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20 Most Expensive Conditions Requiring Hospital Stay, 2017

The top 10 of 20 most expensive conditions that people got hospitalized for in 2017, were Septicemia, osteoarthritis, liveborn infants, heart attack (AMI), congestive heart failure (CHF), back problems, respiratory failure, coronary atherosclerosis, cerebral infarction (stroke), and diabetes with complication. The full list identifies 20 health conditions that cost the nation the most in hospital charges in 2017. The top 10 represented 43% of the total national hospital bill. For Medicaid patients, complications during childbirth, schizophrenia and previous C-section were in the top 10. For self-pay patients/no insurance, diabetes with complications was the 3rd most expensive condition. 18-page Statistical Brief #261 by AHRQ uses 2017 HCUP data; published July 2020.

2020 National Health Costs at $12,530 per person Editor's Pick

National Health Costs for 2020 reached an estimated level of $12,530 per capita (per person). Which means every man, woman and child spent on average, over $34 EACH DAY (either through insurance, out-of-pocket costs or taxes) to pay for America’s healthcare. This represented 19.7 percent of GDP, $4.1 trillion. Total health spending increased 9.7% in 2020; and the percent of GDP grew by 2 points from 2019. This is due to the overall economy shrinking during the year, while healthcare took up a bigger proportion. Federal government spending on healthcare went up 36%. Federal spending included

  • the Provider Relief Fund,
  • the Paycheck Protection Program,
  • public health spending including Operation Warp Speed to get a vaccine, and
  • picking up the federal portion of increased Medicaid payments.

Medicare spending grew 3.5%,compared to 6.9% in 2019. On the other hand, Medicaid growth was 9.2% compared to 3% in 2019. Private insurance decreased by 1.2% as fewer people used healthcare while the coronavirus circulated. Out of pocket declined by 3.7% as people used fewer services during the year, and Covid expenses were covered by government spending. Dental spending was also down in 2020. Retail prescription drug spending was up 3.0%. Nursing home and retirement community spending was up 13% due to pandemic-related federal funding. CMS data published December 2021.

Fact Sheet: Underpayment by Medicare & Medicaid (2022)

Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $100 billion. This cost ends up being borne by other payers and commercial insurance. Using 2020 data, it is estimated Medicare paid 84 cents on the dollar, and Medicaid paid 88. February 2022 report.

Factors Expected to Impact Health Insurance Premiums 2021 – AHIP

America’s Health Insurance Plans (AHIP) identifies factors that are expected to impact premium costs for individual plans in the Health Insurance marketplace for 2021. AHIP did not project increases for 2021. Instead, they identified aspects of COVID costs – such as testing, treatment, vaccine availability, how long the outbreak and pandemic lasts, how many people get sick, etc. Overall, there has been a large delay in “regular” care, which lowers insurance company costs. Some of that care is foregone, some will happen later, if there is capacity in healthcare systems to deliver it. For most insurance companies, 2020 is likely to be a profitable year. What happens in 2021 is yet to be seen. Published May 2020.

Healthcare Spending on Obesity – How Much Extra?

Healthcare spending relative to obesity doubles, on average, compared to a normal weight person, according to recent research. Adults with obesity had higher annual medical care costs by an extra $2,505. Every category of care – inpatient, outpatient and prescription drugs, was increased. Costs increased significantly with class of obesity. “Direct medical costs of obesity in the United States and the most populous states” was published in the Journal of Managed Care + Specialty Pharmacy in 2021. With medical inflation since the (2017) dollars reported, $2,505 is worth approximately $2,863 in 2022 dollars.

Medical Spending Attributable to Obesity

Medical spending attributable to obesity is substantial. Research published in 2021 estimates the medical costs of obesity may have risen to $173 billion per year (2019 dollar estimate, using data from 2011 to 2016 MEPS and NHANES). With medical inflation, it could be $188.3 billion in 2022 dollars. Adults with obesity had $1,861 higher medical costs than a normal weight person.  The article notes that half of US adults are projected to have obesity by 2030. Published March 2021 at PLOS ONE.

