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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 ...

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 a...

​BACKGROUND: National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE: To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription. DESIGN: Retrosp...

HCCI often reports the prices of health care services, defined as the average amount a provider is paid for a given service based on negotiations with health care insurers. These prices typically represent a portion of charges, which are the amounts health care providers bill for the procedures they perform. The charge amount is often the starting point for negotiations between insurers and provid...

​Abstract:  We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States 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 ...

Abstract: Using the Health Care Cost Institute (HCCI) database, which contains claim information on approximately 47 million members annually over a seven-year time period, we examined which characteristics best predict and describe high-cost members. We found that cost history, age, gender and prescription drug coverage are all predictors of future high costs, with cost history being the most pre...

ABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program...

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...

HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER CPT codes were higher in 2016 than in 2009, th...

 ABSTRACT Objective: To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. Data Sources: Commercial health insurance claims data, 2009–2013. Study Design: Retrospective analyses using two‐stage residual inclusion instru...

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...

In a recent issue brief, HCCI found that the already high cost of care for people with multiple sclerosis (MS) rose dramatically over the past several years. The primary driver was the increasing cost of a small group of prescription drugs called Disease Modifying Therapies (DMTs). To illustrate the role prescription drug prices play in driving overall health care spending for people with MS, we d...

This issue brief investigates how the cost of prescription drugs affects the total cost of care for people with multiple sclerosis (MS). It decomposes total health care spending by category, specifically separating out spending on specialty drugs used to treat MS, called Disease Modifying Therapies (DMTs). The issue brief subsequently examines whether changes in spending on DMTs are due to changes...

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...

This issue brief compares trends in health care spending from 2012 to 2016 for adults with employer-sponsored insurance who were diagnosed with hypertension to those not diagnosed with hypertension. It also considers how changes in prescription drug spending compare to changes in prescription drug use for adults with a hypertension diagnosis.   Excel Data Tables Machine-Readable Data   D...

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...

Abstract OBJECTIVE: To analyze utilization of, and payments for, pelvic organ prolapse procedures after the 2011 U.S. Food and Drug Administration (FDA) communication regarding transvaginal mesh. METHODS: This is a retrospective cohort study examining private claims from three insurance providers for inpatient and outpatient prolapse procedures from 2010 to 2013 in the Health Care Cost Institute. ...

It is well documented that Americans spend a lot on health care, but this issue is often discussed in terms of share of GDP, billions of dollars, or an astoundingly high hospital bill. These numbers can be hard to relate to; it's hard to imagine billions of dollars, let alone a share of the national economy. A pricey bill may get our attention, but can seem like a special case that doesn't relate ...

 HEALTH AFFAIRS BLOG: "Perhaps nothing illustrates the intractability of America's struggle with health spending more than the recent announcement by Amazon, JP Morgan, and Berkshire Hathaway that they were founding a new entity to address health care costs for their employees. Despite lacking any concrete details this announcement managed to wipe billions of dollars in market capitalization ...

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...

 NEJM CATALYST: "The concentration of most U.S. health care spending in a small proportion of individuals is well documented. The notion that high health care spending only affects a small portion of people in a given year is particularly relevant to the ongoing policy debate about how to make health insurance affordable for all, while accommodating people with complex health care needs and a...

 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...

Past literature has found links between higher opioid use and local economic conditions for people enrolled in public health programs, but there has been little discussion of whether this relationship occurs among the privately insured. Using HCCI claims data and county level income data from the US Census Bureau, we examined how a county's median household income relates to long-term opioid use a...

HEALTH AFFAIRS BLOG: "As policymakers consider actions to address challenges with the Affordable Care Act and ongoing growth in health spending, the importance of understanding local health care market dynamics is more important than ever. Traditionally, policy makers and other stakeholders have evaluated commercial health care markets' total spending and often attributed high spending to high pri...

Medical bills from the Emergency Room (ER) are a mystery to many patients in the US health system. From incredibly high, varying charges to surprise bills resulting from in/out of network confusion, many Americans have no idea what to expect when it comes to the cost of this necessary service. Recently, Vox reporter, Sarah Kliff, has begun collecting ER bills in an attempt to "bring transparency t...