BOSTON — Massachusetts regulators are mounting pressure on lawmakers failing to curb the trend and achieve a consensus vision of controlling costs as health care prices spiral out of control. issued one of the strongest warnings ever.
Health Policy Board experts Wednesday said rising total health care costs in Massachusetts and an increasing financial burden on patients are forcing Gulf State residents to make tough choices about which basic needs to prioritize. said to have been.
From 2019 to 2021, per capita commercial health spending increased by an average of 5% each year, more than a percentage point above the national growth rate and double the rate of income growth over the period, HPC said. announced in a report on Wednesday. Annual cost trend report preview.
Established more than a decade ago to curb rising health care costs, the agency took an even longer-term view to highlight the impact on families. Between 2000 and 2021, the premium an employee must pay for a workplace-paid health insurance plan increased by $295. That’s more than triple his 88 percent increase in household income and 60 percent overall inflation.
“This trend of expenditures growing faster than incomes is unsustainable for governments, employers and residents alike, and if premiums grow faster than incomes, take-home wages will erode and people will lose money. We know that caregiving avoidance among people will increase, their health will deteriorate, and they will need the medical care they need.People will have to choose between health care and other basic needs.” said David Auerbach, Senior Director of Research and Cost Trends at HPC. “We know that we must limit the increase in healthcare spending, and the fact that we want to increase spending in other areas such as primary care, behavioral health, and health equity. With that in mind, we need to find areas where we can spend more quickly as we need to provide labor to providers who are short on resources.”
HPC said before Total per capita health spending fell by 2.3% in 2020, but rose by 9% in 2021, officials said as an outlier due to the pandemic. The average annual growth rate of 5% for 2020 and 2021, announced Wednesday, points specifically to per capita commercial spending. Head.
Auerbach said Massachusetts’ commercial health spending grew slower than the nation as a whole from 2013 to 2018, before the Bay state overtook the nation in recent years.
Highlighting some of the key findings that will be featured in the full annual report due out in September, Auerbach said there are two factors behind the significant cost increase: overspending and overspending. Identified higher-than-expected utilization of healthcare services.
Private insurers often pay hospital-based providers far more than Medicare pays for certain services, inflating total costs, HPC study finds bottom. As evidence of that momentum, HPC said non-maternity hospitalizations fell by 16% between 2017 and 2021, but commercial spending for the reduced hospitalizations increased by 12% over the same period. rice field.
Analysts forecast 2021 commercial totaled over $3 billion in “overspending”. Overspending, which often refers to service fees more than double what Medicare “pays the baseline,” is about one-eighth of all Massachusetts health care spending, Auerbach said.
Most of the overspending noted by HPC was on prescription drugs. Massachusetts commercial payers in 2021 overpaid nearly $1.9 billion for drugs priced at least 20% above international prices, according to HPC.
HPC compared Medicare population data to other states to understand overuse of health services, such as hospitalizations for certain chronic conditions that could have been prevented or treated in lower-cost settings.
“It’s not just avoidable hospitalizations, it’s really high for all hospitalizations,” Auerbach said.
Officials found Massachusetts at or near the top of the list, a measure that reflects how well Medicare subscribers use hospitals. Massachusetts will have 247 hospitalizations per 1,000 Medicare beneficiaries in 2021, the most of any state.
The Bay State also saw 67,000 more Medicare admissions in 2021 than expected based on population and historical trends, an increase of about 20%, topping all states.
“That’s also an amazing finding. If there were no hospitalizations, it would certainly reduce the burden on employees,” Auerbach said. “But we don’t have much insight as to why that’s the case.”
One reason Auerbach suggested is that Massachusetts providers may overuse imaging services compared to other states. Another is the relatively low availability of independent ambulatory surgery centers (ASCs).
Professor Auerbach said that some common surgeries, such as phacoplasty, cataract surgery, colonoscopies, and arthroscopy, cost on average more in hospital outpatient departments than in outpatient surgical centers. presented data showing that it was about 75 percent higher in
According to the HPC, Massachusetts has 59 Public Health Service-licensed ASCs, the sixth-lowest number per capita of any state. Auerbach said the low ranking likely reflected a moratorium on building a new ambulatory surgery center at the site from 1971 to 2017.
“Preliminary HPC findings from the Cost Trends report show that healthcare costs in Massachusetts are rising to unsustainable levels for families and businesses,” said MAHP President and CEO Lola Pellegrini. “It shows what we already know that we are doing. We need to act urgently to solve this problem.” Doctors argued that lowering prescription drug prices was “one of the most important steps we can take.”
HPC hopes to give lawmakers new tools to enforce cost containment more aggressively, including tiered fines for industry players who contribute to excessive growth.
The Democrats who control the House and Senate have said they want to keep health care costs in check, but have done so for years. can’t get to the same page. The House’s last legislative session focused on subjecting the expansion of large hospitals to greater scrutiny, the Senate sought to revise prescription drug prices, and former Gov. Charlie Baker cut spending on primary care. Asked for an increase. None of these proposals ultimately became law.
At Tuesday’s hearing on the Prescription Drug Pricing Act, Health Care Finance Committee Senator Cindy Friedman likened it to a cycle in which parts of the industry blame each other for rising costs. while her children argue About who started the fight.
