Spending Is Up While Utilization is Down for the Privately Insured

Privately insured Americans used fewer medical services in 2013, but spent more on these services, according a report by the Health Care Cost Institute. There was a 3.9% increase in spending for enrollees of employer health plans, continuing the moderate growth trend that began in 2010. “Price growth for medical services and brand name drugs remained strong in 2013. Health spending grew moderately, but that was only because consumers used fewer services,” said HCCI Executive Director David Newman.

Spending averaged $4,864 per enrollee in 2013, up $183 from the year before. Out-of-pocket costs remained stable including co-payments and deductibles. In 2013, there was a decline in the use of brand prescription drugs, inpatient admissions, and outpatient services. Yet average prices increased for all three categories, and at higher rates than in 2012. Acute inpatient hospital admissions fell 2.3% while prices rose 6.7%, causing inpatient spending to rise 3.8%. The average price per-admission grew by $1,101, in 2013 to $18,030. Outpatient visits declined 0.8% while prices rose 6.4%. Total outpatient visit spending grew 5.5%.

The use of brand name prescriptions (filled days per 1,000 insureds) dropped 15.5% while the average price per filled day grew more than 21.2%. Total spending on brand name drugs grew 2.4%. The use of professional services grew in 2013, including office visits and lab tests. The use of generic prescriptions grew 4.5%. Preventive visits to primary care physicians and contraceptive hormone use both rose 5%. Antidepressants dominated generic prescription drug use, accounting for over 10% of all generic drugs used in 2013.

In 2013, consumers spent an average of $800 out-of-pocket — a 4% increase over 2012. Women 19 to 25 spent an average of $662 out-of-pocket — the same as the year before. This was almost completely due to a drop in out-of-pocket spending on generic and brand hormone contraceptives. Hormone contraceptives are generally covered without cost sharing, a provision of the Affordable Care Act that went into effect January 1, 2013. “This is the first time we have seen flat out-of-pocket spending growth by any group of the privately insured,” said HCCI Senior Researcher Amanda Frost.

In 2013, out-of-pocket spending for medical services went up (especially for acute inpatient admissions), but went down for brand and generic prescriptions. In 2013, women 19 to 54 used more outpatient and professional services compared to men. But after 54, the gender gap narrowed, as mens’ use of radiology, laboratory, and pathology services increased.

Adults 19 to 25 visited the ER more often than did adults 55 to 64. However, older adults had a higher average price for their visits, due partially to use of more intensive care. Spending on ER visits averaged $314 per capita for older adults, compared to $310 for young adults.

Anti-depressants account for 10% of generic drug use. In fact, anti-depressants were the most commonly filled class of CNS generic prescriptions and the most used generic drug class for young men, intermediate men, middle age women, and pre-Medicare women. For more information, visit www.healthcostinstitute.org.

Last Updated 10/20/2021

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