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The latest news from HCCI

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Sep
19

Health Affairs: Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective

ABSTRACT Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories of health services, although the ...
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Jun
20

Vox: The absurdity of American health care pricing, in one chart

​Research using HCCI data shows the different prices patients face for the same procedures performed in the same hospitals. " a new paper from economists Zack Cooper, Stuart Craig, Martin Gaynor, and John Van Reenen sheds light on another fascinating type of variation: price differences within a single hospital.  Their research is the first I've seen that shows insurers pay different prices f...
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Jun
19

2016 Health Care Cost and Utilization Report

The 2016 Health Care Cost and Utilization Report shows that spending per privately insured person grew by 4.6 percent, faster than in previous years. Price increases were the primary driver. The report covers the period 2012 through 2016 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. ​  The data in the report can a...
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Jun
11

INQUIRY The Journal of Health Care Organization, Provision, and Financing: How do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare with Medicare Fee-for-Service Prices?

ABSTRACT The prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans. More in...
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May
01

NBER: The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured

ABSTRACT: We use insurance claims data covering 28 percent of individuals with employer-sponsored health insurance in the US to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across...
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Apr
01

American Journal of Obstetrics & Gynecology: Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women

ABSTRACT Background: Laparotomy followed by inpatient hospitalization has traditionally been the most common surgical care for hysterectomy. The financial implications of the increased use of laparoscopy and outpatient hysterectomy are unknown. Objectives: The objective of the study was to quantify the increasing use of laparoscopy and outpatient hysterectomy and to describe the financial implicat...
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Mar
01

Medical Care: The Differential Effects of Insurance Mandates on Health Care Spending for Children’s Autism Spectrum Disorder

ABSTRACT Objectives: There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD f...
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Feb
01

NBER: Hospital Pricing and Public Payments

ABSTRACT: A longstanding debate in health economics and health policy concerns how hospitals adjust prices with private insurers following reductions in public funding. A common argument is that hospitals engage in some degree of "cost-shifting," wherein hospitals increase prices with private insurers in response to a reduction in public payments; however, evidence of significant costshifting...
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Feb
01

Top Spenders Among the Commercially Insured Increased Spending Concentration and Consistent Turnover from 2013 to 2015

 This issue brief explores the distribution of health care spending among commercially insured individuals, with a focus on the top 5 percent of spenders and turnover within that group from year to year. It considers the share of spending incurred by this group of top spenders, how those dollars are distributed among the health care service categories, turnover within the group of top spender...
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Dec
01

Health Affairs: Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

ABSTRACT:  Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received cons...
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Nov
20

New England Journal of Medicine: The Value of Health Insurance through Price Discounts

 NEJM CATALYST: " As context for the ongoing health care reform debate, we analyzed Health Care Cost Institute (HCCI) data. HCCI is a nonpartisan, nonprofit organization aimed at providing complete and accurate information about health care utilization and costs in the United States. Our goal was to demonstrate the value of insurance through these discounted rates. We did so by calculating me...
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Sep
01

Health Affairs: Insurer Market Power Lowers Prices In Numerous Concentrated Provider Markets

 ABSTRACT: Using prices of hospital admissions and visits to five types of physicians, we analyzed how provider and insurer market concentration—as measured by the Herfindahl-Hirschman Index (HHI)—interact and are correlated with prices. We found evidence that in the range of the Department of Justice's and Federal Trade Commission's definition of a moderately concentrated market (HHI of...
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Sep
01

Women's Health Issues: Maternal Medical Complexity Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section

ABSTRACT Background: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. Objective: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending d...
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May
17

Becker's Hospital Review: 20 key takeaways on medical service prices - inpatient, outpatient, and physician services

By: Laura Dyrda The Health Care Cost Institute issued the " Healthy Marketplace Index: Medical Service Category Price Index " report for 2017 in April. The report calculates metrics comparing aspects of price, competition and productivity of healthcare markets over time, which shows trends for potential future research. The report includes data for inpatient, outpatient and physician medical servi...
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Apr
04

Congressional Budget Office Working Paper Series: An Analysis of Private-Sector Prices for Hospital Admissions

ABSTRACT: Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this paper, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them wit...
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Feb
28

Non-Shoppable Health Care Services: Inpatient Hospitalizations

This data brief reports on spending and utilization in populations likely unable to shop for a hospital prior to seeking care, comparing spending and length-of-stay for individuals who were admitted through the emergency department (ED) to that of individuals who needed ambulance services the day of their admission through the ED.    Download PDF File Here
Jan
01

JAMA Internal Medicine: A Perspective on Out-of-Pocket Spending

To the Editor Understanding out-of-pocket spending is critical to understanding health care costs in the United States. We applaud the efforts of Adrion et al as an important contribution to understanding the out-of-pocket spending of the commercially insured population younger than 65 years. The commercially insured comprise over 50% of the nonelderly US population and, as demonstrated by Ad...
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Dec
01

