{
  "data": {
    "checkedOn": "2026-09-26",
    "searchType": "Focused update, not a systematic review",
    "queries": [
      "PubMed E-utilities: California[tiab] AND hospital*[tiab] AND (price OR prices OR \"negotiated rates\")[tiab] AND 2025:2026[dp] (3 hits)",
      "PubMed: California AND hospital AND (price OR prices) AND (commercial OR negotiated OR \"private insur*\") AND 2025:2026[dp] (69 hits; titles screened)",
      "PubMed: California AND (hospital merger* OR hospital acquisition* OR hospital system*) AND price* AND 2025:2026[dp] (144 hits; titles screened)",
      "PubMed: (\"price transparency\" OR \"transparency in coverage\") AND hospital AND California AND 2025:2026[dp]",
      "PubMed: California AND hospital AND (\"Health Care Payments Database\" OR \"all-payer claims\") AND 2025:2026[dp]",
      "Web: RAND hospital price transparency study round 6 2026 (rand.org)",
      "Web: California hospital commercial negotiated prices study 2025",
      "Web: California hospital consolidation prices cross-market merger study 2025 Health Affairs",
      "Web: California hospital price transparency negotiated rates JAMA Network Open 2025",
      "Web: OHCA hospital sector target high-cost hospitals commercial price report (hcai.ca.gov); OHCA Data and Reports page",
      "Web: Petris Center California hospital prices 2025 2026",
      "Web: NBER working paper 2025/2026 California hospital prices mergers/commercial insurers (nber.org)",
      "Web: Sutter Health settlement price effect study; 2026 California HPD hospital price variation"
    ],
    "eligibility": "Include only California-specific hospital-level price (or explicitly bounded hospital payment-proxy) evidence with a clear, published method, published 2025-2026. Exclude national studies, region/county service prices pooled across provider types, charges, and items not verifiable at the primary page.",
    "decisions": [
      {
        "citation": "Zhuang et al. 2023, CORR",
        "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10194750/",
        "decision": "Retain: direct California total-joint-arthroplasty negotiated-price study. March 2021, one system; not current statewide prices.",
        "screenedOn": "2026-09-07"
      },
      {
        "citation": "Mead, Sheckter, Ibrahim. Surgery 2025;188:109714. DOI 10.1016/j.surg.2025.109714",
        "url": "https://pubmed.ncbi.nlm.nih.gov/41005004/",
        "decision": "Relevant contemporary context: 2024 cross-sectional posted negotiated prices for nine procedures. Public abstract does not establish a California-specific estimate; do not replace the California table or infer causal effects.",
        "screenedOn": "2026-09-07"
      },
      {
        "citation": "Inter- and Intrahospital Price Variation for Common Cardiovascular Admission Diagnoses, Diagnostic Tests, and Therapeutic Procedures. 2025",
        "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12132732/",
        "decision": "Potential national context, 16 cardiovascular services, December 2023\u2013January 2024 query. Not substituted for a California estimate.",
        "screenedOn": "2026-09-07"
      },
      {
        "citation": "Hospital Price Markup and Outcomes of Major Elective Operations. JAMA Surgery 2025;160:1241\u20131249",
        "url": "https://jamanetwork.com/journals/jamasurgery/article-abstract/2839141",
        "decision": "Exclude from negotiated-price synthesis: national hospital markup ratios and 2022 readmissions data answer a different question.",
        "screenedOn": "2026-09-07"
      },
      {
        "citation": "Lovchikova M, Meseli Teague G, Pegany V, Feher A. Examining Hospital Inpatient and Outpatient Spending in California, 2022-2023. California HCAI Office of Health Care Affordability issue brief, April 2026.",
        "url": "https://hcai.ca.gov/document/examining-hospital-inpatient-and-outpatient-spending-in-california-2022-2023/",
        "decision": "Include as payment-proxy method source: California-specific, hospital-level, explicit published method and dataset; it is the issue brief accompanying the Hospital Measurement Combined Dataset already used in pricing_evidence.json (cite it as the method source). Boundary: NPR per adjusted unit is a payment/spending proxy, not a negotiated price for a standardized service. Uncertain wording: the brief says commercial median was 'approximately 212% higher' (2022) and '231% higher' (2023) than Medicare, whereas the April 22, 2026 Board deck says 'approximately 230% of' Medicare; the arithmetic ($23,609 vs. Medicare median) supports 'of', not 'higher than'. Quote as a ratio of roughly 2.1-2.3x, not 'X% higher'.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Lovchikova M, Pegany V, Howard CJ, Feher A. Examining Regional Variation in Commercial Prices for Shoppable Services and Projected Savings from Reference Pricing. California HCAI Office of Health Care Affordability issue brief, September 2026.",
