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Insured Patients Paying Much Higher Percentage of Hospital Visits

ANN ARBOR, MI — Who pays what for visits to your hospital is undergoing some dramatic changes.

Cost sharing for insured adults increased 37% per inpatient hospitalization from 2009 to 2013, according to an article published online by JAMA Internal Medicine. It also found that variations in insurance policies sometimes resulted in a higher burden of out-of-pocket costs for some patients.

Background information in the article notes that while proponents argue that making patients increasingly responsible for a growing share of their healthcare expenditures has the potential to reduce overuse and inappropriate care, opponents respond that increased out-of-pocket spending can also impede access to care and affect treatment decisions.

For the study, University of Michigan Medical School-led researchers looked at 7.3 million hospitalizations, using 2009 to 2013 data from Aetna, UnitedHealthcare, and Humana, which represent about 50 million members. The nonelderly adults all were enrolled in employer-sponsored and individual-market health insurance plans.

Results indicate that cost-sharing per inpatient hospitalization increased from $738 in 2009 to $1,013 in 2013, primarily because more of the costs were applied to deductibles. That amount grew by 86% from $145 in 2009 to $270 in 2013, and by increases in coinsurance, which grew 33% from $518 in 2009 to $688 in 2013, the authors report.

The highest total cost-sharing was for those enrolled in individual market plans and consumer-directed health plans.

“These results open up the ‘black box’ of healthcare, and show all the costs of hospitalization that are billed to people with private insurance. For many, these may appear to be ‘hidden costs’ that they didn’t realize they would owe,” explained first author Emily Adrion, PhD, MSc. “It shows that even people with the most comprehensive insurance are paying thousands of dollars, at a time when they need hospital care and may not have time to shop around.”

Regions, diagnoses, and procedures varied in terms of cost-sharing. For example, the states in 2013 with the highest total cost-sharing per inpatient hospitalization were Utah, Alaska, and Oregon. In terms of diagnoses, out-of-pocket spending associated with emergency hospitalization for heart attack grew by 37% to $1,586 and for acute appendicitis by 40% to $1,509, according to the report.

One limitation of the study, according to the authors, is that it did not extend far enough to capture the implementation of several provisions of the Affordable Care Act of 2010. "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 hospitalizations remains an important, if often overlooked, area for policy reform," the researchers concluded.

JAMA Internal Medicine Deputy Editor Mitchell H. Katz, MD, notes in an accompanying editor’s note, "To require consumers to pay large amounts of out-of-pocket expenses for healthcare may lead to delay or foregoing of needed care or to financial ruin, the latter of which insurance is supposed to protect you against. There are no easy answers for how to deal with the rising cost of medical care, but increasing out-of-pocket spending for unavoidable, necessary care is counter to the goals of a health insurance system."