Benefits Think The price variation hiding inside your health plan

Published 4 Min Read

Medical billing statement, stethoscope and calculator
Adobe Stock

A recent Wall Street Journal analysis showed that Americans pay roughly four times what patients in peer countries pay for routine medical procedures. That gap is real and well documented. But the hospital pricing data now available under federal transparency mandates reveals something arguably more actionable: The price variation within a single American state is just as large as the gap between the United States and the rest of the developed world.

For more than five decades, researchers and policymakers have called for transparency in hospital pricing. The idea was simple: If patients, employers, and insurers could see what hospitals actually charge, the market could begin to function. In 2021, the federal government finally mandated that every hospital publish its negotiated rates in machine-readable files. The data is now public. It is updated regularly. And yet few in the employer benefits world appear to be using it.

Diwas KC
Professor, Emory University's Goizueta Business School

Diwas KC is a professor at Emory University's Goizueta Business School, where his research focuses on healthcare delivery and pricing. He has been analyzing CMS-mandated hospital pricing data to … Read full bio


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