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来源类型 | Report |
规范类型 | 报告 |
DOI | https://doi.org/10.7249/RR4378 |
来源ID | RR-4378-RC |
The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care | |
Erin Lindsey Duffy; Christopher M. Whaley; Chapin White | |
发表日期 | 2020-03-12 |
出版年 | 2020 |
页码 | 59 |
语种 | 英语 |
结论 | Strict out-of-network payment limits on hospital care could yield savings similar to more-sweeping proposals, such as Medicare for All, rate setting, and global budgets
Although cost containment can benefit patients facing rising health costs, such changes are disruptive to hospital revenues
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摘要 | A bipartisan consensus has emerged around the need to address "surprise medical bills," and policymakers have shown a growing interest in using out-of-network payment limits as a tool to control rising health care spending in the United States. Such policies cap the total amount that hospitals and physicians can be paid when they are not in network and prohibit providers from billing patients for an excess balance. Medicare Advantage currently limits payments to out-of-network providers at traditional Medicare payment rates, and the state of Oregon has recently enacted an out-of-network payment limit for its public employee insurance plans. In addition, limits on out-of-network payments to hospitals have been proposed by U.S. senators and 2020 presidential candidates. However, there is a lack of information about the potential impacts of applying such payment limits broadly to hospital services. This lack of information is complicated by the nuanced role that out-of-network limits play in the negotiation process for in-network prices. To fill this gap, RAND researchers estimated the effects that four proposed out-of-network payment limits for hospital care—125 percent of Medicare payments (a strict limit), 200 percent of Medicare payments (a moderate limit), state average payment by private plans (a moderate limit), and 80 percent of average billed charges (a loose limit)—would have on negotiated in-network prices and total payments for hospital care. These four scenarios reflect the variation in base measure (traditional Medicare, market price, and charges) and payment generosity among existing policy proposals. |
目录 |
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主题 | Economic Burden of Health Care ; Health Care Cost Inflation ; Health Care Payment Approaches ; Health Care Reform ; Health Insurance Cost Sharing ; Health Insurance Markets ; Measuring Health Care Costs ; Medicare |
URL | https://www.rand.org/pubs/research_reports/RR4378.html |
来源智库 | RAND Corporation (United States) |
引用统计 | |
资源类型 | 智库出版物 |
条目标识符 | http://119.78.100.153/handle/2XGU8XDN/524031 |
推荐引用方式 GB/T 7714 | Erin Lindsey Duffy,Christopher M. Whaley,Chapin White. The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care. 2020. |
条目包含的文件 | ||||||
文件名称/大小 | 资源类型 | 版本类型 | 开放类型 | 使用许可 | ||
RAND_RR4378.pdf(580KB) | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 | ||
x1584018491459.jpg.p(1KB) | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 |
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