Decomposing Trends in U.S. Health Care Spending Among Nonelderly Adults, 2007-2016

2019 ◽  
pp. 107755871986508
Author(s):  
Fredric Blavin ◽  
Michael Karpman ◽  
Diane Arnos
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Health Care Spending ◽  
Policy Changes ◽  
The Great Recession ◽  
Technological Developments ◽  
Capita Spending ◽  
Per Capita ◽  
Spending Growth

Using the 2007 to 2016 Medical Expenditure Panel Survey–Household Component, this study analyzes trends in per capita health expenditures among nonelderly adults from the Great Recession to the period following full implementation of the Affordable Care Act. We find that the growth in total per capita spending—and specifically for prescription drug and emergency room spending—from 2007-2009 to 2014-2016 was largely driven by increases in expenditures per unit, that is, increases in per unit prices, quality, and/or intensity of treatment. We also find that changes in the health insurance distribution were the largest driver behind the increase in total per capita expenditures over this period, while changes in prevalence of chronic conditions explained a smaller portion of the increase. Identifying policies for containing health care spending growth requires a detailed understanding of the sources of that growth, particularly during periods of economic fluctuations, policy changes, and technological developments.

Immigrants and Private Insurance

Pained ◽  
2020 ◽  
pp. 57-60
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Health Care ◽  
Medical Expenditure Panel Survey ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Undocumented Immigrant ◽  
Common Belief ◽  
The Us ◽  
The Common ◽  
Per Capita

This chapter assesses the accusation that immigrants, particularly undocumented immigrants, take advantage of societal resources at the expense of native-born citizens. Between 2002 and 2009, immigrants paid an estimated $115.2 billion more into Medicare than they used. Meanwhile, a 2018 Health Affairs study used data from the Medical Expenditure Panel Survey (MEPS) to measure both premiums and expenditures from private health insurance. Both documented and undocumented immigrant groups had positive net contributions, meaning they paid more toward their private insurance coverage than they spent in receiving health services. In contrast, US natives had a negative net contribution, meaning that, per capita, their expenditures on health care were greater than their premiums. Thus, these findings upend the common belief that immigrants are a drain on the US health care system. In reality, immigrants who contribute to Medicare and to private health insurers are subsidizing the health care of US citizens.

scholarly journals Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status

2019 ◽  
Vol 56 ◽  
pp. 004695801989385
Author(s):  
Bradley Herring ◽  
Erin Trish
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Expected Utility ◽  
Low Income ◽  
Health Care Services ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Health Care Spending

The exclusion of employment-based health insurance from income and payroll taxes is thought to increase the generosity of insurance coverage and, in turn, increase the overutilization of low-value health care services. We examine this inefficiency of overinsurance by quantifying the change in expected utility across 4 benchmark plans varying in actuarial value (AV) and focus on the distribution of each of these estimates across different groups of people varying in health status. Specifically, we quantify the changes in health care spending due to moral hazard and the changes in uncertainty tied to risk aversion using data from the nationally representative sample of adults with employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey, and produce estimates of expected utility for 24 groups of people based on their age, gender, and preexisting conditions. Our model suggests an average preferred AV of 78% without the tax exclusion, with 29.0% of the population preferring a 60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4% preferring a 90% AV. When incorporating the distortionary effect of the employment-based tax exclusion, the preferred plan increases to an 83% AV for low-income people (with 71.0% of the population preferring a 90% AV) and an 84% AV for high-income people (with 76.0% of the population preferring a 90% AV). We estimate that policy changes to make subsidies independent of a plan’s AV could result in increases in utility equal to about 2.7% of total health care spending, but with those net gains concentrated among the healthy.

scholarly journals Trends in Pediatric Private Insurance and Medicaid Spending: A Repeated Cross-Sectional Analysis of Data from 2002 to 2014

2021 ◽  
Vol 58 ◽  
pp. 004695802110104
Author(s):  
Anjani Sheth ◽  
Rishi Agrawal
Keyword(s):  
Health Care ◽  
Hospital Care ◽  
Private Insurance ◽  
Annual Growth ◽  
Cross Sectional ◽  
Total Spending ◽  
Capita Spending ◽  
Per Capita ◽  
Spending Growth ◽  
Sectional Analysis

Given increased focus on health spending, this investigation aims to compare trends in pediatric Medicaid and private insurance spending on type of service from 2002 to 2014 in order to inform policy and research. A repeated cross-sectional analysis of 2002 to 2014 National Health Expenditure Accounts data was conducted. Total spending, per capita spending, and compounded annual growth rates for type of service were determined for children ages 0 to 18 at the national level. Per capita spending growth was higher for private insurance than for Medicaid, and the areas of high per capita spending growth differed for private insurance and Medicaid. While Medicaid spent more per capita on hospital care than private insurance, private insurance demonstrated greater per capita spending growth on hospital care than Medicaid (8.49% vs 1.99%, respectively). Conversely, per capita spending on home health care grew more for Medicaid (6.79%) than for private insurance (3.18%). Trends in private insurance and Medicaid overall and per capita spending differ. Medicaid experienced higher annual growth in total spending than per capita spending, while private insurance had greater annual growth in per capita spending than total spending. Growth in private insurance per capita spending was higher than growth in Medicaid per capita spending, but growth in Medicaid total spending was higher than growth in private insurance total spending. These data suggest that Medicaid and private insurance may have different drivers of spending growth, highlighting the need for policy makers to examine spending patterns by payer. Further research to determine why such differences in spending growth exist will better inform efforts to increase health care value.

Einkommenswachstum, steigende Gesundheitsausgaben und Finanzierung / Income Increase, Health Spending Growth and Financing

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Hans Adam
Keyword(s):  
Health Care ◽  
Gross Domestic Product ◽  
Health Spending ◽  
Domestic Product ◽  
Health Care Spending ◽  
Public Provision ◽  
Health Care Consumption ◽  
Out Of Pocket Payments ◽  
Per Capita ◽  
Spending Growth

SummaryIn 2005, total health spending in Germany amounted to € 239,4 billion or € 2900 per capita. Given the aging of the population in the next decades and the progress in medical technology there are some doubts about the affordability of health spending growth. One important criterion which has been proposed is that increasing health care spending should not lead to an absolute reduction of real per capita non-health care consumption. Calculations for the period 2005-2075 show that non-health consumption will not fall if per capita health care spending growth exceeds per capita gross domestic product growth by 1 percentage point. Health care spending as a share of the gross domestic product will rise from 10.4 percent in 2005 to 21 percent in 2075. An increase in the ratio of health care spending to the gross domestic product must be expected to change the funding of the German health care system. The public provision of health care will decline while the share of income devoted to private health spending (additional insurance, out-of-pocket-payments) will increase.

scholarly journals National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008

2011 ◽  
Vol 29 (20) ◽  
pp. 2821-2826 ◽  
Author(s):  
Didem S.M. Bernard ◽  
Stacy L. Farr ◽  
Zhengyi Fang
Keyword(s):  
Health Care ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Health Care Expenditure ◽  
Chronically Ill ◽  
Medical Expenditure ◽  
Never Married ◽  
Patients With Cancer ◽  
Nationally Representative ◽  
Total Burden

Purpose To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer. Methods The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums). Results The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions. Conclusion High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

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