Study determines out-of-pocket spending for hospitalization increased from 2009-2013

A study released by JAMA Internal Medicine titled “Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults” reveals that out-of-pocket spending on inpatient hospitalizations increased 37.3% in the years following the passage of the Affordable Care Act.

Researchers with the University of Michigan at Ann Arbor examined claims data compiled by the Health Care Cost Institute for approximately 7.3 million cases of hospitalization of adults who were enrolled in employer-sponsored group or individual Health Care Marketplace health plans from 2009 through 2013. This analysis looked at data over a four-year period and determined that about 70% of inpatient hospitalization claims had some type of cost sharing, and on average, total out-of-pocket spending (also known as cost sharing) on hospitalization grew from an average of $738 in 2009 to $1,013 in 2013.

The study revealed that out-of-pocket costs were highest among those enrolled in individual health plans and consumer-directed health plans. These two types of plans also experienced the slowest growth in cost sharing.

Costs for patients enrolled in HMO’s grew 34.0%, while cost sharing for non-HMOs grew 37.7%. Cost sharing for patients with consumer-directed health plans rose 25.2% while non-CDHP cost sharing went up 34.4%.

The factors driving the increases are both the amounts applied to patients’ deductibles (as opposed to copayments), which rose by 86%, and increases in coinsurance, which grew by 33%.

Average coinsurance cost increases went from $518 in 2009 to $688 in 2013, while the amount applied to deductibles rose from $145 in 2009 to $270 during the four-year period. Copayments fell to 26.7% to $55 in 2013 as fewer inpatient hospitalizations required a copayment.