Aggressive price growth pushes healthcare spending up

Spending on healthcare for the privately insured in the United States increased 4.6% in 2015, outpacing previous years’ growth, according to a report from the Health Care Cost Institute (HCCI).

The study, 2015 Health Care Cost and Utilization Report, covers the healthcare cost and utilization trends for Americans younger than age 65 and covered by employer-sponsored insurance for 2012 through 2015. It includes claims data from Aetna, Humana, Kaiser Permanente and UnitedHealthcare. In addition to reporting on national trends, the report includes snapshots of 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.

This growth was faster than previous years’ growth: 3.0% growth in 2013 and 2.6% growth in 2014, according to HCCI Senior Researcher Amanda Frost.

Frost

“The 4.6% spending growth rate was slightly higher than might be expected, given the previous years’ growth rates,” Frost tells Managed Healthcare Executive. “In every year studied, the biggest driver of per capita spending growth was increasing prices. In 2015, we saw faster growth in prices than in previous years, and small increases in the utilization of professional services and outpatient-other services.”

Out-of-pocket spending per capita for the study population increased each year of the study period, to $813 in 2015. Between 2012 and 2014, the proportion of total spending that consumers paid out of pocket was relatively stable, moving only from 16.1% to 16.2%. However, in 2015, that percentage declined slightly, to 15.8%.

“Out-of-pocket spending per capita by consumers grew at slower rates than did payer spending in 2014 and 2015,” Frost says. “In 2015, the proportion of total healthcare spending per person fell slightly to 15.8%-a trend we had not observed before. One important driver of this was out-of-pocket spending on prescription drugs.”

Of the 18 states reviewed, the lowest per capita out-of-pocket spending was observed in D.C. ($636) followed by Maryland ($682), while the highest was observed in Texas ($983).

Spending out-of-pocket per capita on both brand and generic prescriptions declined between 2012 and 2015, according to the report.

“We might expect the decline in out-of-pocket spending per capita on brand prescriptions, as use of these decreased each year studied,” she says. “The decline in out-of-pocket per capita spending on generic prescriptions might be more surprising, as use of these increased each year studied.”

While spending per person increased with age, the report also found that the increase in spending per person increased with age. Between 2012 and 2015, total per capita spending (from both payers and consumers) increased within each age band. For the youngest groups, ages 0 to 18 years, 19 to 24 years, and 25 to 44 years, the increase in spending was just under $350 per person. For the group ages 45 to 54 years, the increase in spending from 2012 to 2015 was $599 per person. And for the oldest group studied, ages 55 to 64 years, the increase in spending was $901 per person.

Between 2012 and 2015, the number of office visits to primary care providers (PCPs) per 1,000 insured declined each year. Over the same period, office visits to specialists, preventive visits to PCPs, and preventive visits to specialists per 1,000 insured generally increased; the largest increase in use was in the rate of office visits to specialists. However, between 2012 and 2015, there was a net decline in the number of doctor visits (across all four types) per 1,000 insured.

The most common types of hospital admissions (medical and surgical admissions) declined in use over the study period, according to the report. However, rates of use of the less common admissions-mental health and substance use, labor and delivery, and newborn admissions-remained stable over the study period.

Next: Prescription drug spending

Spending per capita on prescription drugs increased each year studied. The majority of this spending was on brand prescriptions (~67% in 2015). Spending per capita on both brand and generic prescriptions increased each year, but spending on brand prescriptions generally grew at faster rates.

Other notable prescription drug trends include:

·      Use of brand prescriptions declined each year studied; so the increase in brand prescription spending per capita was due to increases in price.

·      Use of generic prescriptions increased each year studied; so the increase in generic prescription spending per capita was due to both increases in use and increases in price.

·      In 2014 and 2015, the declines in the use of brand prescriptions were larger than the increases in the use of generic prescriptions, this led to a net decline in prescription use in those years.

The average price of a medical hospital admission grew 10.4% in 2015, to $17,689, according to the report, the highest price growth for any type of hospital admission.

In addition:

·      The average price of an ER visit grew 10.5% in 2015, to $1,863.

·      The average price of an administered drug (for example, a chemo drug) grew 12.5% in 2015, to $534 per service.

·      The average price per filled day of a brand anti-infective agent grew 41.5% in 2015, to $83 per filled day.

Frost says that she won’t speculate on future trends under president-elect Trump. “But, given the relative stability of trends that we observed over the last four years-increasing prices combined with either declines in utilization or just small increases-I think the same areas that we note as of interest in this report, will continue to be important in the future,” she says.