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The staggering death toll of the novel coronavirus pandemic in the United States has been widely reported, surpassing 523,000 as of March 8, 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 gro...

As the production and distribution of SARS-CoV-2 vaccines ramps up in the United States, there is a need to ensure that communities at highest risk for severe COVID-19 morbidity and mortality are targeted. As of February 2021, the Pfizer/BioNTech and Moderna mRNA vaccines, which were approved by the U.S. Food and Drug Administration (FDA) under Emergency Use Authorization (EUA) in late 2020, remai...

Community Health Centers (CHCs) serve over 29 million vulnerable patients, making the lack of data on COVID-19-related racial disparities in patients served in CHCs a critical knowledge gap in assessments of the pandemic's national impact. In rural and poor urban areas, CHCs may be the only accessible healthcare option. Even when other options exist, CHCs reduce barriers such as cost, lack of insu...

Increasingly, policymakers are considering proposals that tie payments made by private health insurers, in some way, to rates paid by Medicare. These proposals are inspired by the rising cost of health care and widespread variation in health care prices. For example, we recently found that the cost of the same service can vary by 5-fold, 10-fold or more within the same market among the commerciall...

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...

 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...

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...

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...

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...

 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...

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...

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...

The COVID-19 pandemic has resulted in a previously unimaginable impact both in the United States and globally. It is increasingly clear as we enter the fifth month of the pandemic, with rising caseloads and deaths, that the United States will need to continue to address the COVID-19 pandemic for the foreseeable future. Each day, we learn more – about the virus clinically, about the people and...

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 ...

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...

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...

Surgery accounts for the largest share of inpatient and outpatient spending among individuals with employer-sponsored insurance, representing 49 percent of inpatient spending and 37 percent of outpatient spending in 2018 according to HCCI's most recent annual report. In recent years, the number of surgical procedures performed using robot assistance has increased dramatically. Intuitive, Inc., whi...

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...

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 ...

Abstract: There is abundant literature on efforts to reduce opioid prescriptions and misuse, but comparatively little on the treatment provided to people with opioid use disorder (OUD). Using claims data representing 12–15 million nonelderly adults covered through commercial group insurance during the period 2008–17, we explored rates of OUD diagnoses, treatment patterns, and spending. We found th...

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...

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...