{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T07:44:41Z","timestamp":1696664681665},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T00:00:00Z","timestamp":1429660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Agency for Health Care Research and Quality (AHRQ)","award":["(1 R01 HS022098-01A1","Agreement 2011-6342"],"award-info":[{"award-number":["(1 R01 HS022098-01A1","Agreement 2011-6342"]}]},{"name":"California Public Employees' Retirement System (CalPERS)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Reference pricing (RP) theories predict different outcomes when reference prices are fixed (exogenous) versus being a function of market prices (MPs) (endogenous). Exogenous RP results in MPs at both high\u2010price and low\u2010price firms converging towards the reference price from above and below, respectively. Endogenous RP results in MPs at both high\u2010price and low\u2010price firms decreasing, with low\u2010price firms acting strategically to decrease the reference price in order to gain market share. We extend these models to a hospital context focusing on insurer and consumer payments. Under exogenous RP, insurer and consumer payments to low\u2010price hospitals increase, and insurer payments to high\u2010price hospitals decrease, but predictions regarding consumer payments are ambiguous for high\u2010price hospitals. Under endogenous RP, insurer payments to high\u2010price and low\u2010price hospitals decrease, and consumer payments to low\u2010price hospitals decrease, but predictions regarding consumer payments are ambiguous for high\u2010price hospitals. We test these predictions with difference\u2010in\u2010differences specifications using 2008\u20132013 data on patients undergoing joint replacement. For 2\u00a0years following RP implementation, insurer payments to high\u2010price and low\u2010price hospitals moved downward, consistent with endogenous RP. However, when the reference price was not reset to account for changes in MPs, insurer payments to low\u2010price hospitals reverted to pre\u2010implementation levels, consistent with exogenous RP. 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