As frustrating and unsustainable as relentlessly rising health care prices are, they are often the result of businesses responding to market incentives.
Getting prices under control requires establishing health market incentives that encourage competition and make it in a businesses best interests to improve the value of care rather than simply pushing prices to the breaking point.
We’ve had great success in working with the Texas Legislature to address market incentives that are not aligned with improving health plan value, including:
Banning anti-competitive contracting practices like gag-clauses, “most favored nation” clauses, and anti-steering and tiering clauses;
Banning anticompetitive, outdated laws and regulations that prevented health plans from providing customers with information about quality; and
Allowing primary care physicians and groups to enter into contracts that include capitation and other value-based incentives without penalty from health plans.
These reforms provide a strong foundation from which to continue aligning market incentives with value so that employers and their employees can get quality care at competitive price.
Practices tied to private equity, hospitals charge significantly more than independent radiology groups
“Our findings demonstrate significant differences in negotiated radiologic service prices by practice ownership, with hospital and PE-affiliated practices able to negotiate higher professional fees than independent practices,” corresponding author Yashaswini Singh, PhD, MPA, a healthcare economist and professor with the Providence, Rhode Island, institution, and colleagues concluded.
There’s too little antitrust enforcement in the US hospital sector
“From 2002 to 2020, there were over 1,000 mergers of US hospitals. During this period, the FTC took enforcement actions against 13 transactions. However, using the FTC’s standard screening tools, we find that 20 percent of these mergers could have been predicted to meaningfully lessen competition.”
How to halt the cycle of health care’s broken incentives
“The U.S. health care system isn’t broken by accident – it’s broken by design. But if we change the incentives, we can change the outcomes. The question is: “Are we willing to change the way we play?”
TXEAHC joins national effort to fight hospital pricing abuse
“Lawmakers have taken crucial steps towards unwinding abusive practices in the health care industry,” said Dr. Chris Skisak, executive director of TXEAHC. “But due to the distorted incentives that exist in the health care industry, corporations have gained monopoly powers. That results in unrelenting efforts to extract as much money as possible from Texas businesses and their employees.”