State of Healthcare: Policy Considerations to Constrain Commercial Prices
The continuous rise in healthcare spending compels states to consider adopting price-restraining policies that address the economic, geographic, and social needs of their residents. To explore these challenges, Catalyst for Payment Reform (CPR) tested stakeholder sentiments and policy receptiveness in three key states—Florida, Michigan, and Nevada—each chosen for their geographic, economic, and political diversity.
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This research highlighted some common themes across all three states that are likely applicable to others considering policy proposals to constrain health cost growth including:
- More than two-thirds of participants expressed interest in using state policy to lower healthcare prices.
- Stakeholders almost unanimously recognized the burden high prices place on healthcare purchasers and on patients but disagreed on the best methods to alleviate this pressure.
- Stakeholders other than hospitals expressed the most support for policies that ban facility fees for outpatient services; prohibit anti-tiering and anti-steering clauses in network contracts; and mandate that providers or health plans notify the state attorney general prior to mergers or acquisitions.
- Most stakeholders believe hospitals leverage the complexity of the healthcare system to overcharge patients for services and fight price-reducing policies. They view hospitals, not politicians or insurers, as the primary opponents of common-sense policies to constrain healthcare prices.
- Purchasers are enthusiastic about price-reducing health reforms that preserve their ability to choose among healthcare providers and plans, which can be partially accomplished by passing legislation to ban anti-competitive clauses from health plan and provider contracts.
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