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In recent analysis, we document extensive variation across states and metropolitan areas in the frequency of out-of-network visits among individuals with health insurance provided by an employer. These differences raise the question of whether individual providers bill out of network at dissimilar rates. To explore whether a small group of providers are responsible for most out-of-network billing,...

Prenatal care leads to healthier pregnancy, healthier pregnant people, and healthier babies. In fact, birthing parents who receive prenatal care are three times less likely to deliver low birthweight babies, and the baby is five times more likely to survive delivery. To explore the kind of prenatal care pregnant people receive, we looked at utilization of two prototypical prenatal services – labor...

Childbirth is the most frequent reason for an inpatient admission in the United States, and Cesarean-section (C-section) is the most common operating room procedure in an inpatient hospital stay. Among people who get insurance through an employer, the combination of labor, delivery, and newborn care makes up nearly one in six dollars spent on inpatient care. Childbirth accounts for an estimated fo...

The postpartum period is a vulnerable time for both birthing parent and newborn and is critically important to their health and well-being. The American College of Obstetricians and Gynecologists (ACOG) recommends ongoing, comprehensive care, including physical, social, and psychological services, during the postpartum period. In large part because of an increasing maternal mortalit...

Abstract:  We analyzed the relationship between prices paid to 30,549 general internal medicine physicians and the cost and quality of care for 769,281 commercially insured adults. The highest-price physicians were paid more than twice as much per service, on average, as the lowest-price physicians were. Total annual costs for patients of the highest-price physicians were $996 (20 percent) hi...

Abstract:  Any Willing Provider (AWP) regulations require insurers to allow health care providers network membership, eliminating an insurer's ability to commit to a limited network of providers. We study the effect of AWP on prices negotiated between insurers and providers by exploiting the introduction of a regulation targeting retail pharmacies in the state of Maine. Using insurance c...

Abstract:  Patients treated at in-network facilities can involuntarily receive services from out-of-network providers, which may result in "surprise bills." While several studies report the surprise billing prevalence in emergency department and inpatient settings, none document the prevalence in ambulatory surgery centers (ASCs). The extent to which health plans pay a portion or all of out-o...

The pandemic of a new coronavirus, COVID-19, is increasing demand on hospitals as unprecedented numbers of people with respiratory disease seek treatment. In addition to straining hospital resources directly related to care of COVID-19, the outbreak may also displace other types of care. In this analysis, we hope to inform the understanding of the distribution of care provided in hospitals and how...

The 2018 Health Care Cost and Utilization Report presents data on health care spending, utilization, and average prices from 2014 through 2018 for individuals under the age of 65 who receive health insurance coverage through an employer. The report draws on data from more than 2.5 billion medical and prescription drug claims for approximately 40 million individuals enrolled in employer-sponsored h...

As previous reports have indicated, there is widespread price variation in the U.S. commercial health care system. Many studies have shown that prices are dramatically different not only across geographies, but they vary substantially even within the same market for the same service. For example, we found that prices for the same blood tests could vary 39-fold within Tampa, Florida and the cost of...

% Total Medical Spending % Out-of-Pocket Medical Spending % Medical Charges% Medical  Utilization All Medical Care 11.8 15.6 12.317.2Inpatient Care7.95.68.04.8Outpatient Care13.116.513.717.2 In response to high and growing health care spending, policymakers have proposed improving price transparency as a solution. Several such proposals rely on consumers taking action on publicly av...

The International Federation of Health Plans (iFHP), a CEO 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 eight countries, today published the latest International Comparison of Health Prices Report. The report compares the median prices paid by a sample of private he...

​Using HCCI's data, we assessed the share among individuals younger than 65 years covered by employer-sponsored insurance from 2013 to 2017.  We assessed primary care spending using 2 main definitions: a definition which included the total spending on services rendered by primary care clinicians (broad definition) and one where only CPT codes for specific services specified as prima...

Using data from the Health Care Cost Institute (HCCI) and Centers for Medicare & Medicaid Services (CMS), we examined trends in inpatient hospital admissions and post-acute care (PAC) utilization among Medicare Advantage (MA) and Fee-for-Service (FFS) beneficiaries. Specifically, we compared how frequently individuals in each group were discharged from the hospital, whether they had evidence o...

​The methodology for HCCI's Healthy Marketplace Index was published in a Methods Brief for Health Services Research. Abstract Objective: To compare different methods of indexing health care service prices for the commercially insured population across geographic markets.Data Sources: Health Care Cost Institute commercial claims data from 2012 to 2016.Study Design: We compare price i...

Congress is considering legislation to address "surprise bills", which occur when a person visits an in-network facility, but receives services from a provider that is outside of their insurer's network. Bills in both the House and Senate include provisions to determine a benchmark rate for out-of-network payments based on what in-network providers of the same specialty are paid for delivering sim...

In HCCI's publication in Health Affairs Blog, we examine the case for systemic health system transparency and directing changes towards key stakeholders.  From the article: "Health care costs strain the budgets of families, businesses, and governments, leaving less room for other spending and forcing painful tradeoffs. In 2017, the United States spent $3.5 trillion on health care - ...

Air ambulances are either fixed wing (airplane) or rotary wing (helicopter) aircraft used to transport people in often time-sensitive medical situations. Air ambulances have become a frequent topic in the news due to their high cost and propensity to lead to surprise bills. Our analysis shows that although air ambulances are not frequently used and their use declined over the 2008 to 2017 period, ...

When a person unknowingly receives health care services from a provider that is outside of their insurer's network, it gives rise to the potential for a "surprise bill". Congress continues to consider legislation aimed at reducing the financial burden of "surprise bills" for patients. The approach approved by committees in both the House and Senate is to set a benchmark for the amount that can be ...

Depression is a common mood disorder that affects how people feel, think, and conduct daily activities. Approximately 17 million adults (1 in 14) had at least one major depressive episode in 2017. Surveys have found that antidepressant prescribing has increased over the past two decades. For example, a 2017 National Center for Health Statistics survey found that, among people age 12 and ...

We previously published two blogs discussing trends in out-of-pocket spending on insulin products. First, we presented data illustrating how average monthly out-of-pocket spending in 2017 varied considerably by month, particularly for individuals enrolled in consumer-directed health plans (CDHPs) that carry higher deductibles. Second, we examined the relationship between increasing point-of-sale p...

Earlier this week we presented data on out-of-pocket spending on insulin during each month in 2017. In that blog, we showed that enrollees in employer-sponsored health insurance paid more out-of-pocket for insulin products at the beginning of the calendar year. We examined the relationship between increasing point-of-sale prices for insulin and higher out-of-pocket spending in January for a subset...

People who get health insurance through their jobs pay more than twice as much for insulin at the beginning of the year than they do at the end of the year, on average. New analysis of HCCI data shows that, nationally, in January 2017, average out-of-pocket spending on insulin was $105. This spending declined every month throughout the calendar year, likely as enrollees met their annual deductible...

Changes in opioid utilization correlated with state-level policy changes aimed at decreasing opioid prescription rates. Previous research by HCCI illustrated that national opioid utilization in pills per person fell 27% between the years of 2008 and 2017, driven by declines in the use of hydrocodone (Vicodin). In addition to giving insight into prescription opioid utilization by the commercially i...

Spending per person in employer-sponsored plans reaches all-time high of $6,335 Health care spending for the average New Yorker with employer-sponsored health insurance is increasing faster in New York State than the rest of the country, according to a new analysis released today by the New York State Health Foundation (NYSHealth) and the Health Care Cost Institute (HCCI). Per-person spending grew...