July 9, 2025
Commercial health insurance payments increasing, vary widely
Annual OHA report: Hospital payments for inpatient procedures grew the most between 2019 and 2023
SALEM, Ore. – Payments hospitals receive from commercial insurance companies have largely increased in recent years, according to an interactive Oregon Health Authority dashboard updated with 2023 data.
The online tool – which shows Oregon hospitals collectively received more than $2.16 billion from commercial insurance companies in 2023 for providing 179 different common procedures – offers another example of health care’s growing costs. These payments covered a variety of hospital procedures that range from the removal of brain tumors and chemotherapy to hip replacements and COVID-19 tests.
OHA’s Hospital Payment Report tracks commercial insurance payments to Oregon hospitals on an annual basis to understand health care cost trends. When combined with prices that are required to be posted on hospital websites and other OHA reports, the Hospital Payment Report’s dashboard can help inform health-related decisions by patients as well as policymakers.
“Understanding how and where health care costs are rising is essential for our efforts to make health care more affordable and accessible for all Oregonians,” said OHA Health Policy and Analytics Director Clare Pierce-Wrobel. “OHA’s Hospital Payment Report monitors not only how much health care costs, but also how much the price can vary depending on where someone receives care and what coverage they have.”
Among other information, the dashboard provides the median insurance payment for common procedures across the state, within different regions, at individual hospitals, and among distinct types of hospitals.
Most payments increased, some grew slower than inflation
The updated dashboard shows that commercial insurance payments for procedures that involve staying overnight at a hospital – including heart valve replacements and appendectomies, for example – grew the most between 2019 and 2023. The statewide average payment for an inpatient procedure was $38,208 in 2023, up a total of 23.4% – or 5.3% after adjusting for inflation – over that five-year period. While payments grew, the number of common inpatient procedures for commercially insured patients actually decreased 17.7%.
The dashboard also shows that Oregon hospitals received an average of $8,521 for pregnancy-related procedures such as delivery and newborn care in 2023. That’s a net increase of 20.3% – or 2.7% after adjusting for inflation – between 2019 and 2023. When comparing median commercial payments for routine deliveries without complications by region, Northern Coast hospitals received the most ($14,172) and those in the Portland area received the least ($10,115). The number of deliveries and newborn care procedures for commercially insured patients decreased by 14.4% between 2019 and 2023.
However, when adjusting for inflation, the dashboard shows that commercial insurance payments for some procedures declined between 2019 and 2023. For example, hospitals received 5.6% more in net payments for diagnostic imaging such as X-rays and CT scans, but that equated to a 9.9% decrease when considering inflation. Similarly, outpatient surgical procedures such as colonoscopies and cast applications increased by a total of 14.5%, but declined by 2.3% when adjusted for inflation. This offers another example of how health care costs can vary and how commercial insurance payments are the result of complex negotiations between hospitals, health systems and insurance carriers.
Comparing commercial insurance with public health plans
The dashboard also compares commercial insurance payments with the reimbursements that hospitals receive for patients who have traditional Medicare coverage and those who are covered by Oregon’s Medicaid insurers, which are also known as coordinated care organizations. Medicare covers older adults and people with disabilities, while Medicaid largely covers people with lower incomes. The dashboard does not include data for Medicare Advantage plans, alternatives to traditional Medicare that are provided by a private insurance company with federal approval.
For example, commercial insurance paid an average of 1.85 times the amount that Medicare paid and 2.68 times what Medicaid insurers paid Oregon hospitals for inpatient procedures in 2023. The biggest payment difference for Medicare involved outpatient surgical procedures, for which commercial insurers paid just over three times the traditional Medicare rate. For Medicaid, the largest difference involved outpatient radiation and chemotherapy, for which commercial insurers paid nearly five times the rate Medicaid provided.
If commercial insurance payments in Oregon were capped at 200% of Medicare reimbursement rates, OHA estimates more than $500 million could have been saved across all of the inpatient and outpatient hospital procedures tracked in the 2023 Hospital Payment Report. Tying commercial insurance payments to Medicare rates is a policy tool that can limit health care cost growth for certain hospitals while exempting more financially vulnerable facilities. For example, rates for two Oregon health plans for public employees – the Public Employees Benefit Board and Oregon Educators Benefit Board – are capped at 200% of Medicare rates for some hospitals, except for critical access hospitals and some others with a high proportion of Medicaid revenue.