Medicare Advantage Health Care Utilization - Observation Stays

This data brief reports on outpatient observations stays in the Medicare Advantage population from 2010 through 2014. The results show that the rate of observations stays increased in total as well as following hospitalizations.    Download PDF File Here
Nov
22

2015 Health Care Cost and Utilization Report

The 2015 Health Care Cost and Utilization Report shows that spending per privately insured averaged $5,141 in 2015, up $226 from the year before. Key Findings  ​Health care spending averaged $5,141 per individual in 2015, up $226 from the year before. Out-of-pocket spending rose 3.0 percent in 2015, to an average of $813 per capita. Spending on prescription drugs grew faster than spending on ...
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Nov
01

Medicare Advantage Health Care Utilization - Hospital Readmissions

 This data brief, reports on five readmission rate measures for the Medicare Advantage (MA) population: 30-day all-cause hospital-wide readmissions and 30-day all-cause readmissions following acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. The results show that MA readmission rates have been declining over the past five years. &nb...
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Oct
01

NBER: Why Don't Commercial Health Plans Use Prospective Payment?

ABSTRACT One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. "Prospective" payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System an...
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Sep
01

JAMA Internal Medicine: Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults

ABSTRACT Importance: Patients' out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults. Objectives: To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, ...
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Aug
01

Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays

ABSTRACT There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per a...
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Oct
29

2014 Health Care Cost and Utilization Report

The 2014 Health Care Cost and Utilization Report tracks changes in health care prices, utilization, and spending for people younger than 65 covered by employer-sponsored health insurance (ESI). The 2014 Health Care Cost and Utilization Report shows that spending per privately insured person grew 3.4% in 2014, with more dollars going to brand-name drugs than in prior years.   Download Report A...
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Jul
08

Children's Health Spending: 2010-2013

Children's Health Spending: 2010–2013 shows that spending on healthcare for children (ages 0-18) covered by employer-sponsored insurance grew an average of 5.7% per year. The increase in spending in 2013 occurred despite a drop in the use of prescription drugs and visits to the emergency room, demonstrating that rising health care prices were an evident driver behind the spending increase in that ...
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Oct
23

2013 Health Care Cost and Utilization Report

The 2013 Health Care Cost and Utilization Report shows that spending per privately insured grew 3.9% in 2013, as falling utilization offset rising prices. The 2013 Health Care Cost and Utilization Report tracks changes in health care prices, utilization, and spending for people younger than 65 covered by employer-sponsored health insurance (ESI).   Download Report Appendix Tables   Key F...
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Sep
01

Selected Health Care Trends for Young Adults: 2007-2012

This issue brief is one of the first to examine health care trends for young adults (ages 19-25) with employer-sponsored insurance before and after implementation of Section 1001 of the Affordable Care Act that allows parents to include their adult children in family health plans.    Download PDF File Here
Sep
13

2012 Health Care Cost and Utilization Report

The 2012 Health Care Cost and Utilization Report shows that the growth rate of health care spending among privately insured people under age 65 remained low in 2012, growing 4.0 percent, slightly lower than in 2011 (4.1%).   Download Report Appendix Tables Key Findings ​ Spending grew fastest for young adults, women, and people living in the Northeast. Out-of-pocket spending rose more quickly...
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Feb
01

The Impact of the Mental Health Parity and Addiction Equity Act on Inpatient Admissions

 The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to mental health and substance use services. The Health Care Cost Institute, Inc. (HCCI) analyzed mental health, substance use, and medical/surgical inpatient per capita spending, utilization, prices, and out-of-pocket payments for individuals younger than age 65 and covered by employer-sponsored health ...
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Sep
25

2011 Health Care Cost and Utilization Report

 The Health Care Cost and Utilization Report: 2011 provides the first broad look at 2011 health care spending among those with employer-sponsored insurance (ESI). HCCI found that average dollars spent on health care services for that population climbed 4.6 percent in 2011, reaching $4,547 per person. This was well above the 3.8 percent growth rate observed in 2010. Download Report Appendix Ta...
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Sep
01

Spending on Prescriptions in 2011

Findings from HCCI's Health Care Cost and Utilization Report: 2011    Download PDF File Here
May
21

2010 Health Care Cost and Utilization Report

The 2010 HCCI Health Care Cost and Utilization Report is the first report of its kind to track changes in expenditures and utilization of health care services by those younger than 65 covered by employer sponsored, private health insurance (ESI). This report assesses the levels and changes in prices and utilization (including changes in the mix of services) focusing on 2009 and 2010. This report i...
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