Healthcare Spending Among Privately Insured Report

As the healthcare industry, payers and policymakers look to curb the growth of U.S. health costs, new efforts are required to understand the substantial differences in spending and utilization between privately insured individuals under age 65 and Medicare age 65 and over populations. We examine the characteristics, dynamics and drivers of healthcare spending and utilization between the commercially insured under 65 segment and those commonly cited among health service researchers, including the Agency for Healthcare Research and Quality, and the Centers for Medicare and Medicaid Services. 

Healthcare Spending Among Privately Insured Individuals Under Age 65

This report, authored by the IMS Institute and IMS Payer Solutions, sheds light on cost drivers, member characteristics and utilization trends within the small segment (1%) of the privately insured population that drives a significant portion (25%) of overall health costs.

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Key Findings and Accompanying Charts

• Distribution of healthcare costs differs from commonly cited research.
• Outpatient services represent the largest share of overall spending, where professional and facility visits account for 74% of all outpatient spending.
• Inpatient spending is highest among those with chronic conditions, averaging $14,248 per inpatient admission.
• Pharmacy spending represents 21% of overall spending where health plan members with chronic conditions filled 78% of all prescriptions.
• Healthcare spending is highly concentrated, validating that the top 1% of health plan members are vastly disproportionate users of healthcare resources.

Potential Implications

• The Affordable Care Act is expected to extend health insurance coverage to an additional 44 million Americans through 2020. Recognizing the impact of the privately insured segment is essential to understanding the potential implications.