Prices

The “No Surprises Act,” which establishes new federal protections against most surprise out-of-network medical bills when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice, will take effect next month. A new KFF brief outlines what to expect in 2022.

This analysis examines transparency data currently shared by hospitals to comply with federal law and finds that they are messy, inconsistent and confusing, making it challenging if not impossible for patients or researchers to use them to compare prices. Many of these shortcomings stem from a lack of specificity in the requirements for what hospitals must report.

Since 2021, federal law has required hospitals to publicly post information about their standard prices and negotiated discount rates for common health services to encourage consumers to compare prices and to promote competition. To date, however, the transparency data currently shared by hospitals to comply with the law are messy,…

This brief explains the role of federal and state antitrust agencies in challenging anticompetitive practices among hospitals and other health care providers, including the legal authority of federal and state agencies, the role that they play in enforcing antitrust laws, and proposed options for strengthening their authority.

This brief explains the role and implications of cross-market mergers between hospitals and health systems that operate in different regions and describes the approaches that government antitrust agencies have taken in reviewing these types of transactions.

Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. This brief provides resources to privately insured patients who receive surprise balance bills and also summarizes relevant policies and how they apply to balance billing.

Promoting price transparency in health care is a policy approach with bi-partisan support in Congress and the public at large. This analysis examines the vast troves of price transparency data that payers are required and finds unlikely prices, inconsistencies, and other oddities that pose major challenges for efforts to use it to promote competition and drive down prices.

This brief analyzes prices for medical care compared to other goods and services using consumer price index (CPI) and producer price index (PPI) data. Overall prices grew by 3.5% in March 2024 from the previous year, while prices for medical care increased by only 2.2%.

This analysis finds that Medicare’s negotiated prices for 10 high-expenditure prescription drugs are lower than what private Medicare drug plans had been paying, but still much higher than the prices available in 11 other wealthy nations.. It is available on the Peterson-KFF Health System Tracker.

As policymakers and regulators pay more attention to consolidation in health care provider markets, this brief examines and summarizes the evidence about consolidation, including recent trends, the impact on prices and quality, and proposals to address consolidation and increase competition.