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- Title
Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults.
- Authors
Adrion, Emily R.; Ryan, Andrew M.; Seltzer, Amanda C.; Chen, M.; Ayanian, John Z.; Nallamothu, Brahmajee K.; Chen, Lena M
- Abstract
<bold>Importance: </bold>Patients' out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults.<bold>Objectives: </bold>To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, region, and type of insurance.<bold>Design, Setting, and Participants: </bold>A retrospective analysis of medical claims for 7.3 million hospitalizations using 2009-2013 data from Aetna, UnitedHealthcare, and Humana insurance companies representing approximately 50 million members was performed. Out-of-pocket spending was evaluated by age, sex, type of insurance, region, and principal diagnosis or procedure for hospitalized adults aged 18 to 64 years who were enrolled in employer-sponsored and individual-market health insurance plans from January 1, 2009, to December 31, 2013. The study was conducted between July 1, 2015, and March 1, 2016.<bold>Main Outcomes and Measures: </bold>Primary outcomes were total out-of-pocket spending and spending attributed to deductibles, copayments, and coinsurance for all hospitalizations. Other outcomes included out-of-pocket spending associated with 7 commonly occurring inpatient diagnoses and procedures: acute myocardial infarction, live birth, pneumonia, appendicitis, coronary artery bypass graft, total knee arthroplasty, and spinal fusion.<bold>Results: </bold>From 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37%, from $738 in 2009 (95% CI, $736-$740) to $1013 in 2013 (95% CI, $1011-$1016), after adjusting for inflation and case-mix differences. This rise was driven primarily by increases in the amount applied to deductibles, which grew by 86% from $145 in 2009 (95% CI, $144-$146) to $270 in 2013 (95% CI, $269-$271), and by increases in coinsurance, which grew by 33% over the study period from $518 in 2009 (95% CI, $516-$520) to $688 in 2013 (95% CI, $686-$690). In 2013, total cost sharing was highest for enrollees in individual market plans ($1875 per hospitalization; 95% CI, $1867-$1883) and consumer-directed health plans ($1219; 95% CI, $1216-$1223). Cost sharing varied substantially across regions, diagnoses, and procedures.<bold>Conclusions and Relevance: </bold>Mean out-of-pocket spending among commercially insured adults exceeded $1000 per inpatient hospitalization in 2013. Wide variability in out-of-pocket spending merits greater attention from policymakers.
- Subjects
UNITED States; HOSPITAL care; INSURANCE statistics; MEDICAL care cost statistics; APPENDICITIS; CORONARY artery bypass; INSURANCE; HEALTH insurance; LABOR (Obstetrics); MEDICAL care costs; MYOCARDIAL infarction; PNEUMONIA; RESEARCH funding; SPINAL fusion; TOTAL knee replacement; RETROSPECTIVE studies; ECONOMICS
- Publication
JAMA Internal Medicine, 2016, Vol 176, Issue 9, p1325
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2016.3663