Center for Policy and Research, AHIP, 601 Pennsylvania Ave, NW, South Bldg, Ste 500, Washington, DC 20004, USA.
Am J Manag Care. 2013 Mar 1;19(3):e106-13.
Our goal was to present detailed descriptive data on transaction prices paid by commercial insurers and their enrollees for inpatient hospital care.
To estimate transaction prices for inpatient hospital stays (hospital cost only), we used the MarketScan data set of commercial claims and administrative records for 45 to 50 million covered enrollees under age 65 years with commercial group health insurance. Prices are defined as average allowed charges, including insurer-paid reimbursements plus patient costsharing obligations, and are shown for 350 specific admission categories and for many states and localities. Intensity adjustments to account for increased complexity or resource use in hospital stays were estimated from changes in the numbers of procedures per admission, the complexity of admission codes, and patients' risk scores.
Unadjusted inpatient hospital prices per admission grew by 8.2% per year from 2008 to 2010 for the commercially insured population (under age 65 years) in the MarketScan data set. We estimate that approximately 1.3 to 1.9 percentage points of the growth in prices can be attributed to increased intensity per admission. Thus, we estimate that intensity-adjusted price increases ranged from 6.2% to 6.8% annually in the 2008-2010 period. Price levels and trends varied considerably across admission types, states, and localities.
我们旨在呈现商业保险公司及其参保者为住院治疗支付的交易价格的详细描述性数据。
为了估算住院治疗（仅住院费用）的交易价格，我们使用了 MarketScan 商业索赔和行政记录数据集，该数据集涵盖了 4500 万至 5000 万 65 岁以下有商业团体健康保险的参保者。价格定义为平均允许收费，包括保险公司支付的报销金额加上患者自付费用分担义务，并按 350 个具体入院类别和许多州和地方展示。住院治疗中复杂性或资源使用增加的强度调整是根据入院人数、入院代码的复杂性以及患者风险评分的变化来估计的。
在 MarketScan 数据集中，2008 年至 2010 年，商业保险人群（65 岁以下）的未经调整的每次住院医院价格每年增长 8.2%。我们估计，价格增长的约 1.3%至 1.9%可以归因于每次入院的强度增加。因此，我们估计，2008-2010 年期间，经强度调整的价格涨幅在每年 6.2%至 6.8%之间。价格水平和趋势在入院类型、州和地方之间差异很大。
