Author: Avalon Health Economics LLC

The health care landscape in the U.S. has been changing rapidly in the past 20 years, a phase of evolution that began with the reluctance of private employers to continue to fund double-digit growth in employee health care costs, thereby creating incentives for third-party payers to develop “managed” insurance products. The next phase of those...

A large proportion of our nation’s health care infrastructure is located in urban markets with declining population. For example, according to the U.S. Census, cities with the largest population decline in recent years include New Orleans, Detroit, Cleveland, Pittsburgh, Toledo, and Buffalo. These very same cities, however, are home to some of the most reputable...

In most markets and in most industries, the prices paid by consumers (or businesses, in the case of business-to-business transactions), are not randomly made up by sellers. To be sure, in less competitive markets, where information is “fuzzy” or sellers have monopolistic power, a seller might be able to name a price and get it....

In the United States, a variety of “usual, customary and reasonable” (UCR) databases are used by health care entities to benchmark their fees (in the case of health care providers) and to create prospectively determined fee schedules (in the case of health care payers). Both of these exercises have essentially the same objective: to assign...