Cover: Transparency in Coverage Data and Variation in Prices for Common Health Care Services

Transparency in Coverage Data and Variation in Prices for Common Health Care Services

Published in: JAMA Health Forum, Volume 4, Issue 10, e233663 (2023). doi: 10.1001/jamahealthforum.2023.3663

Posted on Nov 6, 2023

by Benjamin L. Chartock, Kosali Ilayperuma Simon, Christopher M. Whaley

Over half of the US population receives health insurance from private insurers, and prices are negotiated rather than set administratively (eg, Medicare). This negotiation process contributes to a landscape in which private insurance prices are both higher than Medicare rates and highly variable. The private market lacked meaningful price transparency for patients and purchasers until the recent implementation of Hospital Price Transparency and Transparency in Coverage (TiC) rules. Lack of transparency limits the ability of regulators to monitor prices and of employers, patients, and purchasers to impose market discipline on prices. We examined TiC price data for common services from Humana, a large national insurer, and highlighted use cases of such novel data for future research. New TiC payer data are released each month by all payers. Informed health care consumerism is a potential lever for managing costs and improving patient satisfaction.

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