This project evaluates the effectiveness of reference pricing in reducing expenditures while maintaining quality of care for five common procedures: hip replacement surgery, knee replacement surgery, arthroscopic surgery, cataract surgery and colonoscopy. It is intended to produce knowledge that will significantly improve the efficiency of healthcare in the U.S. while maintaining both quality and effectiveness.
The specific aim of this project is to test the following hypotheses: (1) the implementation of reference pricing will resul in a decrease in average total expenditures per procedure for each of the five procedures listed above, (2) the implementation of reference pricing will result in a decrease in average total expenditures per procedure paid for by the insurer for each of the five procedures listed above, (3) the implementation of reference pricing will result in a small increase in average out-of-pocket expenditures per procedure for each of the five procedures listed above, and (4) the implementation of reference pricing will result in no change in the quality of each of the five procedures listed above. The project will evaluate a public-private reference pricing initiative in California using six years of medical claims data and employ a quasi-experimental design with one treatment group and two control groups. Both parametric difference-in-difference models and advanced non-parametric matching techniques (genetic matching) will be employed in order to determine whether the results are sensitive to the analytic approach used.

Public Health Relevance

This project evaluates the effectiveness of reference pricing in reducing expenditures while maintaining quality of care for five common procedures: hip replacement surgery, knee replacement surgery, arthroscopic surgery, cataract surgery, and colonoscopy. Reference pricing can be described as a reverse deductible where the insurer must first pay a large reference price with the consumer being responsible for the remaining balance. This research will produce knowledge that will significantly improve the efficiency of healthcare in the U.S. while at the same time maintaining quality and effectiveness.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS022098-01A1
Application #
8690663
Study Section
Health Systems Research (HSR)
Program Officer
Hellinger, Fred
Project Start
2014-04-10
Project End
2019-03-31
Budget Start
2014-04-10
Budget End
2015-03-31
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of California Berkeley
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
124726725
City
Berkeley
State
CA
Country
United States
Zip Code
94704