Nowicki, M. (2018). (Vol. Seventh edition). Chicago, Illinois: Health Administration Press. Part 2; pages 93-179, and pages 198-211. Retrieved from the Trident Online Library. View: Taylor, M. (2014). Managerial Accounting: Cost – Volume – Profit and Break-Even. Available at: In recent years, healthcare pricing has come under much scrutiny. Calls for price transparency have been made, loudly and clearly. Discounting prices to some recipients or payers occur, but how and why does this happen? Patients with insurance typically pay an insurance-negotiated discounted rate, while patients without insurance can be asked to pay the full amount that is charged by the provider or facility. Why can’t you simply look on each provider’s website to see the exact cost of your office visit, or your x-ray? With the many methods of cost-setting available to us as healthcare managers, we see how there is a high degree of variability in the amount charged per service from person to person, and state to state. In moving towards either voluntary or state-mandated transparency in healthcare pricing, we consider the following Case assignment questions. After completing the required background readings, please complete the following questions:

In recent years, there has been increased scrutiny on healthcare pricing and calls for price transparency. Discounting prices to certain recipients or payers has become a common practice in the healthcare industry, but the methods and reasons behind these discounts can vary. Patients with insurance typically pay an insurance-negotiated discounted rate, while patients without insurance may be charged the full amount.

This variability in pricing has made it difficult for patients to determine the exact cost of their healthcare services. Unlike other industries where prices are readily available, such as retail or hospitality, healthcare providers do not usually disclose their prices on their websites. This lack of transparency has led to frustration and confusion among patients.

As healthcare managers, we have various methods for determining costs, which contributes to the variability in pricing. Cost-setting in healthcare involves analyzing the different expenses incurred in providing a service and allocating those costs to determine the appropriate charge. Some common methods of cost-setting include activity-based costing, cost-based pricing, and value-based pricing.

Activity-based costing (ABC) is a method that assigns costs to various activities or processes involved in providing a service. This method aims to link costs to the activities that drive them, providing a more accurate allocation of costs. By understanding the cost drivers, healthcare managers can determine the appropriate price for a service.

Cost-based pricing is another method used in healthcare pricing. This approach involves determining the costs associated with providing a service and adding a desired profit margin to calculate the price. The goal of cost-based pricing is to ensure that the price adequately covers the costs incurred and allows for a reasonable profit.

Value-based pricing is an emerging approach in healthcare pricing. This method takes into consideration the perceived value of a service to the patient or payer. Instead of solely relying on costs, value-based pricing considers factors such as outcomes, patient satisfaction, and quality of care. This approach aims to align the price with the value delivered to the patient.

The variability in healthcare pricing is also influenced by factors such as location and reimbursement policies. Pricing can vary from state to state due to differences in healthcare regulations and market dynamics. Additionally, reimbursement policies and contracts negotiated with insurance companies can affect the pricing for different patients or payers.

Moving towards price transparency in healthcare pricing has been a topic of discussion and debate. Advocates argue that transparency can empower patients to make informed decisions and encourage competition among healthcare providers. However, implementing price transparency is complex and requires collaboration among stakeholders, including providers, payers, and policymakers.

In conclusion, healthcare pricing has come under scrutiny in recent years, and there have been calls for price transparency. The variability in pricing can be attributed to various factors such as cost-setting methods, location, and reimbursement policies. As healthcare managers, it is important to understand these factors and their implications on pricing. Moving towards transparency in healthcare pricing requires careful consideration and collaboration among all stakeholders involved.