Medical Technology and Growth in Healthcare Costs – CBO Editor's Pick

How does medical technology contribute to growth in the cost of healthcare? Technology-related changes in medical practice are estimated by the Congressional Budget Office (CBO) 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 also discusses the contribution to rising costs from population aging, health insurance, rising personal income, price increases, defensive medicine and more. The report’s 75-year forecast predicts health spending will reach 49% of GDP at the rate we’re going in the US. One of our favorite classic reports, released January 2008.

Readmissions to hospital in 30 days

A new report shows data on hospital readmissions within 30 days following an initial hospitalization. In 2018, the readmission rate for all payers combined was about 14 per 100 admissions. The average cost was $15,200. For a private insurance patient, the readmission rate was lower, but the average cost was higher, at $16,400. Charges would have been higher, but are not shown. 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. High numbers of return to hospital occurred for septicemia. The second most common category was heart failure. The highest rate (36.1%) was for sickle cell trait/anemia. For Medicaid readmissions associated with sickle cell, the cost was close to $20,000 HCUP Statistical Brief #278 was published by AHRQ July 2021.

Five Most Costly Medical Conditions, 2012 (2015 pdf)

Five most costly medical conditions in 2012 were cancer, arthritis, trauma-related disorders, mental disorders, and heart conditions. The top 5 most costly illnesses were 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 $8,125 for a cancer patient, $4,852 for an adult with heart disease, $2,603 per trauma patient, $1,727 for mental health care, and $1,909 for someone with arthritis. Average out of pocket payments by consumers not shown. Consumers may wish to add medical inflation since 2012 of about 31%. AHRQ Statistical Brief 471, April 2015.

Other Helpful Listings

Chronic Kidney Disease Rises to 30 million in US; most people unaware

Chronic Kidney Disease Rises to 30 million in US.  Most people are unaware, according to the CDC (Centers for Disease Prevention and Control). This fact sheet states that 30 million people constitutes about 15% of US population, with the vast majority (96%) of people having no idea they have chronic kidney disease (CKD) in its early to mid-stages. Such prevalence leads to more dialysis and kidney transplants. If sizable efficiency improvements don’t happen, and the incidence of kidney failure continues to rise, look for rising health insurance premiums. Published 2017.

Compare Countries on Healthcare

Compare countries on healthcare. Read the results of an in-depth study to compare US healthcare and 10 other highest-income countries (UK, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland and Denmark). Both costs and factors such as health status, utilization, salaries and prices paid were examined. Prices for labor, pharmaceuticals and administrative costs appeared to be the major drivers of the higher US costs. Authors suggest policy makers consider these data in making decisions. Published in the respected JAMA – Journal of the American Medical Association, March 13, 2018.

Cost-Shifting adds $1,788 to health insurance cost for family of four (Milliman study)

Study by Milliman shows that cost-shifting from Medicare and Medicaid underpayments added $1,788 to a family health insurance cost in 2006-2007. This amounted to 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. With medical inflation, the cost shift would be more than $2,700 in today’s dollars, or more than $225 on the monthly premium. Study was commissioned by the AHA (American Hospital Association), AHIP and Blue Cross Blue Shield Assn/Premera Blue Cross, released December 2008. Old study.

Healthcare Expenses for Seniors (MEPS)

Healthcare expenses for seniors are outlined in this MEPS report on Health Care Expenditures for the Elderly Age 65 and over. Median annual expenditures were $4,206 per person (about $5,507 in 2021 dollars). Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 is about $12,915 in 2021 dollars. Medicare paid over 62% (up considerably from 10 years earlier); 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 $3,199 per day (sticker shock, and nearly $4,200 in 2021 dollars); ER visit was $884 on average ($1,158 in 2021 dollars); office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014. Add about 31% to account for medical inflation to 2021.

