Hospitals and Insurers Increased Public Brinkmanship

Research documented over 1,200 public threats between hospitals and insurers from 2021 through 2025.

Updated on Sept. 24, 2026 in Healthcare

Isometric editorial illustration showing two heavy steel structural volumes pulled apart, representing healthcare contract brinkmanship. — A Brown University study found that healthcare providers and insurers issued over 1,200 public threats to end network contracts between 2021 and 2025. AI Illustration. Upload story photo >

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Should hospitals and insurers prioritize avoiding public contract disputes to protect patient access to care?

A study published September 23, 2026, analyzed 14,918 hospital-insurer contracts, identifying 1,249 instances where parties publicly threatened to end network relationships between August 2021 and July 2025. While only 2% of these relationships resulted in actual withdrawals, 28% of those who issued public threats followed through with ending the contract.

Why it matters

Parties in healthcare negotiations engage in public brinkmanship when they believe the leverage gained by threatening network withdrawal outweighs the potential risks in non-dominant market conditions. This trend highlights how contract disputes increasingly become public, impacting the stability of coverage networks for patients across the country.

Researchers documented that public threats occurred in 8% of all analyzed relationships, with that frequency climbing to 16% in specific market conditions. For-profit hospitals proved twice as likely to engage in these public disputes compared to their non-profit counterparts.

The players

Brown University

This is a private Ivy League research university based in Providence, R.I., whose faculty conducted the study on contract negotiations.

The details

Brown University researchers cataloged these disputes by reviewing news databases and performing manual analysis of negotiation tactics. The data indicates that national insurers utilized public threats in approximately 10% of their total hospital interactions during the four-year study period.

August 2021 marked the start of the contract relationships analyzed in the study.
August 2023 was the period after which the majority of threat episodes took place.
July 2025 represented the end of the contract relationships reviewed by researchers.
September 23, 2026, serves as the official date the research study was published.

Market Landscape

This study identifies a shift toward public brinkmanship in healthcare markets, suggesting that contract disputes have moved from private negotiations to public arenas. It highlights a competitive environment where hospital and insurer shares determine the frequency of these adversarial public tactics.

When hospitals and insurers engage in public threats, patients may face sudden uncertainty regarding which facilities remain in-network for their insurance plans. These disputes can cause significant disruption to continuity of care and may lead to unexpected out-of-pocket costs for medical services.

The takeaway

Public threats in healthcare contracts serve as a tool of negotiation rather than a reliable indicator of imminent network termination. Readers should verify their specific provider-insurer coverage directly with their insurance company rather than relying solely on news reports of contract disputes.