Maryland’s All-Payer Model and Hospital Financial Stability: A Comparative Study with Massachusetts, 2004–2024

Maryland’s all-payer hospital model is a unique statewide experiment in regulated payment reform aimed at controlling costs and stabilizing finances. This concept paper proposes a comparative study to analyze the impact of Maryland’s All-Payer Model (APM), launched in 2014, on hospital financial health and patient cost burdens, using Massachusetts as a policy benchmark. The study will leverage longitudinal panel data from the RAND Hospital Cost Report Information System (HCRIS) covering 2004 to 2024. A difference-in-differences (DiD) approach will compare trends in operating margins, revenue volatility, and hospital cost growth before and after implementation between the two states. The goal is to determine whether Maryland’s global budget strategy achieved its policy goals without harming patients. The findings might influence broader U.S. policy discussions on payment reform and rate regulation.