The staggering death toll of the novel coronavirus pandemic in the United States has been widely reported, surpassing 383,000 as of January 14, 2021. Over the course of the current pandemic a common method for measuring the probable number of deaths caused by COVID-19 has been comparing actual deaths in 2020 to the expected number of deaths in 2020 based on deaths in previous years. To add to the ...
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Jan
14
Dec
21
Abstract: We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting th...
Dec
18
Updated 12/18/2020 to include data through 10/02/2020. Since the original post on 9/9/2020, the following updates have been incorporated: Data on the administration of HIV tests and on obesity counselling have been added. Data have been adjusted to account for claims lag, see Methods Note below. COVID-19 has had an extraordinary impact on the US health care system since its eme...
Dec
09
Introduction As rising health care costs force difficult choices for families, employers, and federal, state, and local governments, a range of policy proposals are emerging to address health care spending in the U.S. In this presidential election year, there has been heightened attention on lowering health care costs and making care more affordable, which will likely accelerate with the ele...
Nov
12
In the first brief of the Past the Healthy Marketplace Index series, we explored how prices compared across the country and found that, in 2017, health care prices for specific services varied by as much as 22-fold across metro areas and even up 40-fold within them. In this next brief, we looked at variation in price growth and examined if that variation was related to the substantial observed dif...
Nov
12
How much people spend on health care from place to place reflects multiple, interwoven, and dynamic factors, such as the cost and use of services. Health care spending and its driving factors change over time, differ across geographies, and vary by type of service. The Health Care Cost Institute's (HCCI) Healthy Marketplace Index (HMI) provides a number of metrics illustrating how health care spen...
Oct
14
Since the onset of the COVID-19 pandemic, a growing body of research has found alarming disparities in rates of the virus among Black and Hispanic communities. For example, the CDC reports that "American Indian or Alaska Native, Non-Hispanic" people and "Hispanic or Latino" people each have 2.8 times as many COVID cases than white people, Black patients have 2.6 time as many, and Asian people have...
Oct
14
Summary: Since April, 1.9 million excess years of life have been lost, 13% above historical average. Over the course of the pandemic, we found age and sex contributions to excess YLL have shifted. Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. Since April, working age adults 20-64 have accounted for 47% of excess YLL, and males 20...
Sep
11
Abstract: Objectives: To quantify the proportion of health plan spending on services for which surprise billing is common—provided by radiologists, anesthesiologists, pathologists, emergency physicians, emergency ground ambulances, and emergency outpatient facilities—and estimate the potential impact of proposed policies to address surprise billing on health insurance premiums. Study D...
Aug
13
People in the United States routinely cite health care and health care costs as top concerns.1,2,3,4 For the more than 160 million people who get insurance from their employer, the cost of health care is high, growing, and outpacing growth in wages.5,6,7 Across the country, health care costs show up in the form of higher premiums and higher out-of-pocket costs (for services that are both...
Aug
13
Earlier HCCI research found that at the national level, commercial payers paid prices that were, on average, 122% of Medicare. However, we found that commercial professional service prices varied dramatically across states from 98% of Medicare in Alabama to 188% of Medicare in Wisconsin. There was similar variation within states, such as California, and also substantial variation within Metro Area...
Jul
27
Abstract: Changes in the way health insurers pay healthcare providers may not only directly affect the insurer's patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that ...
Jun
26
In the start of 2019, Centers for Medicare and Medicaid Services finalized federal policies that required hospitals to publish the amount they charge for common services, documents commonly referred to as chargemasters. While similar policies have been in place at the state level since the early 2000s, this was the first federal mandate to require this type of transparency. These policies have bee...
Jun
19
Alzheimer's disease and related dementias (ADRD) represent a significant and growing cost to the United States health care system. While the prevalence and cost of ADRD related to Medicare Fee-for-Service beneficiaries is documented in the Center for Medicare and Medicaid Services' Chronic Conditions Warehouse, less is known about the prevalence and cost of ADRD among individuals covered by employ...
Jun
10
Recent analysis by HCCI finds that enrollment in consumer-directed health plans (CDHPs) increased dramatically since 2008. Nationally, nearly a third of commercially insured individuals were enrolled in a CDHP in 2017, up from 7.5% in 2008. Over ten years, enrollment in CDHPs doubled in 85 of the 88 metro areas studied. High-deductible health plans (HDHPs) have become increasin...
Jun
02
In HCCI's publication in Health Affairs Blog, we examine the cost and utilization of out-of-network care in commercial claims. From the article: "People receiving surprise bills, sometimes totaling tens of thousands of dollars, have been frequently chronicled by high-profile media stories and in academic research over the past several years. Previous research from the Health ...
Jun
01
In HCCI's publication in Health Affairs, we examined out-of-network spending in the privately insured population. Abstract: "While out-of-network or potential "surprise" billing has garnered increasing attention, particularly in emergency department and inpatient settings, few national studies have examined out-of-network care overall or in other settings. We examined out-of-network sp...
May
28
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,...
May
13
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...
May
13
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...
May
13
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...
Apr
29
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...
Apr
01
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...
Feb
13
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...
Jan
29
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...
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