Total patient out-of-pocket cost sharing – per inpatient hospitalization – is on the rise, driven by a number of insurance benefit design changes in recent years, according to a new study.
Researchers at the University of Michigan, Ann Arbor, performed a retrospective analysis of medical claims for 7.3 million hospitalizations using data from Aetna, UnitedHealthcare and Humana, and found that between 2009 and 2013, total cost sharing per inpatient hospitalization for patients aged 18-64 years increased by 37% – to $1,013 in 2013 from $738 in 2009 – after adjusting for inflation and case-mix differences.
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“We found that the growth in cost sharing was driven primarily by increases in the amount applied to patients’ deductibles, which rose by 86%, and by increases in coinsurance, which grew by 33% during the study period, rather than by copayments,” wrote Emily Adrion, Ph.D., of the University of Michigan, Ann Arbor, and colleagues in a study published online in JAMA Internal Medicine (JAMA Intern Med. 2016 Jun 27. doi:10.1001/jamainternmed.2016.3663).
“Our findings indicate a trend toward fewer plans requiring copayments at the point of service and more plans requiring higher coinsurance and deductibles after care is delivered,” the authors said.
The investigators called these trends “notable,” as research cited in the article suggests “that most Americans lack a basic understanding of the different forms of cost sharing associated with medical care.”
Dr. Adrion and colleagues also point out a large part of the variation in cost sharing for inpatient hospitalizations is driven by the type of insurance product. Those enrolled in individual market and consumer-directed health plans were associated with significantly higher cost sharing for inpatient hospitalizations during the study period.
“Increasing cost sharing may also reflect a recent elevation in insurer and provider consolidation, which may limit competition and increase costs for beneficiaries,” the authors noted, adding that future research should “assess the market dynamics” underlying patient cost sharing.
“With an estimated 85% of all commercial health insurance benefit packages requiring coinsurance for inpatient hospitalizations in addition to meeting an annual deductible, cost sharing for inpatient hospitalization remains an important, if often overlooked, area for policy reform,” Dr. Adrion and colleagues concluded.
The report’s authors claimed no financial conflicts of interest.