Beyond average spending: distributional and seasonal commercial insurance trends, 2012-2021.

IF 2.5 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES American Journal of Managed Care Pub Date : 2024-09-01 DOI:10.37765/ajmc.2024.89600
Erin L Duffy, Sarah Green, Samantha Randall, Erin Trish
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引用次数: 0

Abstract

Objectives: The annual mean spending measures typically used to study longitudinal trends mask distributional and seasonal variation that is relevant to patients' perceptions of health care affordability and, in turn, provider collections. This study describes shifts in the distribution and seasonality of plan and patient out-of-pocket spending from 2012 through 2021.

Study design: Analysis of multipayer commercial claims data.

Methods: Medical spending per enrollee was calculated by summing inpatient, outpatient, and professional services, which comprised plan payments and out-of-pocket payments (deductible, coinsurance, co-payment). To account for the long right tail of the spending distribution, enrollees were stratified by their decile of annual medical spending, and annual mean spending estimates were calculated overall and by decile. Mean spending estimates were also calculated by quarter-year.

Results: Inflation-adjusted medical spending grew most quickly among the highest decile of spenders, without proportional growth in their out-of-pocket expenses. Out-of-pocket spending increased for the majority of enrollees in our sample prior to the COVID-19 pandemic, in real dollars and as a share of total medical spending. Out-of-pocket spending was increasingly concentrated in the early months of the calendar year, driven by deductible spending, and was lower in 2020 and 2021, plausibly due to policies limiting cost sharing for COVID-19-related services.

Conclusions: Insurance is working well to protect the highest spenders at the cost of reduced insurance generosity among spenders elsewhere in the distribution. The increasing cross-subsidization among enrollees through cost-sharing design-vs premiums-is a trend to watch among rising public concerns about underinsurance and medical debt.

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超越平均支出:2012-2021 年商业保险的分布和季节性趋势。
目的:通常用于研究纵向趋势的年度平均支出指标掩盖了分布和季节性变化,而这些变化与患者对医疗负担能力的看法以及医疗服务提供者的收款情况息息相关。本研究描述了从 2012 年到 2021 年计划和患者自付支出的分布和季节性变化:研究设计:分析多方商业索赔数据:每位参保者的医疗支出由住院、门诊和专业服务的总和计算得出,其中包括计划支付和自付支出(免赔额、共同保险、共付额)。为了考虑到支出分布的右长尾,参保者按其年度医疗支出的十分位数进行了分层,并计算了总体和十分位数的年度平均支出估算值。此外,还按季度计算了平均支出估计数:通货膨胀调整后的医疗支出在支出最高的十等分人群中增长最快,但他们的自付费用并没有相应增长。在 COVID-19 大流行之前,我们样本中的大多数参保者的自付支出都有所增加,无论是按实际美元计算,还是按其在医疗总支出中所占的比例计算。在免赔额支出的推动下,自付支出越来越集中在日历年的前几个月,而在 2020 年和 2021 年则有所降低,这可能是由于限制 COVID-19 相关服务费用分担的政策所致:结论:保险在保护高消费人群方面运作良好,但其代价是降低了分布中其他人群的保险慷慨程度。通过费用分担设计与保费之间的交叉补贴不断增加,这是公众对保险不足和医疗债务日益关注的一个趋势,值得关注。
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来源期刊
American Journal of Managed Care
American Journal of Managed Care 医学-卫生保健
CiteScore
3.60
自引率
0.00%
发文量
177
审稿时长
4-8 weeks
期刊介绍: The American Journal of Managed Care is an independent, peer-reviewed publication dedicated to disseminating clinical information to managed care physicians, clinical decision makers, and other healthcare professionals. Its aim is to stimulate scientific communication in the ever-evolving field of managed care. The American Journal of Managed Care addresses a broad range of issues relevant to clinical decision making in a cost-constrained environment and examines the impact of clinical, management, and policy interventions and programs on healthcare and economic outcomes.
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