Bump in use of outpatient care and professional services contributed to quicker growth in spending in 2015 for the privately insured over previous years

Washington D.C., November 22, 2016 – Spending on health care for the privately insured in the United States increased 4.6 percent in 2015, outpacing previous years’ growth, finds a new report from the Health Care Cost Institute (HCCI). Spending grew just 3.0 percent in 2013 and 2.6 percent in 2014. Prices for outpatient, inpatient, professional services, and prescription drugs increased between 3.5-9.0 percent in 2015, a bigger hike than in the prior two years, according to the analysis. Price increases were the primary reason spending grew more quickly in 2015 than in previous years, and were the largest driver of spending growth throughout the four-year study period.

The study 2015 Health Care Cost and Utilization Reportcovers the period from 2012 through 2015 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. In addition to reporting on national trends, the report includes snapshots of spending and out-of-pocket spending in the District of Columbia and 17 states: Arizona, Colorado, Florida, Georgia, Illinois, Kentucky, Maryland, Nevada, New York, Ohio, Oklahoma, Oregon, Tennessee, Texas, Virginia, Washington, and Wisconsin.

“Spending grew faster than we might have expected in 2015, given the slower growth in previous years,” said HCCI Senior Researcher Amanda Frost. “The combination of people using more health care services and the faster growth in prices pushed up spending, with prices playing the bigger role.”

Spending for Americans younger than age 65 and covered by employer sponsored insurance (ESI) increased to $5,141 per person in 2015. Out-of-pocket spending on deductibles, co-pays and co-insurance rose 3.0 percent in 2015, to an average of $813 per capita. People aged over 45 spent more than $1,000 out-of-pocket, and women of all ages spent $236 more out-of-pocket than men. Of the 18 states reviewed, in 2015, the lowest per capita out-of-pocket spending was observed in DC ($636) followed by Maryland ($682), while the highest was observed in Texas ($983).

Use of outpatient care and professional services, such as doctor visits and lab tests, rose slightly in 2015. While use of generic prescriptions increased, use of brand prescriptions declined, resulting in an overall drop in the use of prescriptions. ER visits and common medical and surgical hospital admissions declined in 2015, continuing a pattern seen in previous years. The number of office visits to primary care physicians fell each year since 2012. In contrast, office visits to specialists increased over the study period.

Spending on prescription drugs grew faster than spending on any other health care service. In 2015, $649 per capita was spent on brand prescriptions, an increase of 11.4 percent from the previous year, with more dollars going to brand hormones and synthetic substitutes (such as insulin and contraceptives) and to anti-infective drugs (such as those used to treat Hepatitis C and HIV). Spending on generic prescriptions reached $313 per person, a 3.3 percent increase from 2014.

Notable price trends:

  • The price of an ER visit jumped 10.5 percent to an average of $1,863 in 2015.
  • Prices for administered drugs—chemotherapy and other medications which are given by a healthcare professional—grew 12.5 percent, increasing to an average of $534 in 2015.
  • Prices for a filled day of brand anti-infective drugs more than doubled over the study period. The average price per filled day rose from $35 in 2012 to $83 in 2015. As a result of these higher prices and despite a decrease in use, spending per capita on brand anti-infective agents nearly doubled over the study period, going from $53 per person in 2012 to $101 per person in 2015.
  • The average price of for an acute hospital admission increased by an average of $1,000 each year of the study, hitting $19,967 in 2015.
  • The average price per filled day for generic prescriptions was $1 in every year of the study period.

“Using data from four of the nation’s largest health insurers, we’re able to look closely at the changes in health care use and prices over time to understand what is driving costs,” said HCCI Executive Director David Newman. “Year after year in our study period we see that rising prices are leading to spending growth.”

For this report, HCCI examined approximately 3.7 billion insurance claims for nearly 40 million Americans covered by ESI per year, which accounted for about 26 percent of the nation’s privately insured population in 2015. HCCI does not report on premiums. All price and spending trends reported by HCCI are current or nominal dollars.

The 2015 Health Care Cost and Utilization Report will be made available on the HCCI website: www.healthcostinstitute.org.

About the Health Care Cost Institute
The Health Care Cost Institute was launched in 2011 to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending. HCCI holds one of the largest databases for the commercially insured population and in 2014, became the first national Qualified Entity (QE) entitled to hold Medicare data. For more information, visit healthcostinstitute.org or follow us on Twitter @healthcostinst.

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