Thread by @lorenanthes

#Ohio hospitals charge about 241% of Medicare rates to private insurers.

Let's look into this a bit...

https://twitter.com/kschroederDDN/status/1130464143960682497

Some argue transparency will help. If consumers are informed, they can shop.

Research has documented how this does not work: 1) khn.org/news/as-hospit…

2) jamanetwork.com/journals/jama/…

Providers often argue they HAVE to increase prices because Medicare doesn't pay enough to cover their costs.

But high spending is an outgrowth of a few factors, including prices for labor and goods, Rx and DME, and admin:

jamanetwork.com/journals/jama/…

Well what about mergers? In most economic contexts, the scale that comes from consolidation mean lower prices. There's lots of M&A with hospitals, so we should be getting lower prices, right?

Nope:
advisory.com/daily-briefing…

OK, but what about the patient? Shouldn't they bare some of the responsibility here? Shouldn't they better utilize services?

Well, we don't spend much on social services (social determinants): well.blogs.nytimes.com/2013/11/21/spe…

We also don't utilize services more than other countries and some countries (like Japan) use much more tech, so that's not the issue either: ajmc.com/newsroom/healt…

And we've already been increasing cost-sharing for patients across the board. That isn't affecting price: healthsystemtracker.org/brief/increase…

To recap:
1) prices are illogical (healthaffairs.org/doi/10.1377/hl…)
2) transparency doesn't work
3) utilization and "skin in the game" isn't going to solve this problem
4) scale isn't going to solve this problem

This issue does not start/end w/PBMs, they're just an example.