Publications
The latest content from HCCI

HCCI’s original reports and external researcher publications powered by #HCCIdata

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 Pediatrics: Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

ABSTRACT Importance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have add...
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Sep
01

Consumer-Driven Health Plans: A Cost and Utilization Analysis

This data brief examines the health care use and spending from 2010-2014 for people who are enrolled in consumer-driven health plans (CDHPs), and compares these trends to non-CDHP enrollees. Findings indicate that although fewer total dollars were spent on health care for CDHP enrollees, they had higher per capita out-of-pocket spending on deductibles, copays, and coinsurance.    Downloa...
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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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Jul
01

Necessary versus Sufficient Claims Data

This data brief compares membership characteristics and health care service prices in non-ERISA and ERISA populations. The results suggest that non-ERISA data may be sufficient for policy relevant analyses, even when ERISA data is not available.    Download PDF File Here
Jun
03

Journal of Telemedicine and Telecare: Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States

ABSTRACT: Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursem...
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Apr
01

The Price-Quality Paradox in Health Care

This data brief compares average state-level prices against quality measures for asthma, diabetes and hypertension care and finds that higher prices for medical services are not always indicative of higher quality of care.    Download PDF File Here
Mar
01

Spending on Shoppable Services in Health Care

This issue brief examines health care spending on shoppable services in 2011. Contrary to expectations, giving consumers prices so they can shop for health care services may only have a modest effect on reducing health spending.   Key Findings: ​ In 2011, about 43% of the $524.2 billion spent on health care services for commercially insured people was considered shoppable. About 15%—near...
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Sep
01

Taking the Pulse of Health Care Markets

 This data brief discusses patterns in the price and utilization indices reported in the 2015 Healthy Marketplace Index Report.   Download PDF File Here
May
07

Per Capita Health Care Spending on Diabetes: 2009-2013

This issue brief examines health care spending for adults and children with diabetes relative to those without diabetes, both in terms of total per capita health care spending and out-of-pocket costs from 2009-2013.  Key Findings:  ​   In 2013, $14,999 was spent per capita on health care for people with diabetes. Per capita health care spending for children with diabetes rose 7% fro...
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Feb
01

Shopping for Health Care Makes “Cents” for Consumers

This data brief looks at p er capita out-of-pocket spending rates nationally and statewide and examines a verage differences in consumer prices for a set of five common medical procedures: office visit for the evaluation of a new patient, colonoscopy, cataract removal, lower leg MRI; and ultrasound for pregnancy nationally and in nine states: Arizona, Colorado, Florida, Georgia, Maryland, New Jers...
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Nov
20

American Journal of Managed Care: Overcoming barriers to a research-ready national commercial claims database

ABSTRACT Objectives: Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome. Study Design: In this study, we discuss some of the issues around holdin...
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Oct
01

Out-of-Pocket Spending Trends 2013

This issue brief accompanies the 2013 Spending Cost & Utilization Report and examines trends in out-of-pocket expenditures per capita for the national, younger than age 65 population covered by employer-sponsored insurance for the period of 2011 through 2013.    Download PDF File Here
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
Aug
01

Health Affairs: Health Spending Slowdown Is Mostly Due To Economic Factors, Not Structural Change In The Health Care Sector

ABSTRACT: The source of the recent slowdown in health spending growth remains unclear. We used new and unique data on privately insured people to estimate the effect of the economic slowdown that began in December 2007 on the rate of growth in health spending. By exploiting regional variations in the severity of the slowdown, we determined that the economic slowdown explained approximately 70...
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Feb
01

Key Findings from Children's Health Spending 2009-2012 Report

This issue brief summarizes the main findings of the Health Care Cost Institute's (HCCI's) Children's Health Spending: 2009-2012.    Download PDF File Here
Dec
01

The Prevalence of Diagnosed Diabetes, Pre-Diabetes, and Gestational Diabetes among the ESI Population, 2008-2012

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Oct
01

Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five

ABSTRACT Little is known about the trends in health care spending for the 156 million Americans who are younger than age sixty-five and enrolled in employer-sponsored health insurance. Using a new source of health insurance claims data, we estimated per capita spending, utilization, and prices for this population between 2007 and 2011. During this period per capita spending on employer-sponsored i...
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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
05

Changes in Health Care Spending in 2011

A summary of HCCI's 2011 Health Care Cost and Utilization Report.    Download PDF File Here
Sep
01

Spending on Prescriptions in 2011

Findings from HCCI's Health Care Cost and Utilization Report: 2011    Download PDF File Here
Jul
02

Differences in Health Care Spending of Children and Adults 2007-2010

This research brief highlights findings from the Health Care Cost Institute's (HCCI) Children's Health Care Spending Report: 2007—2010.    Download PDF File Here
Jul
01

Trends in Children's Health Care Costs and Utilization

This research brief highlights findings from the Health Care Cost Institute's (HCCI) Children's Health Care Spending Report: 2007—2010. 1 The report tracks changes in expenditure and utilization of health care services for children age 18 and younger, who were covered by employer-sponsored private health insurance (ESI).   Download PDF File Here