Term of Award
Spring 2025
Degree Name
Doctor of Public Health in Health Policy and Management (Dr.P.H.)
Document Type and Release Option
Dissertation (open access)
Copyright Statement / License for Reuse
This work is licensed under a Creative Commons Attribution 4.0 License.
Department
Department of Health Policy and Management (COPH)
Committee Chair
Linda Kimsey
Committee Member 1
Melvin Lamboy-Ruiz
Committee Member 2
Yelena Tarasenko
Abstract
Background: Healthcare price transparency has emerged as a pivotal policy tool to improve consumer decision-making and reduce healthcare costs. In 2021, the Centers for Medicare & Medicaid Services (CMS) implemented federal regulations requiring hospitals to disclose standard charges for medical services. Hospital compliance has varied widely, and the influence of state-level efforts prior to the federal mandate remains unclear.
Objectives: The study examined (1) changes in hospital compliance with federal price transparency requirements between 2021 and 2024, (2) the importance of early state-level policy efforts for hospital compliance, and (3) potential hospital organizational and geographic-level predictors of hospital compliance.
Methods: This was a retrospective repeated measures observational study of all operating U.S. hospitals in 2021 and 2024. The study synthesized secondary data from multiple national sources to construct a comprehensive dataset capturing compliance behavior, institutional characteristics, and policy environments for hospitals observed in the two time periods. The primary outcome was hospital compliance status. Key predictors included hospital organizational and geographic-level characteristics. States were categorized as early, partial, or non-adopters based on their transparency-related policies through 2014. A multilevel binary logistic regression model was used to address the research objectives. All statistical analyses were conducted using Stata 18.0.
Results: While there was an overall increase in compliance between 2021 and 2024, significant disparities persist. Hospitals that were system-affiliated, medium and large-sized, and had higher profit margins had significantly higher odds of compliance than hospitals that were not system-affiliated, smaller-sized, and with lower profit margins, respectively. Government-owned and urban hospitals were less likely to comply with the federal mandate than non-profit and rural hospitals, respectively. Early state policy adoption efforts were not associated with hospital compliance in the adjusted analyses.
Conclusion: The increase in hospital compliance suggests growing responsiveness to federal hospital price transparency mandates. While early state-level efforts did not significantly predict compliance, internal organizational factors and resource availability seemed to have a dominant role. These findings underscore the need for targeted support to low-resource hospitals and a continued focus on structural enablers of compliance.
Recommended Citation
Patel, Foram, "Early State Actions and Federal Directives: Evaluating a Dual Approach to Advancing Hospital Price Transparency Compliance in the U.S." (2025). Electronic Theses and Dissertations. 2925.
https://digitalcommons.georgiasouthern.edu/etd/2925
Research Data and Supplementary Material
No