        "url": "https://hcai.ca.gov/document/examining-regional-variation-in-commercial-prices-for-shoppable-services/",
        "decision": "Exclude: California-specific with clear method and current (2024) data, but prices are pooled across provider types (professional, lab, imaging, facility) at region level, not hospital-level facility prices; excludes Kaiser/capitated care (>41% of commercial enrollment). Use only as contextual evidence of commercial price dispersion, not in the hospital price table. Note the abstract's '3 percent' is of total commercial claims spending while the key-points '34.7%' is of shoppable-service spending (Table 1).",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Melnick G. Hospital Prices Post-COVID-19: Troubling Trends From California. Health Affairs Forefront, January 2026.",
        "url": "https://www.healthaffairs.org/do/10.1377/forefront.20260106.16070/full/",
        "decision": "Exclude: Primary page blocked by a Cloudflare bot check (not bypassed); author, figures, hospital count, and whether the measure is case-mix adjusted could not be verified. Forefront is editorially reviewed commentary, not peer-reviewed research, and uses a revenue-per-discharge proxy. Re-check manually; if verified it is the most current California hospital commercial price-trend evidence and could be added as a bounded context item.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Gordon BS, Burke K, Chang J. California Health Care Service Spending, Price, and Affordability Variation by County. Health Care Cost Institute, June 30, 2026.",
        "url": "https://healthcostinstitute.org/all-hcci-reports/california-health-care-service-spending-price-and-affordability-variation-by-county/",
        "decision": "Exclude: California-specific and HPD-based, but reports county-level service prices, not hospital-level prices, and HCCI is not among the specified peer-reviewed/major-report sources. Details taken from the report landing page only (full PDF not reviewed). Possible county-context use only.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Eibner C, Chase EC, Kerber R, Liu JL. State Spending Growth Benchmarks and Hospital Revenue, Hospital Prices, and Premiums. JAMA Netw Open. 2026;9(2):e2558283.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/41719045/",
        "decision": "Exclude: Not a California hospital price estimate; California has at most one post-period year. Useful only as policy context for OHCA's spending target.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Arnold DR, King JS, Fulton BD, et al. New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality. Health Serv Res. 2025;60(1):e14291.",
        "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC11782062/",
        "decision": "Exclude: National; not California-specific. Consolidation context only.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Gudiksen KL, Caballero AE, Ginsburg PB, Allain B, Greaney TL, Fulton BD. Hospital Consolidation Across Geographic Markets: Insights from Market Participants on Mechanisms for Price Increases. J Health Polit Policy Law. 2025;50(5):681-708.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/40176412/",
        "decision": "Exclude: Qualitative, no price estimate, not California-specific.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Li SE, Jones D, Rich E, Lansdale A. How do hospitals exert market power? Evidence from health systems and commercial health plan prices. Health Aff Sch. 2025;3(1):qxae179.",
        "url": "https://academic.oup.com/healthaffairsscholar/article/3/1/qxae179/7958335",
        "decision": "Exclude: National; no California-specific estimate.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Koos H, Scheinker D, Schulman K, Baker L. Who Contracts on Diagnosis Related Groups and How Are They Priced? Evidence From Hospital Price Transparency. Health Serv Res. 2026;61(2):1-11.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/41109326/",
        "decision": "Exclude: National contract-structure study; no California estimate.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Mackleby G, Bejarano G, Meiselbach MK, Meyers DJ, Wilson J, Trish E. Most Hospitals With Vertically Integrated MA Plans Charge Similar Prices To Affiliated And Unaffiliated Plans. Health Aff (Millwood). 2026;45(8):871-879.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/42546239/",
