All ETDs from UAB

Advisory Committee Chair

Eric W Ford

Advisory Committee Members

Doug Ayers

Olena Mazurenko

Lisa C McCormick

Andrew Rucks

Document Type

Dissertation

Date of Award

2020

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Hospital pricing is not uniformly disclosed to patients up-front before the delivery of healthcare. Moreover, pricing is not commonly understood by consumers and researchers, because the information was largely unavailable due to the lack of a federal policy mandate to make the information publicly available up until recently. The federal government instituted a series of regulations that initially began to take effect in 2019 in order to increase hospital pricing transparency with the aim of bending the healthcare cost curve. In this dissertation, hospital response, hospital standard charge variation, and healthcare management and policy expert opinion surrounding the implementation of U.S. healthcare pricing transparency are studied. Compliance testing, sentiment analysis, variance analysis, differential statistical analysis, multivariate analyses, and survey assessment were used to this end in order to better understand complexity in hospital pricing. Various data sources were utilized. Primary data was collected for a random, cross-sectional sample of U.S. hospitals as well as for survey responses from healthcare experts. Secondary data sets were also utilized, such as the American Hospital Association Annual Surveys or Hospital Compare. The data showed many hospitals were not presenting pricing data in a useful manner in accordance with the law. Additionally, the standard charges for similar hospital services presented extreme price variation across America. In particular, medical type services (as opposed to surgical type services) displayed the greatest variation. Importantly, chargemaster data also showed that there iv were various statistically significant indicators of hospital quality associated either positively or negatively with standard charges. Finally, healthcare experts did not unanimously expect the full intended implementation to take effect for the hospital pricing transparency regulation of 2021, meaning there might be delays and/or alterations in the public availability of negotiated pricing information for 300 ‘shoppable’ services at each American hospital. They also believe consumers are unlikely to utilize this information to make informed healthcare decisions. On the contrary, they optimistically believe the disclosure of such information will indeed aid in bending the healthcare cost curve. Lastly, healthcare experts believe the American healthcare system will face significant challenges in producing and making use of negotiated insurance pricing information.

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