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Leader Education - Learn More about Health Care Costs

Primary Listings

20 Most Expensive Conditions Requiring Hospital Stay, 2011 (pdf)

Septicemia, osteoarthritis, complication of device, implant or graft, childbirth, heart attack (AMI), back problems, pneumonia, congestive heart failure (CHF), coronary atherosclerosis and respiratory failure were the top 10 of a list of 20 health conditions that cost the nation the most in hospital charges in 2011 - to nearly half (47%) of the total national hospital bill. Most expensive condition billed to the uninsured was heart attack (AMI). 12-page Statistical Brief #160 by AHRQ uses 2011 HCUP data; pub. Aug. 2013

2016 National Health Costs at $10,348 per person (est.)  Editor's Pick

Health spending increased 4.3% in 2016 to a level of $10,348 per capita (per person), representing 17.9 percent of GDP, $3.3 trillion. Which means every man, woman and child spent on average $28 EACH DAY (either through insurance, out-of-pocket costs or taxes) to pay for America's healthcare. Medicare spending grew 3.6%, Medicaid growth finally slowed to 3.9%; private insurance was up 5.1%. Out of pocket grew 3.9%. Includes nursing home and drug costs. CMS data

Fact Sheet: Underpayment by Medicare & Medicaid (2014)

Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $51 billion. This cost ends up being borne by other payors and commercial insurance. Using 2014 data, it is estimated Medicare pays 89 cents on the dollar, and Medicaid pays 90. January 2016 report

Factors Affecting Rising Health Insurance Premiums 2016-2017

A report prepared by America's Health Insurance Plans (AHIP) addresses causes for increased premium costs for individual plans on the Insurance Exchange for 2017. Published May 2016

Five Most Costly Medical Conditions, 2012 (2015 pdf)

Cancer, arthritis, trauma-related disorders, mental disorders, and heart conditions were identified as the top 5 most costly illnesses for adults ages 18 to 64 in 2012. For seniors, COPD and asthma replaced mental disorders. Medical expenditures (payments) according to MEPS data (household component) show average costs (ages 18-64) were $8125 for a cancer patient, $4852 for an adult with heart disease, $2603 per trauma patient, $1727 for mental health care, and $1909 for someone with arthritis. Average out of pocket payments by consumers not shown. AHRQ Statistical Brief 471, April 2015

Healthcare Spending Forecast and Obesity (CBO 2010)

Congressional Budget Office forecasts per capita spending on health care for adults will rise 59% to 71% between 2007 and 2020 from $4550 to over $7200 (2009 dollars), depending on assumptions made relative to US obesity rates. Almost 2/3 of adults in US are overweight or obese. Published Sept. 2010, after health reform has been enacted

How much does hospital equipment cost?

See how much hospitals and other healthcare providers pay for capital equipment such as MRI, cardiac cath, digital mammography, and CT systems, as well as operating tables, bed, and medical supplies such as hip and knee implants, stents, pacemakers and cochlear implants. Average prices are current from ECRI and Modern Healthcare in this monthly index

Medical Spending Attributable to Obesity (2009)

Health Affairs research estimates the medical costs of obesity may have risen to $147 billion per year (2008 dollar estimate, using data from 2006 MEPS and NHEA). Obese people had 42% higher medical spending, $1429 more than a normal weight person. Data for overweight people were not provided. Higher prevalence of obesity accounted for 89 percent of the increase in obesity spending between 1998 and 2006. Costs are almost entirely from treating diseases (such as diabetes) that obesity promotes. Published online July 27, 2009

Medical Technology and Growth in Healthcare Costs - CBO, 2008 (pdf)  Editor's Pick

Technology-related changes in medical practice are estimated by the Congressional Budget Office to account for about half of the long-term growth in health care spending. CBO pub. 2764 [Technological Change and the Growth of Health Care Spending] released January 2008 also discusses the contribution to rising costs from population aging, health insurance, rising personal income, price increases, defensive medicine and more. Also shows the 75-year forecast for health spending to reach 49% of GDP at the rate we're going in the US

