Medical Care Price Indexes for Patients with Employer‐Provided Insurance: Nationally Representative Estimates from MarketScan Data

Dunn, Abe; Liebman, B S Eli; Pack, Sarah; Shapiro, Adam Hale

doi:10.1111/1475-6773.12008

Cited by 37 publications

(41 citation statements)

References 11 publications

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“…First, for nearly every disease category, there is a shift away from spending on inpatient services. This is consistent with the results of Aizcorbe and Nestoriak () and Dunn et al, , who showed that substitution away from inpatient services generally leads to a lower MCE relative to an SPI. This savings from reduced utilization on inpatient services is partly offset by a strong increase in the utilization of physician services for most disease categories.…”

Section: Resultssupporting

confidence: 92%

“…In particular, they found that the SPI‐encounter measure grows faster than an episode‐based MCE measure, implying that the SPI‐encounter measure would overstate inflation in the health sector. This result appears to be quite robust and has been replicated in other studies, including those by Dunn et al and Aizcorbe et al . Overall, this research hints that official price indexes may not be an accurate measure for tracking the cost of disease treatment.…”

Section: Introductionsupporting

confidence: 77%

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Implications of Utilization Shifts on Medical‐care Price Measurement

2014

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The medical-care sector often experiences changes in medical protocols and technologies that cause shifts in treatments. However, the commonly used medicalcare price indexes reported by the BLS hold the mix of medical services …xed. In contrast, episode expenditure indexes, advocated by many health economists, track the full cost of disease treatment, even as treatments shift across service categories (e.g., inpatient to outpatient hospital). In our data, we …nd that these two conceptually di¤erent measures of price growth show similar aggregate rates of in ‡ation over the 2003 to 2007 period. Although aggregate trends are similar, we observe di¤erences when looking at speci…c disease categories.

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Section: Resultssupporting

confidence: 92%

Section: Introductionsupporting

confidence: 77%

Implications of Utilization Shifts on Medical‐care Price Measurement

2014

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“…First, MarketScan Commercial data are a convenience sample of the US population with ESI that over-represents states in the South and underrepresents states in the West, which have the highest expenditures. 25 The average expenditures for preterm infants in the South were 12% less than the sample mean, and in the West they were 32% greater than the sample mean. Therefore, the unweighted expenditures likely underestimate expenditures for US ESI plans.…”

Section: Discussionmentioning

confidence: 91%

Employer-Sponsored Plan Expenditures for Infants Born Preterm

et al. 2017

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BACKGROUND Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging. METHODS We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects. RESULTS We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ~$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally. CONCLUSION Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.

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“…Both samples have a high proportion of PPO plans accounting for about two thirds of all observations. 22 We removed outliers we believe are attributable to clerical data input error by discarding episodes in the bottom first percentile and top 99th percentile based on price per service and utilization. 23 An important benefit of the SK&A data relative to other data sources is that they provide information about physician medical practice groups (i.e., firms).…”

Section: Creating a Measure Of Service Pricesmentioning

confidence: 99%

Do Physicians Possess Market Power?

Dunn

Shapiro

2014

The Journal of Law and Economics

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112

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We study the degree to which greater physician concentration leads to higher service prices charged by physicians in the commercially insured medical-care market.Using a database of physicians throughout the entire United States, we construct physician-firm concentration measures based on market boundaries defined by fixed driving times-we label the"fixed-travel-time HHI" (FTHHI). Similar to the measure constructed by Kessler and McClellan [2000], the FTHHI is constructed to mitigate omitted-variable bias attributable to higher quality physicians attracting a higher share of patients. We link these concentration measures to health insurance claims.We find that physicians in more concentrated markets charge higher service prices.Cross-sectional estimates show that a ten percent increase in concentration is associated with a 0.5 to 1 percent increase in fees. Panel estimates show the effect may be twice as large, although estimates are less precisely estimated. Our estimates imply that physician consolidation has caused about an eight percent increase in fees over the last 20 years.

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Medical Care Price Indexes for Patients with Employer‐Provided Insurance: Nationally Representative Estimates from MarketScan Data

Cited by 37 publications

References 11 publications

Implications of Utilization Shifts on Medical‐care Price Measurement

Implications of Utilization Shifts on Medical‐care Price Measurement

Employer-Sponsored Plan Expenditures for Infants Born Preterm

Do Physicians Possess Market Power?

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