This is a story about a $2,000 popsicle, and it's also a story about a question that's harder to answer than you might think: How much are Colorado's health care costs increasing?
Almost any way you look at it, health care costs are getting higher, in some cases significantly higher. For example, prescription drug payments by patients and health insurers in Colorado increased by 97% between 2013 and 2020, according to the Denver-based Center for Healthcare Value Improvement.
Overall, health care payments averaged $7,200 per person in 2020, an increase of 27% from 2013. The portion of this that patients actually paid (so-called out-of-pocket costs) was $870 per person for those with commercial insurance. 22% increase since 2013.
But this isn't the only story about Colorado's rising health care costs. Because “health care” is not a single product or a single system. What you pay for it depends on a thousand individual circumstances and decisions. Some of these can be controlled to reduce the amount you pay, and some are not. How these are combined will determine whether medical costs actually increase.
“There are so many variables in the health care industry,” said Priya Teran, communications manager for the Colorado Consumer Health Initiative.
Now, back to that expensive popsicle.
Colorado's high prices
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ER visit and $2,110 bill
In 2021, my then 2-year-old daughter developed a fever. It's bad.
The thermometer registered 103 degrees and then rose to over 104 degrees. Tylenol did little to slow it down. Her wife tried to get a same-day appointment with the pediatrician, but she was told there were no openings. Emergency treatment was not an option because there was no guarantee that she would see a pediatric specialist.
So, at the urging of a nurse, I went to the emergency department of a nearby pediatric hospital.
In the ER, a nurse hooked my daughter up to a regular machine. Her doctor examined her without much alarm.
They gave her Motrin and told her to start a rotation with Tylenol every 3 hours. They performed tests for urinary tract infections. (Negative.) They gave her Zofran as a precaution for her nausea. And they brought her a bomb pop.
That was the last drug that seemed to be the most effective. A happy smile appeared on her grumpy face, as she had never before known that doctors could prescribe popsicles. After about an hour, her fever had dropped to a level that was no cause for concern, and she was discharged from the hospital without a diagnosis. (She later turns out to be Roseola. Common childhood viral infections. )
A few weeks later, the bill arrived.
$2,110 plus $82.80 in physician fees;
He worked for a company different from the hospital.
Surprised, but not surprised, my wife and I laughed when we saw the bill. How can some very common medications and routine tests cost so much? As a medical journalist, I knew the answer. The bill was extremely high due to the hospital facility fee. ER visits were especially taxing. But accepting the dark humor of the situation, we settled on a different answer.
And so the legend of the $2,000 popsicle was born in our house.
Falling into a high cost funnel
If you live in the United States, you've probably had a similar story about exorbitant medical costs.
In our case, the bill was painful but not financially devastating. We had enough medical savings accounts to cover it. However, not all Colorado residents are so lucky. In 2021, 11.3% of people surveyed in the large Colorado Health Access Study reported difficulty paying for health care.
But our experience in the ER shows how easily medical costs can spiral out of control.
We knew the ER was the most expensive place you could get treatment. But our efforts to avoid going there run into a brick wall of availability, which is not uncommon.
Average per capita health spending in 2021
Per capita numbers are not the amount the average person paid out-of-pocket for health care costs in 2021. It represents his per capita calculation of all expenditures by both individuals and insurance companies.
According to the Colorado Health Access Survey, in 2021, nearly 19% of people report not being able to get a primary care appointment right when they need it. This lack of access has led us to focus on more expensive treatments.
Once there, we chose to enroll in a bronze tier health insurance plan (a plan with low monthly premiums but high deductibles), so we ended up paying the full cost of the visit. And this, too, is becoming an increasingly common situation.
As insurance premiums continue to rise, more individuals and families who receive coverage through their jobs are opting for this lower upfront cost coverage, formally known as high-deductible health insurance. In 2009, the federal government Found by Bureau of Labor Statistics We found that 15% of workers nationwide are enrolled in high-deductible plans. By 2018, that percentage had risen to 45%.
