The effects of consumer information and cost-sharing on healthcare prices

Non-transparent information about prices is a key piece of many economic models. George Stigler's seminal work first formulated how 'search costs' lead to price dispersion in provider prices. For several decades, refining the relationship between search costs and prices was a key component of the economics literature. With growth of the internet, consumer information about prices has increased substantially. The growth of online retailers has led to substantial decreases in search costs by providing an easy mechanism to compare prices./nRecent technologies have expanded the internet's search-cost reducing powers to the healthcare sector. Compared to other markets, healthcare prices exhibit an enormous amount of price variation and have traditionally been among the most non-transparent of any market. The lack of meaningful price transparency has traditionally made price shopping for healthcare services nearly impossible. As consumer cost-sharing increases, led by the growth in high-deductible health plans, there is a strong imperative to provide the tools necessary for consumers to shop for care. Without accurate price information, increases in consumer cost-sharing will simply shift expenses from employers and insurers to consumers./nWhile the hope is that 'price transparency' information will encourage consumers to shop for care, little is known about how consumers actually use price information. The first chapter of this dissertation uses detailed data from a leading online price transparency firm to examine the consumer effects of price transparency. Large price effects are found for commodity-like services as consumers shift demand from expensive to less-expensive providers. For physician office visits, which entail a more personal relationship, the largest effects are for non-price information, such as provider gender and length of practice./nEven less is known about how providers will respond to consumers using price transparency information to shop for care. Healthcare providers have not traditionally had to account for consumers making decisions based on price and have simply negotiated prices with insures. With the growth of consumer cost-sharing and price transparency, this paradigm will undoubtedly change. The second chapter uses the same data to estimate an initial look at how providers respond to consumer price transparency. Following the consumer analysis, large effects are found for non-differentiated products. Consistent with Stigler's observations, reducing consumer search costs leads to both reductions in consumer prices and the prices that providers charge./nThe third chapter of this dissertation examines a similar topic as the second, how providers respond to increases in consumer-cost sharing. This chapter leverages the implementation of a Reference-Based Benefit (RBB) design by the California Public Employees Retirement System (CalPERS) that capped reimbursements for certain procedures. Previous work has documented large consumer effects to the RBB program but how providers respond has not been studied in detail. The results show large price reductions by providers who have the largest exposure to the CalPERS population./nAs a means to reduce the growth in healthcare spending, employers and insurers have implemented innovative benefit designs and technologies. These changes are largely driven by the recognition that the current healthcare ecosystem has evolved into a market with substantial price variation and no link between price and quality. Consumer cost-sharing and price transparency provide both the incentive and the means to steer patients away from high-cost providers. As these innovations have their desired effects, this dissertation shows how providers respond accordingly. These tandem consumer and provider responses to price transparency and target cost-sharing result in general equilibrium effects that lead to less expensive healthcare and a more efficient healthcare market.

Advisor: Handel, Benjamin