        "decision": "Exclude: Medicare Advantage, national; not California commercial hospital prices.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Mackleby G, Bejarano G, Meyers DJ, Trish E, Meiselbach MK. Inpatient Prices In Medicare Advantage Vary Modestly Across And Within Hospitals. Health Aff (Millwood). 2025;44(10):1250-1255.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/41052396/",
        "decision": "Exclude: MA, national; not California commercial.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Philips AP, Whaley CM. Commercial Price Variation for Common Services in General Surgery. JAMA Netw Open. 2025 (June 25).",
        "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12199050/",
        "decision": "Exclude: National; no California estimate.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Jiang JX. Hospital Price Transparency - Emerging Evidence and Next Steps. JAMA Netw Open. Published January 20, 2026 (invited commentary).",
        "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2844081",
        "decision": "Exclude: Commentary; national.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Fulton BD, Arnold DR, Wolf JM, Scheffler RM. State Health Care Cost Commissions: Their Priorities and How States' Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment. Milbank Q. 2025;103(2):554-580.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/40418114/",
        "decision": "Exclude: State-level policy determinants; no California hospital price estimate.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Akosa Antwi Y, Aouad M, Blascak N. Hospital Billing Regulations and Financial Well-being: Evidence from California's Fair Pricing Law. J Health Econ. 2026;109:103173 (also NBER w35080).",
        "url": "https://pubmed.ncbi.nlm.nih.gov/42570573/",
        "decision": "Exclude: California-specific but outcome is consumer financial well-being, not negotiated hospital prices.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Melnick G. Hospital-Based Emergency and Trauma Care - The Expanding Epicenter of the US Healthcare Delivery System. Healthcare (Basel). 2025;13(12):1424.",
        "url": "https://pubmed.ncbi.nlm.nih.gov/40565451/",
        "decision": "Exclude: Capacity/utilization study; no price estimate.",
        "screenedOn": "2026-09-26"
      },
      {
        "citation": "Melnick G, Fonkych K. Are 'all or nothing' contracts by hospital systems anti-competitive? Evidence from a recent antitrust lawsuit. J Hosp Manag Health Policy. 2024 (September issue). DOI 10.21037/jhmhp-24-59.",
        "url": "https://jhmhp.amegroups.org/article/view/8976/html",
        "decision": "Exclude: California-specific consolidation/contracting price evidence, but published 2024 (outside the 2025-2026 window) and details taken from search summaries, not the full text. Candidate for a separate backfill review; the Sutter settlement received final court approval November 2025 (CA AG press release).",
        "screenedOn": "2026-09-26"
      }
    ],
    "rand": {
      "round6Released": false,
      "details": "RAND Round 6 page (retrieved 2026-09-26 in a browser; WebFetch returned 403) says RAND is recruiting participants; Round 6 covers claims data from 2023-2025; timeline: recruitment/agreements now to November 2026, data transfers began June 2026, data delivery complete November 20, 2026, public report release September 2027.",
      "url": "https://www.rand.org/health/projects/hospital-pricing/round6.html",
      "californiaFindings": "None yet. The latest public RAND report is Round 5.1 (2020-2022 claims; California among states with commercial hospital prices above 300% of Medicare), already cited in pricing_evidence.json (https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html)."
    },
    "conclusion": "One new item qualifies: OHCA's April 2026 issue brief on 2022-2023 hospital inpatient/outpatient spending measures (a payment proxy, and the method source for the dataset already used). No new peer-reviewed 2025-2026 California-specific negotiated hospital price study was found. The OHCA September 2026 shoppable-services brief (2024 HPD allowed amounts) is the most current California commercial price-dispersion evidence but is not hospital-level. The Health Affairs Forefront piece on post-COVID California hospital prices could not be verified (bot wall) and should be checked manually. RAND Round 6 is not released (expected September 2027). No claim of exhaustive coverage. The five bounded historical studies are retained with their age disclosed; update the search at outline and first-draft cutoffs. No claim of exhaustive coverage."
  }
}