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The federal 340B Drug Discount Program was created in 1992 to lower the cost of drugs for non-profit hospitals that disproportionately care for people with lower incomes. Under the program, discounts from drug manufacturers to hospitals are estimated to range from 20 to 50% on most outpatient medications, although the actual discounts are not publicly disclosed. Because the program does not restri...

What are preventive health services? Preventive health services help people stay healthy and detect health problems early. Preventive care includes services like wellness visits, immunizations, contraceptive services, and cancer screenings. Specific services recommended by expert committees must be provided at no cost to the patient. This means that even if a patient has not met their plan deducti...

Primary care offers patients a critical connection point to the health care system. With contact, continuity, comprehensiveness, and coordination as its base1, primary care has been shown to improve health outcomes and population health, reduce health disparities, and save health care dollars. Despite the virtues and benefits of primary care, it seems to be getting harder to access. In 2025, ...

As federal and state policymakers pursue policies to lower health care costs, "site neutral payment" has emerged as a potential tool with bipartisan support to bring down spending. Adopting "site neutral payments" would mean that a given service would cost the same amount regardless of where the care was received (i.e., the site of service). Currently, in many cases, hospital outpatient department...

Forty-five percent of per-person health spending among people with employer-sponsored insurance was spent on inpatient or outpatient services. The Health Care Cost Institute (HCCI) conducted an analysis of hospital inpatient and outpatient prices by key hospital characteristics from 2012-2022. During our study period, we found system-affiliated hospitals were associated with higher prices; non-pro...

Blood cancers represent a range of diseases that can affect blood cells, bone marrow, lymph nodes, and other parts of the lymphatic system. Health care claims data can provide insights into how many people are dealing with blood cancers. Using claims data from people enrolled in Medicaid, employer-sponsored insurance (ESI), and Traditional Medicare, this data brief highlights the percentage of peo...

Spending on hospital (inpatient and outpatient) services accounts for more than half of per-person health care spending in the employer-sponsored insured (ESI) population. In 2022, hospital outpatient facility spending per person accounted for nearly a third of total per person spending. Per-person outpatient spending increased 18% from 2018 to 2022, which was driven by a 12% increase in prices an...

The Health Care Cost Institute (HCCI), in collaboration with West Health, conducted an analysis on health care use and spend patterns among older adults with employer-sponsored insurance (ESI). This group is the key to anticipating future needs and demands on the health care system as they approach Medicare eligibility. We found that from 2018 to 2022, people aged 55-64 used mo...

Childbirth costs, outcomes, and access to care differ between rural and urban hospitals. Rural areas have fewer short-term general acute care (GAC) hospitals, with only about 35% of all GAC hospitals operating in rural locations in 2023. As rural hospitals continue to face financial distress, many unprofitable service lines, such as hospital-based obstetric service units have closed. A recent stud...

The high and rising costs of childbirth pose a financial challenge to many families. One study found that 60% of pregnant and postpartum women reported having difficulty affording care, with women enrolled in commercial insurance more likely to report affordability challenges than those with public insurance. To understand the average total spending on childbirth related services, as well as to lo...

Research has shown that the price of a single service provided in a hospital outpatient department is consistently higher than the same service provided in a physician office. An earlier HCCI analysis examined 46 services that could be provided in either setting and found higher prices in outpatient departments for all services in all years studied. More recently, we evaluated prices for laborator...

Previously, HCCI analyzed Ozempic medication use in the ESI population and found that the percentage of patients using Ozempic that had a diabetes diagnosis, the condition Ozempic is clinically indicated to treat, had decreased from 92% in 2018 to 77% 2021. This indicated a growing trend of off-label use of Ozempic. Our findings aligned with reports at the time of off-label use of Ozempic for weig...

Colorectal cancer is the fourth most commonly diagnosed cancer in the U.S. and the second leading cause of cancer death. Recently, a growing number of young people have been diagnosed with colorectal cancer. According to the American College of Surgeons, the incidence rate of early onset colorectal cancer is expected to double by 2030. While these statistics are alarming, colon and rectal cancer a...

