RAND Health Care Price Transparency Initiative
Measuring what employers and private insurers actually pay for hospital care across the United States
What We Do
Since 2016, RAND has conducted the nation's leading research on commercial hospital prices, analyzing billions of dollars in claims data from employers and All-Payer Claims Databases (APCDs) across the United States. Our research provides unprecedented transparency into what private insurers actually pay hospitals compared to Medicare rates.
Our latest findings from Round 5
Claims from self-insured employers and 12 state All-Payer Claims Databases across the United States representing $77.4 billion in hospital spending from more than 4,000 hospitals nationwide and $3.1 billion from over 4,000 ambulatory surgical centers.
Who Uses Our Data
Our research serves multiple stakeholders:
- Employers benchmark their contracts and make informed purchasing decisions
- Policymakers understand market dynamics and design effective reforms
- Researchers study price variation and its drivers
- States monitor their health care markets
Round 5 Key Findings
Employers and private insurers paid about 2.5 times what Medicare would have paid
Across all hospital inpatient and outpatient services (including both facility and related professional claims), employers and private insurers paid on average 254 percent of what Medicare would have paid for the same services at the same facilities in 2022.
Wide variation across and within states
Commercial insurance prices ranged from less than 170% of Medicare (Arkansas) to over 300% (California, Delaware, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin). Even within states, the difference between 25th and 75th percentile hospitals represents a 45% potential reduction in hospital spending.
Hospital market power drives price variation
Most variation in prices is explained by hospital market power. Very little is explained by each hospital's share of patients covered by Medicare or Medicaid.
Prices have remained stable over time
State-level median prices have held steady at approximately 2.5 times higher than Medicare across Rounds 3, 4, and 5, despite changes in data contributors.
Read the Full Report Explore the Interactive Data on Sage TransparencyRound 6: Join Our Research
We are currently recruiting participants for Round 6, which will further expand our geographic coverage and data sources.
We welcome participation from:
- Self-insured employers, employer coalitions, and unions
- State All-Payer Claims Databases (APCDs)
Benefits of participation:
- Benchmark your hospital prices and receive customized analysis tailored to your markets
- Use objective data to evaluate health plan negotiating performance and inform network strategy
- Contribute to research that informs policy and purchasing decisions nationwide
Impact & Applications
Our research is being used to:
- Inform employer actions: Contract renegotiations, network redesign, reference-based pricing adoption, benefit design changes
- Support policy development: Federal price transparency rules, state legislation and regulations, APCD funding justifications, rate review processes
- Enable research and public education: Academic citations, media coverage, policy analysis
About This Initiative
Our Work
This work is conducted by RAND Health, leveraging our deep expertise in health economics, policy analysis, and data science. The project benefits from continuity in our core research team and analytical infrastructure, ensuring methodological rigor and consistency across all rounds of research.
Our Team
This initiative is built on strong partnerships:
Founding Partners
- Employers' Forum of Indiana, project originator
- Robert Wood Johnson Foundation, Rounds 1-5 funder
Current Sponsors
- Arnold Ventures, Round 6
Participants
- State All-Payer Claims Databases
- Employer coalitions and self-insured employers