New research shows that the discounted cash prices set by hospitals for general operations are usually lower than the prices negotiated with insurance companies.

According to an analysis of the charging rates of 922 hospitals for what CMS calls “shopping” services, the proportion of hospitals that set cash prices below the median price of their commercial agreements ranges from 38.4% for liver examinations to 68.5% for C-sections . A study published in the Open Journal of the American Medical Association found that hospitals are unlikely to disclose the prices of more expensive services.

This finding surprised the researchers. They expected lower rates for business negotiations, because individuals have lower bargaining power than insurance companies.

“This tells us that there are some inefficiencies in the commercial insurance purchase process,” said Ge Bai, a professor of accounting at Johns Hopkins University and co-author of the study. Administrative costs Included in the agreed price. “I have always been skeptical of the view that the interests of insurance companies are aligned with patients and payers-they have no fiduciary duty to best serve patients.”

The approximately 26 million uninsured Americans usually pay the cash rate unilaterally set by the hospital.Hospitals usually set these prices based on their billing supervisor, which lists Overestimation of the “total cost” of the programThese documents have been hidden from the public until the price transparency requirements come into effect on January 1.

In addition to publishing their toll collectors, the hospitals were also required to post machine-readable documents and discounted cash prices for the 300 “shopping services” rates they negotiated with the payers. The Centers for Medicare and Medicaid Services hope these prices Can suppress above-average prices.

But compliance is uneven—according to the study, only 922 of the 5,359 hospitals reviewed by Turquoise Health published cash prices and negotiated commercial prices for 70 basic services.Some hospitals will Choose to pay a fine, Which may be as high as $2 million per year, instead of disclosing their pricing data.

“The more expensive hospital services, the less they want to disclose prices,” said John (Xuefeng) Jiang, a professor of accounting at Michigan State University and the study’s lead author.

More Americans are Circumvent their insurance at the pharmacy counter, Although this practice seems to be less common in hospitals.According to the Caesars Family Foundation, by 2020, nearly half of the workforce will participate in a high-deductible health plan data, Which means that they will pay for the prescription or surgery out of their pockets until the deductible is reached.

Bai said that if more patients accept the discounted cash price, this may incentivize insurance companies to negotiate better deals with suppliers. She said that policymakers can encourage patients to pay for daily services directly and provide subsidies for health savings accounts for those who are economically disadvantaged.

“The prices of these services vary greatly-this tells us that competition is limited,” Bai said.

The commercial price of surgery varies greatly between different hospitals, and even between the types of payers in the same hospital. The price of a Caesarean section in a large hospital network in California ranges from US$7,634 to US$70,553. data Display from the Institute of Health Care Costs.