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been pioneered in California by CalPERS

It's been pioneered in California by CalPERS, a giant agency that manages health and retirement benefits for public employees.

CalPERS started with knee and hip replacements in 2011, steering patients to hospitals that had been vetted for quality and charged $30,000 or less.

Ann Boynton, the agency's health benefits director, said the program has been a success, with patients able to choose from about 50 hospitals.

"People do not feel like we went to bargain-basement hospitals where the quality is not good," she said. "The quality is the same, and in some instances, better."

Economist James C. Robinson of the University of California at Berkeley studied the CalPERS experiment and found not only that many patients shifted to lower-cost hospitals, saving money, but that expensive hospitals responded by cutting their prices.

Although insurers don't appear to be using reference pricing on the new health exchanges, Robinson said he thinks it's only a matter of time.

However, the strategy appears to be suitable only for a subset of medical care: procedures and tests that are frequently performed, where the prices charged vary widely but the quality of results generally does not. In addition to knee and hip replacements, that could include such procedures as MRIs and other imaging tests, cataract surgery and colonoscopies military base fire engulfed coastal town ����Դ�Ԑۜ�ܰ���f Dean Baque Prize-winning journalist ���`�h�ݵ�녲��o�k Lee Joon-seok charged] escaped before passengers mourning for agreed to the strike ��Y�������Oֵƽ�o climatic conditions influence love mammals �z��ʹ���·�e�^ �L�~���‘�����ɫ���.

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