Why Are Cash Prices Lower Than Health Insurance Negotiated Prices?

Ge Bai, Contributor I am a professor of accounting and health policy at Johns Hopkins.

Growing evidence demonstrates a counterintuitive phenomenon in healthcare: the cash price is often cheaper than insurance prices for the same service or product. Cash prices are unilaterally determined by a provider, while insurance prices are bilaterally negotiated between a provider and an insurance company. Don’t insurance companies presumably possess more bargaining power than individual patients?

Our study found that among common shoppable services—such as lab tests, imaging, and joint replacements—half of U.S. hospitals set cash prices lower than their median insurance negotiated prices. About 20% of hospitals even set cash prices equal to or lower than their …

Pharma reps have visited doctors for decades. What impact does it have on patients?

By Sydney Lupkin

A economic research study shows that oncologists’ prescribing habits change after they’ve been visited by pharmaceutical sales reps — and it also shows the changes do not extend patients’ lives.

MARY LOUISE KELLY, HOST:

Pharmaceutical company reps have been visiting doctors for decades to tell them about the latest drugs. But how does the practice affect patients? A group of economists tried to answer that question. NPR pharmaceuticals correspondent Sydney Lupkin reports.

SYDNEY LUPKIN, BYLINE: When drug company reps visit doctors, it usually includes lunch or dinner and a conversation about a new drug. These interactions are tracked as payments to physicians, and they work. That is, doctors prescribe about 5% more oncology drugs following a visit from a pharmaceutical representative. That’s according to a new study published by …