By NextBestFitOne public price list for every service
A single fee schedule (single payer or all-payer rates) makes prices identical and public.
Follows from all-payer rates.
Review ledgerHow this path connects
This path
One public price list for every service
Requires:
All-payer rate settingU.S. prices are far higher than in other countriesChosenConcrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Publish one national fee schedule and all hospital budgets
- Ban confidential negotiated rates for covered services
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Patients can't know prices in advance
A public uniform fee schedule ends hidden negotiated rates by making everyone pay the same posted price. Patients and employers no longer need to shop, and transparency files and their enforcement become unnecessary.
What it creates or worsens
- Limits choice or applies one rule to every setting
Uniform prices can be too high in low-cost areas and too low in high-cost areas.
- Faces political, industry, or legal opposition
Setting a public fee schedule creates a target for lobbying.
Who's affected
Who gains
- People with unaffordable deductibles or coinsurance
- Patients can't know prices in advance: Secret contracts and inconsistent transparency make prices hard to know in advance.
- Employers
- Patients can't know prices in advance: Opaque and variable prices make health costs hard to manage.
- People with ongoing or specialist care needs
- Patients can't know prices in advance: A public uniform fee schedule ends hidden negotiated rates by making everyone pay the same posted price. Patients and employers no longer need to shop, and transparency files and their enforcement become unnecessary.
Who loses
- Hospitals and specialist groups with high private prices
- Patients can't know prices in advance: Opaque prices help sustain high charges.
- Health administration and software vendors
- Patients can't know prices in advance: They profit from pricing complexity.
Other ways to soften the losses
- Regional adjustments
Where it has been tried
- Japan: A 2019 study reported that Japan's national fee schedule listed about 4,000 service items and 17,000 pharmaceuticals.Sources: Globalization and Health (2019)