Health care is not the only industry in which price transparency(also called "sunshine policy", Many proponents of price transparency favor complete disclosure of all prices paid to every provider by every payer for every service. This strategy of openness resonates with a population frustrated by secret deals and payoffs that contribute to escalating costs, and it follows the lead of the Physician Payments Sunshine Act, which will establish a searchable database of all payments from pharmaceutical and device companies to physicians.) and MFN agreements ("most-favored nation") have led to higher prices.
政策危害：
Applying the sunshine rule in the provider–payer context, however, could have the opposite of the intended effect: it could actually raise prices charged to patients. To understand why, consider the case in which a well-regarded hospital contracts with two insurers. Suppose the hospital charges a lower price to Insurer 1 because otherwise Insurer 1 would steer patients to a different institution. If the hospital must publicly reveal both prices, it will be less likely to offer the low price to Insurer 1, because Insurer 2 would then pressure the hospital to lower its price as well. So the sunshine policy would create a perverse incentive for the hospital to raise prices (on average), and as a result its rivals could do the same. This adverse effect of price transparency would arise only in cases in which the buyer or supplier in question had some leverage (market power), but such leverage is fairly common in health care settings, including many local hospital markets.
实证研究：
Two recent studies found no effect of hospital price transparency in New Hampshire or California, but these analyses were (of necessity) limited to 1 or 2 years of post-initiative data.1,2
对策：
To stimulate price competition, we believe that transparency initiatives should encourage or mandate disclosure of plan-specific patient copayments. Copayments, after all, are what patients actually pay. To make copayment information most salient, it should be presented in a way that reflects and improves upon consumer decision making. As Sinaiko and Rosenthal observe in their Perspective article in this issue of the Journal (pages 891–894), episode-based payments are more helpful than piecemeal reporting, and quality data should accompany prices.
总结：
The effort to promote cost-consciousness in health care is both noteworthy and laudable. Just as in other industries, consumers need to know what they are on the hook for when they purchase medical care. But complete transparency of prices negotiated between payers and providers could raise costs instead of lowering them, especially in markets where there is some degree of pricing power and where consumers are imperfect decision makers.
- Tu HT, Lauer J. Impact of health care price transparency on price variation: the New Hampshire experience. Issue brief no. 128. Washington, DC: Center for Studying Health System Change, 2009.
- Austin A, Gravelle G. Report for Congress: Does price transparency improve market efficiency? Implications of empirical evidence in other markets for the health sector. Washington, DC: Congressional Research Service, 2008.
