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An Analysis of Private-Sector Prices for Physicians’ Services: Working Paper 2018-01

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  • Daria Pelech

Abstract

Physicians’ services account for a substantial portion of health care spending in the United States. Using 2014 claims data from three major insurers, we analyzed the prices paid for 20 common services and compared those prices with the estimated amounts that Medicare’s fee-for-service (FFS) program would pay for the same services. We found that average commercial prices were substantially higher than Medicare FFS prices and were up to three times higher out of network than in network. In contrast, average prices paid by those insurers in their Medicare Advantage plans were

Suggested Citation

  • Daria Pelech, 2018. "An Analysis of Private-Sector Prices for Physicians’ Services: Working Paper 2018-01," Working Papers 53441, Congressional Budget Office.
    • Handle: RePEc:cbo:wpaper:53441
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    File URL: https://www.cbo.gov/system/files/115th-congress-2017-2018/workingpaper/53441-workingpaper.pdf
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    References listed on IDEAS

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    1. Vilsa Curto & Liran Einav & Amy Finkelstein & Jonathan Levin & Jay Bhattacharya, 2019. "Health Care Spending and Utilization in Public and Private Medicare," American Economic Journal: Applied Economics, American Economic Association, vol. 11(2), pages 302-332, April.
    2. Clemens, Jeffrey & Gottlieb, Joshua D. & Molnár, Tímea Laura, 2017. "Do health insurers innovate? Evidence from the anatomy of physician payments," Journal of Health Economics, Elsevier, vol. 55(C), pages 153-167.
    3. McKnight, Robin, 2007. "Medicare balance billing restrictions: Impacts on physicians and beneficiaries," Journal of Health Economics, Elsevier, vol. 26(2), pages 326-341, March.
    4. Jared Lane Maeda & Lyle Nelson, 2017. "An Analysis of Private-Sector Prices for Hospital Admissions: Working Paper 2017-02," Working Papers 52567, Congressional Budget Office.
    5. Zack Cooper & Fiona Scott Morton & Nathan Shekita, 2020. "Surprise! Out-of-Network Billing for Emergency Care in the United States," Journal of Political Economy, University of Chicago Press, vol. 128(9), pages 3626-3677.
    6. Samuel Kleiner & William White & Sean Lyons, 2015. "Market power and provider consolidation in physician markets," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 99-126, March.
    7. Abe Dunn & Adam Hale Shapiro, 2014. "Do Physicians Possess Market Power?," Journal of Law and Economics, University of Chicago Press, vol. 57(1), pages 159-193.
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    Full references (including those not matched with items on IDEAS)

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    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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