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July 9, 2026Health Economics Policy and LawOpen Access

Recent trends in private health insurance prices and cost-sharing for hospital-based professional services

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Authors

EDErin DuffyCGChristopher GarmonBLBich Ly

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Overview

Analysis describes price trends and patient cost-sharing changes in private health insurance, indicating regulatory impacts.

Key Points

  • This research aims to examine how recent consumer protection regulations affect private health insurance prices and patient cost-sharing for various hospital-based specialists.
  • Analyzed a large multi-payer database of health insurance claims for employer-sponsored health plans in the U.S.
  • Examined price trajectories and patient cost-sharing for emergency physicians, radiologists, pathologists, and neonatologists from 2012 to 2022.
  • Investigated effects of the No Surprises Act and Transparency in Coverage on prices and cost-sharing in 2022.
  • In-network prices and patient cost-sharing increased for emergency physicians, radiologists, pathologists, and neonatologists from 2012 to 2022.
  • Notable declines in out-of-network prices and cost-sharing occurred, particularly from 2021 to 2022.
  • Out-of-network prices and cost-sharing reduced following the implementation of NSA and TIC, especially for self-funded health plans.

Cite This Study

Duffy et al. (2026) studied this question.

synapsesocial.com/papers/6a4f3be52b81a944af5758bahttps://doi.org/10.1017/s1744133126100565
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