Resources

This study examines how Rhode Island's hospital affordability standards – which include a hospital price growth cap adopted in 2010 – affected hospital staffing and labor costs over the following decade. The authors found that by 2022, the standards had resulted in a substantial reduction in labor costs relative to control hospitals. Effects were larger among nonclinical/administrative staff than nursing, and grew over time rather than appearing immediately after implementation.

This report analyzes financial data and commercial insurance prices as a percent of Medicare from over 2,800 hospitals across 49 states and the District of Columbia from 2018-2023. Key findings include that average commercial hospital prices in every state were higher than what Medicare paid for the same services, ranging from 157% to 365% of the Medicare rate. In addition, the 15 largest systems in the country charged on average 2.82 times what Medicare paid for the exact same services. The report also found significant hospital consolidation; in 43 states, just five or fewer health systems in each state controlled at least half of all hospital care in 2023.

This study found that under Maryland's all-payer global budget model, implemented beginning in 2014, aggregate inpatient and outpatient hospital utilization decreased by 11 percentage points more than in other states, after adjusting for demographic changes. Reductions were driven by outpatient care and were largest for services that can be safely provided outside of hospitals. The authors cite Maryland's quality programs and other features that help to mitigate unintended consequences, and call for global budget models to be paired with incentives and comprehensive monitoring mechanisms to protect quality and access.

This resource outlines the rationale for adopting a site-neutral payment approach and provides a comprehensive framework for designing site-neutral payment policies in the commercial market, highlighting a range of options and key considerations across four core decision domains: scope, administration, operations, and payment.

This webinar highlighted the growing state momentum on hospital price caps. State presenters from Vermont, Washington, New Mexico, and Maine shared an inside look at pre-implementation planning, current implementation experience, and pending legislation to address rapidly rising hospital prices.

View the webinar slides

This interactive dashboard shows the amounts commercial insurers paid different Oregon hospitals for common procedures using data from in 2022 and 2023, the variance in commercial payments among hospitals for each procedure, and how commercial payments compared to Medicare fee-for-service payments or Medicaid Coordinated Care Organization payments for the same procedure.

This interactive hospital price transparency dashboard by the Vermont Green Mountain Care Board and Onpoint Health Data shows the payments for commercial payers and across different inpatient and outpatient facilities in Vermont, comparing commercial plan allowed amounts to what Medicare would have paid for the same services, based on the unadjusted national Medicare base rate.

This blog post summarizes legislative actions taken by multiple states in 2025 to address rising health insurance premiums and affordability concerns through the enactment of hospital price caps in either the commercial market or state employee health plans. Highlighted states include Indiana, Vermont, New Mexico, and Washington.

In a study using 2022 Health Care Cost Institute data, the authors estimated that implementing site-neutral payments for commercial insurers by capping prices at 150% of Medicare non-hospital payments would have saved purchasers and patients in 48 states and Washington, D.C. a total of $10.8 billion, or an average of $72.10 per commercially insured person in 2022. The study further provides state-specific figures for estimated total and per capita savings. Using NASHP’s Hospital Cost Tool data, the authors further estimated the state-specific impacts of savings from site-neutral payment on state-level hospital operating margins.

This Century Foundation report describes how states can lower the cost of private coverage by lowering excessive hospital prices via hospital price caps, facility fee bans, site-neutral payments, and limiting consolidation. The report explains and provides evidence on the mechanisms and magnitude of the potential effects of policies to lower hospital prices, and the ways policy design can mitigate unintended consequences. It also explains the rationale for addressing hospital prices at a time when some hospitals are under financial pressure resulting from federal cuts to Medicaid and the Marketplaces.

The authors examine the effect of Oregon’s payment cap, implemented in 2019, on hospitals' finances, operations, and care delivery. They found small and nonsignificant changes in Oregon hospitals’ revenues, expenses, and margins after implementation of the cap. They also observed limited changes in hospital operations and the patient experience of care.

This guide helps policymakers understand the regulations, payment programs, and reporting requirements that apply to hospitals. Through a collection of fact-sheets on hospital payment streams, various designations, and key sources of information, this guide offers a starting point to understand the organizational and financial differences across hospitals in the United States.

This blog post provides an overview of how states have established hospital price controls in their state employee health plans, commercial markets, or across the entire market for both state employee health plans and commercial markets. Highlighted states include Oregon, Washington, Colorado, Nevada, New Jersey, Vermont, Indiana, Maryland, Massachusetts, Montana, and Oklahoma.

Noting limitations that inhibit policymakers from readily assessing the full scope of outpatient facility fees in the commercial market, this article examines states' efforts to analyze facility fees in their commercial markets and highlights key findings from each state, including Colorado, Maine, Connecticut, and Washington.

This two-pager describes how Washington plans to implement reference-based pricing within its state employee health plan to limit hospital prices, lower health care premiums and out-of-pocket costs for public employees and teachers, and increase investments in preventative health services.

This article summarizes Rhode Island’s Health Care affordability standards that were established in 2010, results of an evaluation of the affordability standards, and policy considerations for other states interested in reducing health care costs in the commercial market. The authors conclude that Rhode Island’s affordability standards have led to relative reductions in hospital prices across the state’s commercial market and yielded cost savings for consumers in the fully insured market. While the standards reduced hospital revenues and contributed to lower hospital operating margins, the authors cite to evidence from other research suggesting that the standards may also have led Rhode Island hospitals to operate more efficiently.

This resource includes a list of all legislation successfully passed by 20 states (as of September of 2025) that seek to address facility fees charged by health systems for services, with links to bill language and brief overviews of the legislation.

The paper discusses the problematic payment differential between hospital inpatient and outpatient care and offers payment reform considerations for policymakers. The author argues that reducing or eliminating the differential for services commonly provided in both settings would be complicated, but a fix could reduce costs, remove perverse incentives, and make patient cost sharing fairer and more predictable.

The authors quantify and illustrate the difference in price between hospital outpatient departments and physician offices among people with employer-sponsored insurance between 2018 and 2022. The data show that care delivered in hospital outpatient settings costed more than in physicians’ offices when assessing the same service.

This report provides an overview of existing state, federal, and private sector hospital efficiency measures; the advantages and limitations of those measures; potential modifications to existing measures; and options for how states can employ new or existing measures to better understand current hospital efficiency levels and incentivize improved efficiency. It focuses on measures that primarily use publicly available or state-accessible data and organizes them into three main domains: (1) Delivery of Wasteful Hospital Services; (2) Hospital Revenue per Unit; and (3) Hospital Expenses.