医疗保健价格透明化的雇主策略。

IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-07-31 DOI:10.1089/pop.2024.0085
Ronald J Ozminkowski
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引用次数: 0

摘要

本文介绍了美国和世界部分国家的医院、保险和药品价格透明政策及应用。其中许多政策适用于自保雇主。迄今为止,美国和其他国家的经验表明,联邦和各州的价格透明法规对雇员或家属寻找低成本或高质量的医疗服务提供者,或对其医疗保健的成本和质量影响甚微。这是因为监管不力、联邦和各州的报告要求相互冲突,以及医疗服务提供者和保险公司几乎没有提供易读或可分析价格信息的经济激励。然而,价格透明度要求将继续存在。因此,本文提出了几项建议,以最大限度地发挥雇主、医疗服务提供者、商业保险公司或技术公司为雇员和其他被保险人提供的价格透明工具的效用。从政策角度来看,将报告要求与更明确的技术指导和更有力的监管相结合,将提高价格透明度工作的效用。对于个人雇主而言,将价格透明工具与医疗计划网络和设计策略、行为经济学引导以及旨在改善健康、福利和医疗质量的计划相结合,可以提高价格透明工作的影响力。许多计划供应商合作伙伴、顾问以及精算、技术和研究公司都可以帮助这些工作发挥作用。
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Employer Strategies for Health Care Price Transparency.

This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.

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来源期刊
Population Health Management
Population Health Management 医学-卫生保健
CiteScore
4.10
自引率
4.00%
发文量
81
审稿时长
6-12 weeks
期刊介绍: Population Health Management provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices. Population Health Management coverage includes: Clinical case reports and studies on managing major public health conditions Compliance programs Health economics Outcomes assessment Provider incentives Health care reform Resource management Return on investment (ROI) Health care quality Care coordination.
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