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10 FAQs about Employer-based Health Plans Recent data from the Health Care Cost Institute (HCCI) show that price growth accounted for more than half the change in per person health care spending from 2017 to 2021. Nearly half of people in the US get health insurance through work, either through their own employer or as a dependent. Accordingly, rising health care spending is a big problem for empl...

In this brief, we explain the basics of "facility fees," which have been gaining attention at the state and federal levels. We discuss what a facility fee is, why patients might receive a bill for a facility fee for non-hospital services, why there is controversy around these bills, and what policymakers are doing to address them. Download and read the brief below. As described in the br...

Insulin is a life-saving medication for millions of Americans who live with diabetes. As the price of insulin has risen, people who depend on insulin have had to make difficult decisions about whether to pay for their medication or other necessities. Some have been forced to ration their supply, with devastating results. Recent legislation has limited insulin out-of-pocket...

Every year, 1 million people in the U.S. receive chemotherapy for cancer treatment. Most chemotherapy treatment requires patients to be present in a physician's office or hospital outpatient department to receive the treatment (typically an infusion or injection). Chemotherapy plays a critical role in treatment for many patients with cancer, but it also often leads to high financial costs for pati...

Pre-exposure prophylaxis (PrEP) for HIV are medications that reduce an individual's chances of contracting HIV. The CDC estimates that 1.2 million people are at risk of HIV infection and may benefit from a PrEP prescription. We analyzed health insurance claims for 55 million Americans with employer-sponsored insurance in order to examine utilization and spending on these drugs between 2016 and 202...

Biologic drugs include a range of life-saving medications to treat cancer, diabetes, rheumatoid arthritis, retinal diseases, and many other conditions. Unlike "small molecule" drugs (e.g., statins), which can generally be taken at home, biologics are typically infusions or injections which require administration by a physician or other clinician in a hospital or physician's office. While just...

The population with employer-sponsored health insurance (ESI) includes individuals who receive health insurance coverage from an employer, including employees and their dependents, such as spouses and eligible children. Half of the children in the U.S. are covered by ESI, making this form of coverage the largest source of insurance for American children. In this report, we present data on health c...

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...

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...

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 ...

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: 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.

HCCI's President and CEO Niall Brennan was quoted in an NPR report on a shockingly high bill for a COVID-19 test. From the article: ' "People are going to charge what they think they can get away with," says Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit that studies health care prices. "Even a perfectly well-intentioned provision like this can be hijacke...

The 2019 Health Care Cost and Utilization Report presents data on health care spending, utilization, and average prices from 2015 through 2019 for individuals under the age of 65 who receive health insurance coverage through an employer. This report examines trends within four categories of service: inpatient admissions, outpatient visits and procedures, professional services, ...

HCCI's 2019 Past the Price Index report was featured in Reader's Digest. From the article:  "'Generally, Texas had some of the highest blood test median prices in the country, with 5 of the 12 highest prices studied,' the HCCI authors wrote. For instance, a blood test in Beaumont costs 25 times more than a blood test in Toledo, Ohio." A Blood Test in This State Will Run You 25 Times...

HCCI's President and CEO Niall Brennan was quoted in a Kaiser Health News article on the CMS Transparency in Coverage Final Rule.  From the article:  " 'If the information is presented to consumers so they realize they are paying a higher price without the benefit of the rebates, you'll get a lot of angry consumers,' said Niall Brennan, CEO of the Health Care Cost Ins...

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...

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...

HCCI's research on prices for COVID tests and other panel testing was featured in The New York Times.  From the article: "Insurers typically reimburse the panel test at a higher rate, often paying six times what they would for a regular coronavirus test, according to data provided by the nonprofit Health Care Cost Institute." These Towns Trusted a Doctor to Set Up Cov...

HCCI's 2018 HCCUR report was cited in a GAO study on Medicare payments for anesthesia services.  From the report: "The Health Care Cost Institute calculated that in 2017 private insurance payments ranged from 2 to 7 times Medicare payments, on average, across six common services provided by anesthesiologists in 33 states. Wide state-to-state variation within specific services was reported." U...

HCCI's Guroo tool was cited in a STAT article on direct versus insurance-covered health care service prices.   From the article: "I compared prices from this health system's booklet to the average allowed amounts for the same services reported by the Health Care Cost Institute's Guroo tool for hospitals in the state of Pennsylvania. For all services for which insurers pay more than ...

HCCI's research on comparing commercial and Medicare professional service prices was featured in the newsletter of the Association of Health Care Journalists. From the article:  "In Comparing Commercial and Medicare Professional Service Prices, HCCI researchers compared what health insurers paid to physicians and other providers with what Medicare pays for those services. This repor...