Health Care Cost Growth Among The Privately Insured

Stanford University School of Medicine, California, USA.
Health Affairs (Impact Factor: 4.97). 09/2009; 28(5):1294-304. DOI: 10.1377/hlthaff.28.5.1294
Source: PubMed


Controlling health care cost growth remains a high priority for policymakers and private decisionmakers, yet little is known about sources of this growth. We examined spending growth among the privately insured between 2001 and 2006, separating the contributions of price changes from those driven by consumption. Most spending growth was driven by outpatient services and pharmaceuticals, with growth in quantities explaining the entire growth in outpatient spending and about three-quarters of growth in spending on prescription drugs. Rising prices played a greater role in growth in spending for brand-name than for generic drugs. These findings can inform efforts to control private- sector spending.

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    • "Findings indicate that the financial burden of chronic non-infectious uveitis is comparable to other medically and economically significant disease. Costs of treated patients with uveitis in the baseline and study periods were high for all groups relative to the average privately insured patient, whose average monthly (annual) spending in the USA was US$323 (US$3,868) in 2009 dollars [21]. Comparative study period costs per month in 2009 dollars for CTS, IMS, and BIO patients were US$1,144, US$1,759, and US$2,689, respectively. After taking into account healthcare cost inflation, we estimated that the average cost for non-infectious uveitis patients ranges from 3.1 to 8.3 times the costs of the average privately insured patient in 2009. "
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    ABSTRACT: The purpose of this study was to describe comorbidities, healthcare costs, and resource utilization among patients with chronic non-infectious uveitis initiating corticosteroid, immunosuppressants, or biologics. In this retrospective cohort study, patients with a non-infectious uveitis diagnosis and continuous insurance coverage during a 6-month baseline were selected from a privately insured claims database with 80.7 million enrollees. Index dates were defined as the first prescription/administration of a corticosteroid, immunosuppressant, or biologic between 2003 and 2009. Comorbidities, healthcare costs, and utilization were analyzed in a per-member-per-month (PMPM) framework to account for varying between-patient treatment periods, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. Patients on corticosteroids (N = 4,568), immunosuppressants (N = 5,466), and biologics (N = 1,694) formed the study population. Baseline PMPM inpatient admission rates were 0.029 for patients on corticosteroids, 0.044 for patients on immunosuppressants, and 0.045 for patients on biologics (p < 0.001 immunosuppressants or biologics versus corticosteroids); during treatment, PMPM inpatient admissions increased to 0.044 and 0.048 for patients taking corticosteroids and immunosuppressants, respectively, but decreased to 0.024 for patients taking biologics (p < 0.001 versus corticosteroids and p = 0.003 versus immunosuppressants). Baseline average PMPM costs for patients taking corticosteroids, immunosuppressants, and biologics were US$935, US$1,738, and US$1,439 (p < 0.001 between groups), while on-treatment PMPM costs excluding drug costs increased to US$1,129 for patients taking corticosteroids but lowered to US$1,592 for patients taking immunosuppressants, and US$918 for patients taking biologics (p < 0.001 versus corticosteroids or immunosuppressants). There is significant economic burden associated with existing treatments of uveitis. Corticosteroids may be overused as a treatment for uveitis.
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    • "occur. 2 Advances in medical equipment that minimize the need for professional administration and monitoring have made home care a more viable alternative to hospital care for some conditions. 3 Among patients with private insurance, the mix of medical care shifted towards outpatient services and pharmaceuticals during the period from 2001to 2006 (Bundorf et. al. 2009)."
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    ABSTRACT: The utilization of health care services has undergone several important shifts in recent years that have implications for the cost of medical care. We empirically document the presence of these shifts for a broad list of medical conditions and assess the implications for price indexes. Following the earlier literature, we compare the growth of two price measures: one that tracks expenditures for the services actually provided to treat conditions and another that holds the mix of those services fixed over time. Using retrospective claims data for a sample of commercially insured patients, we find that, on average, expenditures to treat diseases rose 11% from 2003Q1 to 2005Q4 and would have risen even faster, 18%, had the mix of services remained fixed at the 2003Q1 levels. This suggests that fixed-basket price indexes, as are used in the official statistics, could overstate true price growth significantly.
    Full-text · Article · May 2011 · Journal of Health Economics
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    • "Claims datasets such as Pharmetrics and MarketScan have been used in some other studies that explored problems in medical care price indexes (Berndt et al. (2001) and Song et al. (2009)) and in other studies that document shifts in utilization (Bundorff et al. (2009) and Chernew and Fendrick (2009)). Although these indexes are not nationally representative, their advantage is that the large number of observations provides a better representation of spending at the high end of the distribution and the use of administrative records avoids undercount issues typical of household expenditure surveys (Aizcorbe et al. 2010). "
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    ABSTRACT: In recent years, healthcare service utilization has undergone several shifts, having potentially important implications for the cost of medical care.
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