Readmissions to hospital in 30 days - 2013 data

Hospital readmissions are an important measure for assessing performance of the health care system. One strategy for improving health care quality and lowering costs is to reduce rates of preventable readmissions. Statistical Brief #199 presents data on hospital readmissions within 30 days following an initial hospitalization. From 2009 to 2013, the readmission rate for all payers combined stayed at about 14.0 per 100 admissions. Companion Brief #196 shows readmission rates by health condition. Pub. Dec. 2015

Other Helpful Listings

Chronic Kidney Disease Rises to 26 million in US; most people unaware (Nov. 2007)

News release by NIH cites study published in Nov. 7, 2007 Journal of the AMA (JAMA) that about 13% of US population now has chronic kidney disease, with the majority of people having no idea they have the disease in its early to mid-stages. In 15 years time, 60% more people are expected to get to dialysis or kidney transplant. Healthcare system efficiency would have to increase by 40% or more to absorb the costs of the rising numbers of people seeking treatment. If sizable efficiency improvements don't happen, and the incidence of kidney failure continues to rise, look for rising health insurance premiums

Cost Conscious and Growth in Consumer-Driven HSAs and High Deductible Health Plans

May 2017 issue brief (No. 433) presents findings from the Annual (2016) EBRI Consumer Engagement in Health Care Survey. Estimated 14% of the population enrolled in high deductible health plans HDHP, and an additional 14% have a Health Saving Account HSA-eligible (or HRA) plan for a total estimated at 58 million adults. Although the survey reportedly measures consumer satisfaction, this year's report again did not update prior years' findings of lower satisfaction with HDHPs than people with traditional health insurance. Consumers with a high deductible reported more often asking for generic drugs, or checking prices (cost information).

Cost-Shifting adds $1788 to health insurance cost for family of four (Study)

Study by Milliman released December 2008 shows that cost-shifting from Medicare and Medicaid underpayments accounted for about 15% of the amount paid for hospital and physician costs for privately insured people. Premiums paid through employer-provided insurance were estimated to be 10.6% higher due to the cost-shifting. Study uses 2006 and 2007 data; commissioned by the AHA, AHIP and Blue Cross Blue Shield Assn/Premera Blue Cross

Harris Interactive Poll: Concern with Drug Costs (2015)

October 2015 survey of adults shows Americans concerned with rising costs for drugs, and ready to put price caps in place. Nearly 3/4 (73%) supported price controls on pharmaceutical/medical device manufacturers...led by democrats (81%) and 74% of independents. Drug companies, the health care system as a whole and insurance companies get consumers' top blame for the high cost of healthcare. Published by Harris Poll Nov. 2015

Healthcare Expenses for Seniors (MEPS 2011 data)

Special report on Health Care Expenditures for the Elderly Age 65 and over, shows median annual expenditures were $4206. Average expenses for those with expense were $9863 in 2011. Medicare paid over 62% (up considerably from 10 years ago); private insurance paid 16%; out-of-pocket amount declined to 12%. 96% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $76 per purchase. For seniors, the inpatient room rate averaged $3199 per day (sticker shock); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429, Jan. 2014

Pricing Reform in Hospitals - HFMA (pdf)

The respected Healthcare Financial Management Association issued a 32-page Call to Action - Reconstructing Hospital Pricing Systems saying pricing reform is critical because it is [confusing, opaque, secretive and convoluted]. We couldn't agree more, and support HFMA's references to pricing being incomprehensible and troublesome. The cost-shifting ['hydraulic'] from Medicare and Medicaid was identified as a 22% add-on factor to private payers. Answers are not easy to come by, but this report provides a start. Published in 2007 and still relevant 10 years later

Understanding Healthcare Prices (HFMA)

Helpful Consumer Guide to understanding health care prices. Prepared by the Healthcare Financial Management Association (HFMA). The overview identifies questions to ask before you have elective surgery, how to discuss codes in order to get billing info, and guiding principles for improving price information to consumers. Published 2015

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