These plans provide coverage for catastrophic medical expenses, but for small claims (for example, a relatively uneventful emergency room visit), only the patient is responsible for paying until the annual deductible is met. It is located in That could mean spending thousands of dollars before insurance coverage kicks in.
This is creating a new affordability crisis in the healthcare sector.People who subscribe to plans with high deductibles less likely to receive medical care.they are You're more likely to be charged a bill you can't pay. And these high-deductible plans are a major source of medical debt for patients and uncompensated treatment for hospitals.
In 2021, an estimated 12.3% of Colorado's population did not seek necessary primary care because of cost, according to the biennial Colorado Health Care Access Survey conducted by the nonpartisan Colorado Health Institute. (2023 survey data should be available to him in February.)
Of those who report having difficulty paying medical bills, more than half have credit card or credit card debt, and more than one-third struggle to pay food, utilities, or rent because of medical bills. I said yes.
Average per capita spending in the insurance sector by region in 2021
Again, the per capita numbers are not how much the average person paid out-of-pocket for health care costs in 2021. These represent her per capita calculation of all expenditures by both individuals and insurance companies.
Insights from your invoice
None of this actually answers the question, “How much more expensive have health care costs become in Colorado?”
There is quite a bit of data on this That's because the aforementioned Center for Healthcare Value Improvement maintains what's known as Colorado's all-payer claims database. That means they oversee the collection of vast amounts of medical bills that can be used to estimate medical costs in the state.
Between 2013 and 2020, the per capita amount paid to doctors and other health care providers in Colorado increased by 27%. The per capita amount paid for outpatient services increased by 33%. Both are about equal to or slightly above inflation for the year.
It should be noted that the 2020 cutoff (this is the latest year for which CIVHC has complete data) predates the recent period of rapid inflation.But there is evidence nationwide that health care costs are high. rose more slowly than overall inflation in recent years.
The per capita amount paid to hospitals for one area, namely inpatient services, increased by 9% between 2013 and 2020, consistent with hospitals' efforts to treat more people in outpatient care. Diminished.
But, of course, for most people, the pain of medical costs is alleviated, and in some cases alleviated, by insurance and other coverage. And here are some bright spots.
Percentage of spending in 2021
The majority of healthcare spending in 2021 was for doctor's visits and outpatient visits, followed by prescription drug costs. The only area in which spending is decreasing is inpatient payments, as hospitals shift more services to outpatient care.
Colorado's uninsured rate hit an all-time low last year.
For those who buy their own insurance, Colorado has some of the lowest premiums in the country. The average benchmark premium price in Colorado (a convenient standardized way to find out the cost of plans in different states) is $380 per month in Colorado. This is nearly 40% higher than in 2014, but still $76 per month lower than the national average.
Subsidies for people who buy their own insurance are also being increased and expanded, and programs to help pay for deductibles and other out-of-pocket costs are increasing.
These trends are part of the broader impact of the federal Affordable Care Act, making health care less burdensome for Coloradans even as prices continue to rise. It seems that.
For example, 11.3% of people reported having problems paying their medical bills in 2021, which is a significant improvement compared to the previous year. In 2009, this figure was 21.9%.
Bankruptcies due to medical debt also decreased. According to the Colorado Health Care Access Survey, 3.1% of Colorado residents who had trouble paying medical bills in 2021 said they filed for bankruptcy as a result. In 2013, the year before most of the Affordable Care Act's key features took effect, that rate was 11.1%.
So where does this leave us?The United States Abnormal values that are obvious from a global perspective By receiving expensive medical care. However, the financial burden is not equal.
The best thing you can do is choose your insurance plan wisely, choose when and how you receive care wisely, fight charges that seem unfair, and learn the lessons that are right for your family as you move forward. is.
This is mine. We now buy popsicles at the grocery store.
