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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 3 times more for identical tests (such as simple blood and urine tests) when billed by hospital outpatient departments compared to physician offices and inde...

The International Federation of Health Plans (iFHP), an executive network of the global health insurance industry based in London, in partnership with the Health Care Cost Institute (HCCI) in the United States, and iFHP member companies in multiple countries, today published the latest International Health Cost Comparison Report. The report compares the median prices paid by a sample of private he...

Over 10% of the U.S. population— more than 34 million individuals— lives with diabetes, with 1.5 million new cases diagnosed each year. As people with diabetes manage this chronic condition, they often pay substantial amounts out of their own pockets on medical care and prescription medications. Using HCCI's unique health care claims dataset, this brief illustrates the impact of diabetes on the us...

Each year, HCCI publishes an annual update to the Healthy Marketplace Index (HMI), an interactive tool that describes how health care prices, use, and spending vary across metropolitan areas. HMI helps us to understand how these aspects of the health care system compare and contrast to the median metropolitan area. We recently released the latest version of the HMI, which provides data from 2020, ...

Caesarean sections (c-sections) are often life-saving procedures that can prevent injury and death among birthing people and newborns. At the same time, when they are not medically necessary, c-sections may have higher risks to babies and birthing people than vaginal births. Monitoring rates of c-sections among birthing people is an important component of efforts to improve the quality of mat...

It is well-established that the rates hospitals and physicians are paid to provide health care services are significantly lower in Medicaid than in private health insurance. In this brief, we provide new data on this payment gap in the context of childbirth, an especially relevant area of care since Medicaid and ESI together cover the vast majority of births in the United States. We used HCCI's un...

The COVID-19 pandemic shaped health care spending and use over the past two years in numerous ways. We recently released our Health Care Cost and Utilization Report which provides data from the first year of the pandemic on health care use, spending, and prices across different types of services for approximately 55 million individuals enrolled in employer-sponsored health insurance. In the report...

As HCCI has previously documented, the price of childbirth in the U.S. is higher than in many other countries. When prices are high, patients with health insurance pay directly through coinsurance (i.e., cost-sharing calculated as a percent of what their insurer pays for the service) and over time, as higher prices charged to insurers are passed along to individuals through higher premiums. We exa...

The birth of a child is momentous for any person and family. New parents may face a range of challenges, including a lack of paid family leave, the rising costs of childcare, and potential health-related complications for the birthing person and new baby. In the midst of this major life transition, parents also face new financial burdens. A major cost – even among those with health insurance – is ...

The COVID-19 pandemic has impacted Americans in a myriad of ways, including their use of the health care system for both COVID- and non-COVID related services. In this brief, we explore the ways in which the first year of the pandemic affected people for one of the most common hospital services – childbirth. In 2020, the first year of the pandemic, more than 3.6 million babies were born in the Uni...

COVID-19 testing has become a regular part of life for many Americans over the last two years. In addition to facilitating individual returns to work, school, and other activities, testing is a crucial component of the public health strategy to monitor and address the spread of the virus. Even as testing becomes more available, there is widespread concern and frustration about the high and variabl...

Abstract: Recent proposals have sought to limit the amount dialysis clinics charge private payers, but little is known about the prices that private insurers actually pay for dialysis. In this study, we provide novel evidence on dialysis prices based on claims data for a large national sample of private employer-sponsored insurance carriers.

Abstract:  We analyze whether receiving care from higher-priced hospitals leads to lower mortality. We overcome selection issues by using an instrumental variable approach which exploits that ambulance companies are quasi-randomly assigned to transport patients and have strong preferences for certain hospitals. Being admitted to a hospital with two standard deviations higher prices raises spe...

ABSTRACT Importance Physician management companies (PMCs), often backed by private equity (PE), are increasingly providing staffing and management services to health care facilities, yet little is known of their influence on prices. Objective To study changes in prices paid to practitioners (anesthesiologists and certified registered nurse anesthetists) before and after an outpatient facility cont...

Valentine's Day – known for romantic candlelit dinners, lavish jewelry, and red roses – is pricey. Indeed, the National Retail Federation's Annual Valentine's Day Spending Survey suggests that an individual spends an average of $175 on these gifts each year. However, data from the Consumer Product Safety Commission shows that the cost of love may be even greater, as more than 300 emergency room vi...

Abstract: CBO examined potential reasons that the prices paid by commercial health insurers for hospitals' and physicians' services are higher, rise more quickly, and vary more by area than the prices paid by the Medicare fee-for-service program.

Health care in the United States is notoriously fragmented. A patient may receive care from a variety of health systems, physicians, and other providers, and that care may or may not be recorded in a patchwork of administrative claims data systems and electronic health record (EHR) systems. At the same time, health data has become an increasingly valuable commodity. Billions of health data points ...

Introduction Excessive emergency room (ER) spending and utilization have long been major areas of focus for health care stakeholders. The ER is an important source of health care for many individuals, especially those who lack a usual source of care, or those with work schedules that limit the ability to access care during "normal business hours." But an ER visit can be extremely expensive, and pa...

Previous HCCI analysis documented rapid growth in insulin spending over the 2012-17 period. High out-of-pocket spending may deter adherence to insulin among individuals with diabetes, with potentially fatal effects. In this blog, we update our analysis of out-of-pocket insulin spending to 2019 using HCCI's unique commercial claims dataset, which includes prescription drug claims for 29 millio...

Abstract Concern about high hospital prices for commercially insured patients has motivated several proposals to regulate these prices. Such proposals often limit regulations to highly concentrated hospital markets. Using a large sample of 2017 US commercial insurance claims, we demonstrate that under the market definition commonly used in these proposals, most high-price hospitals are in markets ...

Question  What is the association of state surprise-billing legislation with prices paid to anesthesiologists in hospital outpatient departments and ambulatory surgery centers? Findings  This retrospective economic analysis of more than 2.5 million claims filed for patients with private health insurance who received anesthesia services in hospital outpatient departments and ambulatory su...

Question Are there differences in insurer spending and care utilization for patients with private insurance undergoing cancer surgery at National Cancer Institute (NCI) centers vs community hospitals? Findings In this cross-sectional study of 66 878 patients with breast, colon, or lung cancer, surgery at NCI centers, compared with community hospitals, was associated with higher insurer prices paid...

 Abstract Objective: The primary objective is to describe the relationship between the days supplied of postsurgical filled opioid prescriptions and refills. Background: The American College of Surgeons (ACS) has called for surgeons to alter opioid prescribing to counteract the opioid epidemic while simultaneously providing pain relief. However, there is insufficient evidence to inform periop...

 Introduction This study assesses the associations between the recent implementation of robust features of state Prescription Drug Monitoring Programs and the abrupt discontinuation of long-term opioid therapies. Methods Data were from a national commercial insurance database and included privately insured adults aged 18–64 years and Medicare Advantage enrollees aged ≥65 years who initiated a...

 ABSTRACT Objectives: Anesthesiology services are a focal point of policy making to address surprise medical billing. However, allowed amounts and charges for anesthesiology services have been understudied due to the specialty's unique conversion factor (CF) unit of payment and complex provider structures involving anesthesiologists and certified registered nurse anesthetists (CRNAs). This st...