Study Examines Persistent High Spending Among Under-65 Population

Fewer than one-third of enrollees in a national database of people under age 65 were among the top 10 percent of health care spenders in any year between 2003 and 2008, an AHRQ-funded study found. Meanwhile, more than two-thirds of enrollees were never among the top 10 percent of health spenders in any of the years examined by researchers. To better assess the long-term spending patterns of people under age 65, a population with increased access to insurance coverage through the Affordable Care Act, researchers analyzed data of more than 8 million enrollees in the Truven Health MarketScan database during a six-year period from 2003 to 2008. Considerable persistence occurred among both the top and bottom spenders. Some comorbid conditions, including rheumatological conditions, renal disease, diabetes and AIDS, were associated with higher spending during the study period. The findings support the use of disease management, especially for patients with costly conditions that are strong predictors of high long-term costs, the authors concluded. The study, "New Evidence on the Persistence of Health Spending," and abstract were published February 19 in the journal Medical Care Research and Review.

New evidence on the persistence of health spending. - PubMed - NCBI

2015 Jun;72(3):277-97. doi: 10.1177/1077558715572387. Epub 2015 Feb 19.

New evidence on the persistence of health spending.

Hirth RA1, Gibson TB2, Levy HG3, Smith JA3, Calónico S3, Das A3.

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Abstract

Surprisingly little is known about long-term spending patterns in the under-65 population. Such information could inform efforts to improve coverage and control costs. Using the MarketScan claims database, we characterize the persistence of health care spending in the privately insured, under-65 population. Over a 6-year period, 69.8% of enrollees never had annual spending in the top 10% of the distribution and the bottom 50% of spenders accounted for less than 10% of spending. Those in the top 10% in 2003 were almost as likely (34.4%) to be in the top 10% five years later as one year later (43.4%). Many comorbid conditions retained much of their predictive power even 5 years later. The persistence at both ends of the spending distribution indicates the potential for adverse selection and cream skimming and supports the use of disease management, particularly for those with the conditions that remained strong predictors of high spending throughout the follow-up period.