Nov. 13, 2023
By Malorie Burkett

A new study published in the journal Health Services Research describes U.S. hospitals’ initial strategic responses to the federal price transparency rule that took effect January 2021.

Jessica Mittler, Ph.D., associate professor in the Virginia Commonwealth University College of Health Professions’ Department of Health Administration, collaborated with; Jean Abraham, Ph.D., James A. Hamilton chair and professor in the Division of Health Policy and Management in the School of Public Health at the University of Minnesota; Julie Robbins, Ph.D., associate clinical professor of health services management and policy at the Ohio State University College of Public Health; and Paula H. Song, Ph.D., interim dean and Richard M. Bracken chair and professor of Health Administration, VCU College of Health Professions

The purpose of the study was to understand why U.S. hospitals’ compliance with the new rule varied in its first year. The rule required U.S. hospitals to provide the prices for their services in two ways: As a comprehensive machine-readable file (i.e., raw data) with all items and in a separate consumer-friendly, shoppable format. The two goals of this regulation include enhancing consumerism and reducing costs via anticipated benefits of market competition.

“The U.S. health care system is complex for consumers to navigate,” said Mittler, “Our study found that hospitals are supportive of consumerism in principle, but they struggled to fulfill the regulatory requirements due to challenges with clearly interpreting the regulation and their own resource constraints.”

Between November 2021 and March 2022, Mittler and colleagues interviewed 16 key informants across 12 not-for-profit health organizations about their initial strategic responses, investigating the key internal organizational factors and external market factors affecting their approaches.

The researchers found that the study organizations were more likely to comply with the consumer-oriented price tool requirement relative to the raw data file requirements. Hospitals were more likely to comply with rule components when they were more committed to consumerism, had the necessary resources to comply, and had an overall compliance mindset. Two additional factors that influenced hospitals' responses to the regulation included the perceived effects of complying, or not complying, on the hospitals' reputation, and the potential adverse impact that information sharing would have on contract negotiations with insurers.  

“For policymakers, our study highlights the complexity that hospitals are encountering when generating timely and accurate price information in different formats,” said Mittler.

Health Services Research is a leading, peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities. 

To read the full study, visit To be or not to be compliant? Hospitals' initial strategic responses to the federal price transparency rule.