Prior HCCI research has shown that women are more likely to use health care services than men. Among people who receive health insurance through their employer, we find that women are, on average, 1.4 times more likely to receive any health care services than men, and this trend has remained consistent over time. As shown in Figure 1, utilization differences vary slightly by service categories. Wo...

The Health Care Cost Institute (HCCI), in collaboration with West Health, conducted an analysis on the use of office-based mental health services among people with employer-sponsored insurance (ESI). We found that use of mental health services has increased from 2018-2022, and that therapy was the most commonly used service. We found an increase in spending on therapy services from 2018-2022 drive...

The Health Care Cost Institute (HCCI), in collaboration with West Health, conducted an analysis on the use of telehealth mental health services among people with employer-sponsored insurance (ESI). We found that telehealth played an outsized role in the delivery of mental health services starting in 2020, with over 40% of mental health visits occurring via telehealth from 2020-2022. Fema...

The International Federation of Health Plans (iFHP) has published its 2024 International Healthcare Cost Comparison Report, marking its latest biennial analysis of global healthcare costs. Compiled in collaboration with the Health Care Cost Institute (HCCI), the report compares costs for inpatient and outpatient treatments, as well as prescription drugs, across nine countries using data from 2022....

Policymakers and clinician consortia have identified low value care, defined as health care services that provide negligible clinical benefit to the patient when provided, as one way to curb excessive and inefficient medical spending. A previous HCCI report found that 18% of people with employer-sponsored insurance in 2019 received at least one low-value service, which corresponded to 2.6% of over...

High and rising health care costs affect individuals, families, and businesses across the country, and they have for decades. Cost forces difficult choices between health care and other needs. The Health Care Cost Institute's mission of using data and analytics to improve the US health care system recognizes that people are at the heart of health care, and we are committed to putting our clai...

Ambulances contribute to urgent lifesaving and life-enhancing medical care, but the unplanned nature of this essential service can lead to high unexpected costs to patients. This HCCI data brief focuses on ground ambulances, which make up 98% of all ambulance trips, and builds upon earlier work that explored 10-year trends in ambulance prices, utilization, spending, and the frequency of out-of-net...

Recent data from the Health Care Cost Institute (HCCI) show that growth in hospitals' commercial inpatient prices was higher in system-affiliated and non-profit hospitals from 2012-2021.  Key Findings: In the backdrop of a wave of hospital mergers, system-affiliated non-profit hospitals account for more than half of short-term general acute care hospitals in the US (from 50.6% in 2012 to 62.5...

The Health Care Cost Institute (HCCI) in collaboration with West Health conducted an analysis of the high prices that employer-based insurance pays hospital outpatient departments for clinical lab tests. We found that insurers are paying, on average, 3 times more for common lab tests such as blood and urine test when billed by hospital outpatient departments compared to independent laboratories. D...

Building on a commitment to health care price transparency that spans more than a decade, the Health Care Cost Institute is excited to introduce HealthPrices.Org (formerly Guroo), a free health care price transparency tool that shows consumers the average prices for health care services in their local metropolitan area. Access to data on prices can help consumers, employers, and other purchasers o...

According to the most recent year of data available, an estimated 42% of adults have obesity and almost 20% of children are diagnosed with obesity. It is well documented that obesity prevalence and associated health care costs continue to rise. The Kaiser Family Foundation has estimated the average annual health spending for people enrolled in commercial insurance diagnosed with obesity ...

HCCI collaborated with the National Kidney Foundation and The DataFace to develop a national and state-level multi-payer dashboard that examines the current state of Chronic Kidney Disease (CKD) in the US and highlights the gaps in CKD-related care. Our interactive tool allows users to examine the rates of CKD testing and diagnosis among people at-risk for CKD. It also highlights CKD quality of ca...