How much do hospitals and doctors charge insurers for their services? How much and which of those services are privately insured patients using? And, most significant, what drives changes in health-care use, costs and total spending?
They are among the most vexing questions in American health care. A recently amassed trove of data from insurance companies could soon shed light on them.
Compiled by the nonprofit, nonpartisan Health Care Cost Institute, the database will allow researchers to analyze more than 3 billion medical claims for more than 33 million individuals in search of answers.
The previously confidential information, scrubbed of identifying details, is being provided by three of the nation’s largest insurance companies: Aetna, Humana and UnitedHealthcare, whose combined customers account for about 20 percent of Americans under age 65 who are insured through an employer.
The institute offered a first look at its findings, in a report that largely confirmed previously identified trends but added intriguing details. For instance, analysts have been puzzling over why health-care spending is now rising more slowly.
Institute researchers were able to put numbers to one of the most popular theories: People are seeking less health care.
According to the report, from 2009 to 2010, people with employer-sponsored insurance had 3.3 percent fewer admissions to hospitals and other medical facilities, 3.1 percent fewer “outpatient” visits to such facilities, and virtually no change in the number of procedures at doctor’s offices.
There was a slight increase in two categories: procedures performed at medical facilities, which went up by 2 percent, and use of prescription drugs, which increased by just less than 1 percent.
“By analyzing over 3 billion claims, we now know not only the trend but the magnitude of the trend,” said David Newman, the institute’s executive director.
Many analysts say the drop-off is too significant to be accounted for by economic factors alone. Today’s report also fleshes out details of another possible explanation: the rising price of care.
In 2010, the average out-of-pocket payment for an admission to a hospital or other facility went up by more than 10 percent, to $700. The total charge for an outpatient visit — including an emergency- room visit or surgery without an overnight stay — also rose 10 percent, reaching $162.
