Health care cost growth among the privately insured

Health Affairs

Volumn 28, Issue 5, 2009, Pages 1294-1304

  Bundorf, M Kate ^a   Royalty, Anne ^b   Baker, Laurence C ^c  

^a STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b INDIANA UNIVERSITY   (United States)

^c Stanford's School of Medicine   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

GENERIC DRUG;

ARTICLE; COST CONTROL; DRUG INDUSTRY; HEALTH CARE COST; HEALTH CARE UTILIZATION; OUTPATIENT CARE; PRESCRIPTION; PRIVATE HEALTH INSURANCE;

DRUG COSTS; HEALTH CARE COSTS; HEALTH SERVICES RESEARCH; HUMANS; INSURANCE COVERAGE; PRIVATE SECTOR; UNITED STATES;

EID: 70349194759     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.5.1294     Document Type: Article

References (18)

1. Hartman M, Martin A, McDonnell P, Catlin A, et al. National health spending in 2007: slower drug spending contributes to lowest rate of overall growth since 1998. Health Aff (Millwood). 2009;28(1):246-261
2. Congressional Budget Office. Factors underlying the growth in Medicare's spending for physicians' services [Internet]. Washington (DC): CBO; 2007 Jun [cited 2009 Jun 22]. Available from: http://www.cbo.gov/ftpdocs/81xx/doc8193/06- 06-MedicareSpending.pdf
3. Maxwell S, Zuckerman S, Berenson RA. Use of physicians' services under Medicare's resource-based payments. N Engl J Med. 2007;356(18):1853-61.
4. We define significant enrollment as more than 3 percent of enrollees in a capitated plan.
5. We excluded early retirees, Medicare-eligible retirees, enrollees in Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage, employees on long-term disability, surviving spouses and dependents, and enrollees with unknown employment status.
6. Enrollment changes are driven by both changes in the number of employees in the firm and in the number of employees and dependents choosing to enroll in the coverage offered by the employer. The overall decline in enrollment in the study sample represents an increase in some firms offset by a decline in others.
7. The technical appendix is online at http://content.healthaffairs.org/cgi/ content/full/28/5/1294/DC1.
8. The claims were grouped into admissions and assigned by Medstat, the producer of the data. The DRGs were assigned using the Centers for Medicare and Medicaid Services (CMS) DRG grouper.
9. Our decomposition methodology is identical to that used by the Congressional Budget Office to examine the contributions of growth in prices and growth in quantities to spending on physician services. It is described in full in the online technical appendix, as in Note 7.
10. See Agency for Healthcare Research and Quality. MEPS: Medical Expenditure Panel Survey [Internet]. Rockville (MD): AHRQ; [cited 2009 Jun 22]; [about 3 screens]. Available from: http://www.meps.ahrq.gov/mepsweb/about-meps/Price- Index.shtml
11. For outpatient services and pharmaceuticals, the subcategories do not add to the total because of missing data in the claims on provider and drug type. As a result, the decomposition by service type for these categories is based on the subset of claims for which these fields have valid observations. The decomposition for total spending by service type, in contrast, includes valid claims for which these fields are missing.
12. Specifically, the change in outpatient, pharmaceutical, and inpatient spending represented 68.6 percent, 38.3 percent, and -7.0 percent, respectively, of the total growth in real spending. (Percentages do not add to 100 because of rounding.)
13. The change in spending for outpatient services in Exhibit 1 ($277) does not equal the change in spending for outpatient services in Exhibit 2 ($300) because of missing data for provider type or procedure codes.
14. We defined existing procedure as a procedure code that existed in the claims data in 2001 and new procedure as a procedure code that did not exist in the 2001 data.
15. Aitken M, Berndt ER, Cutler DM. Prescription drug spending trends in the United States: looking beyond the turning point. Health Aff (Millwood). 2009;28(1):w151-60.
16. We defined existing drug as an NDC that existed in the claims data in 2001 and new drug as an NDC that did not exist in the data in 2001.
17. McClellan M. Hospital reimbursement incentives: an empirical analysis. J Econ Manage Strat. 1997;6(1):91-128.
18. Appendix to Danzon PM, Furukawa MF. International prices and availability of pharmaceuticals in 2005. Health Aff (Millwood). 2008;27(1):221-33. Available from: http://content.healthaffairs.org/cgi/content/full/27/1/221/DC1