High Deductible Health Plan Enrollees: EBRI 2021 Survey

Are you enrolled in a high deductible health plan (HDHP)?  This 2021 PowerPoint PPT presentation from EBRI summarizes findings from the Annual (2021) Consumer Engagement in Health Care Survey. This year’s survey showed HDHP enrollment dropped 3 points, from 34% of the adult population under age 65 to 31%. In 2021, HDHP enrollees were less satisfied than those in traditional plans. Instead of nearly 2/3 (63%) of traditional plan enrollees being satisfied, only 44%  were very or extremely satisfied with their HDHP plan. The biggest gaps were due to the amounts HDHP enrollees pay out of pocket.

Both Traditional plan members and HDHP enrollees have the same top 3 reasons for selecting their plans: the network of providers, low out of pocket costs and low premiums. HDHP enrollees checked quality ratings for doctors or hospitals more often than those in traditional plans did (38% vs 32%).  They were more likely to check prices than traditional plan members (36% vs 30%). They also were much more likely to ask for a generic drug instead of brand name (38% vs 28%). The survey also looked at telemedicine and found that more than 3/4 were somewhat to very satisfied with the quality of their telemedicine visits. Survey was conducted August 2 to Sept. 7, 2021. Published 2021. The IRS definition of a HDHP in 2021 is a $1,400 deductible for individuals and $2,800 deductible for a family plan. EBRI is the Employee Benefit Research Institute.

Medicare (Inpatient) Prices for Hospitalizations 2020

Medicare inpatient prices for hospitalizations during 2019 are in this difficult to use Excel file. Amounts paid to hospitals by Medicare, on average for 2020 hospital stays, are shown. Listed by DRG and provider. Consumers can see the Medicare volume for that diagnosis and how much the hospital was allowed as Covered Charges, plus what Medicare payments were. If you can wade through it, you’ll see that total payments were quite often only one-fourth of what the covered charges were – a 75% discount. Hence, the file illustrates how hospital pricing (charge) has become meaningless for most people. Here are a few examples. A hip or knee joint replacement (DRG 470) at the Hospital for Special Surgery in New York City, had an average charge of nearly $80,000 for over 2,945 cases. However, the total payment on average was just $23,780, an effective discount of 70% of the total charges. The hospital with the second largest Medicare volume of hip and knee replacements, New England Baptist Hospital in Boston, had an average charge of $26,389, and average total payment of $15,201. Their average discount was “just” 42%. NYU Langone Hospital in NYC, and Sarasota Memorial Hospital (FL) each had effective discounts of about 84%. All four hospitals received total average payments for joint replacement (DRG 470), between $13,000 and $27,500, but average charges ranged from $26,000 to an astounding $177,000. Published July 2022.

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. This document was written before the “shoppable services” price transparency rule. HFMA has not yet updated their reports. Limited information on surprise medical bills and balance billing is also available. The “No Surprises Act” went into effect Jan. 1, 2022.

WA Medical Group Health Care Waste Calculator (Washington Health Alliance)

Compare 32 WA medical groups by how much health care waste they generate. Report by Washington Health Alliance used the Milliman MedInsight Health Waste CalculatorTM (Calculator) to rate medical group performance on 47 measures. The Alliance studied over 9.5 million services using these 47 measures of common treatments, tests, and procedures widely known to be overused. After classifying the services as either Necessary, Likely Wasteful or (definitely) Wasteful, they found about half of the 9.5 million services were probably not needed and therefore classified as “low-value”. Great improvement was made by the medical groups between 2014 and 2017. The top 10 low-value services are identified for both commercially-insured patients and Medicaid. Examples of overused services include annual cardiac screening if you’re low risk and have no symptoms; Opiates for acute low back pain in your first 4 weeks; Antibiotics for acute upper respiratory or ear infections. Consumers can potentially help avoid unnecessary costs by educating themselves on the top 10 low value services. Report titled “Right Care : First, Do No Harm: Calculating Health Care Waste in Washington State”. Alliance’s All Payer Claims Database was used in the 4-year analysis. Analysis is based on the national Choosing Wisely® program. Published October 2019 on .

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