分裂的国会的竞争性医疗改革方案（英）

1PROCOMPETITIVE HEALTH CARE REFORM OPTIONS FOR A DIVIDED CONGRESSHigh health care costs affect nearly all health care debates. High costs make it expensive to expand insurance coverage to new populations or cover new services. High spending in public programs strains government budgets, while high spending in the com-mercial market reduces wages.In this piece, we highlight areas where the 118th Con-gress can make tangible progress in reducing health care costs by increasing competition. We specifically focus on a set of procompetitive policies that have attracted various levels of bipartisan interest in recent years. In each case, we describe the rationale for these proposals and discuss how they are likely to make markets work better, as well as how they would affect the federal budget. This is not meant to be an exhaustive list of all policies that could attract bipartisan interest, but the list we offer here includes some of the most plausible options for passage in a divided Congress. While these poli-cies are far from sufficient to address all inefficiencies in health care markets, they would make tangible prog-ress in the direction of better functioning markets. POLICY BRIEF | MARCH 2023PROCOMPETITIVE HEALTH CARE REFORM OPTIONS FOR A DIVIDED CONGRESSLOREN ADLER AND BENEDIC IPPOLITOI. Transparency and Antitrust Enforcement..............................................p. 2II. Site Neutral Payments...........................p. 3III. Part B Drug Payment............................p. 4IV. 340B Reform........................................p. 5V. Improving and Focusing Competition in Medicare Advantage.............................p. 6VI. Contracting Reforms............................p. 7VII. Reforms to the Pharmacy Benefit Manager Market........................................p. 8VIII. Making the No Surprises Act More Pro-Competitive........................................p. 92PROCOMPETITIVE HEALTH CARE REFORM OPTIONS FOR A DIVIDED CONGRESSTransparency and Antitrust Enforcement A large body of evidence finds that the merger of potential competitors within health care markets increases costs to consumers and is suggestive that it also reduces the quality of care. That is, when hospitals or physician groups in the same geographic market merge together (or one acquires the other) they are able to extract higher prices from private insurers and employers. Newer research suggests that sim-ilar effects also may arise from mergers that occur across different markets within the same state. Higher costs are at least partially passed on to individuals in the form of higher premiums and cost-sharing or to employees in the form or lower wages. A growing body of evidence now also suggests that vertical consoli-dation between hospitals and physician groups leads to increased costs (above and beyond the effects of any resulting horizontal consolidation in the physician specialties being acquired by hospitals) with unclear effects on quality.Despite this ev