., Anyaeche, V. I., Bowers, L., Shah, A. M., Stencel, M. G., Yabes, J. G., Jacobs, B. L., and Davies, B. J. (2023). Large variations in the prices of urologic procedures at academic medical centers 1 year after implementation of the price transparency final rule. JAMA Network Open, 6(1). https://doi.org/10.1001/jamanetworkopen.2022.49581
  22. Gunja, M. Z., Gumas, E. D., and Williams, R. D. (2023). U.S. health care from a global perspective, 2022: Accelerating spending, worsening outcomes (Issue Brief). The Commonwealth Fund. https://doi.org/10.26099/8ejy-yc74
  23. Han, A., Lee, K.-H., and Park, J. (2022). The impact of price transparency and competition on hospital costs: A research on all-payer claims databases. BMC Health Services Research, 22, Article 1321. https://doi.org/10.1186/s12913-022-08711-x
  24. Haque, W., Ahmadzada, M., Janumpally, S., Haque, E., Allahrakha, H., Desai, S., and Hsiehchen, D. (2022). Adherence to a federal hospital price transparency rule and associated financial and marketplace factors. JAMA, 327(21), 2143–2145. https://doi.org/10.1001/jama.2022.5363
  25. Harrington, J. E., Jr. (2012). A theory of tacit collusion (Working Paper No. 588). The Johns Hopkins University, Department of Economics. http://hdl.handle.net/10419/101362
  26. Jiang, J. X., Krishnan, R., and Bai, G. (2023). Price transparency in hospitals – Current research and future directions. JAMA Network Open, 6(1). https://doi.org/10.1001/jamanetworkopen.2022.49588
  27. Jiang, J. X., Polsky, D., Littlejohn, J., Wang, Y., Zare, H., and Bai, G. (2022). Factors associated with compliance to the hospital price transparency final rule: A national landscape study. Journal of General Internal Medicine, 37(14), 3577–3584. https://doi.org/10.1007/s11606-021-07237-y
  28. Liss, S., and Sumida, N. (2021, March 11). Hospitals lift curtain on prices, revealing giant swings in pricing by procedure. Healthcare Dive. Retrieved July 12, 2023, from https://www.healthcaredive.com/news/hospitals-price-transparency-spotty-compliance-swings-price/596183
  29. Mehrotra, A., Dean, K. M., Sinaiko, A. D., and Sood, N. (2017). Americans support price shopping for health care, but few actually seek out price information. Health Affairs, 36(8), 1392–1400. https://doi.org/10.1377/hlthaff.2016.1471
  30. Nelson, P. (1974). Advertising as information. Journal of Political Economy, 82(4), 729–754. https://doi.org/10.1086/260231
  31. Newman, D., Parente, S. T., Barrette, E., and Kennedy, K. (2016). Prices for common medical services vary substantially among the commercially insured. Health Affairs, 35(5), 923–927. https://doi.org/10.1377/hlthaff.2015.1379
  32. Nunnally, J. C., and Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.
  33. Parente, S. T. (2023). Estimating the impact of new health price transparency policies. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60, 1–7. https://doi.org/10.1177/00469580231155988
  34. Rosko, M., Al-Amin, M., and Tavakoli, M. (2020). Efficiency and profitability in US not-for-profit hospitals. International Journal of Health Economics and Management, 20, 359–379. https://doi.org/10.1007/s10754-020-09284-0
  35. Schenker, N., and Gentleman, J. F. (2001). On judging the significance of differences by examining the overlap between confidence intervals. The American Statistician, 55(3), 182–186. https://doi.org/10.1198/000313001317097960
  36. Shadish, W. R., Cook, T. D., and Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Houghton Mifflin.
  37. Sinaiko, A. D., and Rosenthal, M. B. (2016). Examining a health care price transparency tool: Who uses it, and how they shop for care. Health Affairs, 35(4), 662–670. https://doi.org/10.1377/hlthaff.2015.0746
  38. Spence, M. (1973). Job market signaling. The Quarterly Journal of Economics, 87(3), 355–374. https://doi.org/10.2307/1882010
  39. Stigler, G. J. (1961). The economics of information. Journal of Political Economy, 69(3), 213–225. https://doi.org/10.1086/258464
  40. Telesford, I., Rakshit, S., McGough, M., Wager, E., and Amin, K. (2023, February 7). How has U.S. spending on healthcare changed over time? Peterson-KFF Health System Tracker. Retrieved July 10, 2023, from https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time
  41. Tu, H. T., and Gourevitch, R. A. (2014). Moving markets: Lessons from New Hampshire’s health care price transparency experiment. California Healthcare Foundation and Robert Wood Johnson Foundation. https://www.chcf.org/wp-content/uploads/2017/12/PDF-MovingMarketsNewHampshire.pdf
  42. Tu, H. T., and Lauer, J. R. (2009). Impact of health care price transparency on price variation: The New Hampshire experience (Issue Brief No. 128). Center for Studying Health System Change. http://www.hschange.org/CONTENT/1095/1095.pdf
  43. Turquoise Health. (2022). Research dataset. Retrieved April 25, 2022, from https://turquoise.health/researchers
  44. Whaley, C. (2019). Provider responses to online price transparency. Journal of Health Economics, 66, 241–259. https://doi.org/10.1016/j.jhealeco.2019.06.001
  45. Whaley, C., Brown, T., and Robinson, J. (2019). Consumer responses to price transparency alone versus price transparency combined with reference pricing. American Journal of Health Economics, 5(2), 227–249. https://doi.org/10.1162/ajhe_a_00118
  46. Whaley, C., Schneider Chafen, J., Pinkard, S., Kellerman, G., Bravata, D., Kocher, R., and Sood, N. (2014). Association between availability of health service prices and payments for these services. JAMA, 312(16), 1670–1676. https://doi.org/10.1001/jama.2014.13373
  47. White, C., and Eguchi, M. (2014). Reference pricing: A small piece of the health care price and quality puzzle (Research Brief No. 18). National Institute for Health Care Reform. https://www.nihcr.org/wp-content/uploads/2016/07/Research_Brief_No._18.pdf
  48. Wu, S., Sylwestrzak, G., Shah, C., and DeVries, A. (2014). Price transparency for MRIs increased use of less costly providers and triggered provider competition. Health Affairs, 33(8), 1391–1398. https://doi.org/10.1377/hlthaff.2014.0168
  49. Zhang, A., Prang K.-H., Devlin, N., Scott, A., and Kelaher, M. (2020). The impact of price transparency on consumers and providers: A scoping review. Health Policy, 124(8), 819–825. https://doi.org/10.1016/j.healthpol.2020.06.001
  50. Zhang, X., Haviland, A., Mehrotra, A., Huckfeldt, P., Wagner, Z. and Sood, N. (2018). Does enrollment in high-deductible health plans encourage price shopping? Health Services Research, 53(S1), 2718–2734. https://doi.org/10.1111/1475-6773.12784