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Out-of-pocket inpatient hospitalization costs up 37% after ACA passage

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Out-of-pocket spending on inpatient hospitalizations increased 37.3% in the years following passage of the health care reform law, a new study shows.

From 2009 to 2013 among those receiving health coverage through the private sector, total out-of-pocket spending, also known as cost sharing, on hospitalizations grew from an average $738 to $1,013, according to a study published Monday by JAMA Internal Medicine.

The study conducted by researchers with the University Of Michigan at Ann Arbor examined claims data compiled by the Health Care Cost Institute for about 7.3 million hospitalizations of adults enrolled in employer-sponsored group or individual market health plans who were hospitalized over the four-year period.

According to the analysis that was completed in March, about 70% of inpatient hospitalization claims had some type of cost sharing.

Out-of-pocket costs were the highest among those enrolled in individual health plans and consumer-directed health plans, according to the study, “Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults.”

At the same time, individual health plans and CDHPs also experienced the slowest growth in cost sharing.

Cost sharing for patients enrolled in individual health plans grew 17.0% from 2009 to $1,875 in 2013, according to the study.

In the group health insurance market, cost sharing for inpatient hospitalizations increased 37.7% to $997 in 2013.

Cost sharing for patients with consumer-directed health plans rose 25.2% from 2009 to $1,219 in 2013, the study showed. Cost-sharing for non-CDHPs grew 34.4% to $957 during the same time period.

Out-of-pocket costs for hospitalizations among those enrolled in health maintenance organizations grew 34.0% to $1,075 during the four-year period, while cost sharing for non-HMOs grew 37.7% to $1,009 during the study period.

“We found that the growth in cost sharing was driven primarily by increases in the amount applied to patients' deductibles, which rose by 86%, and by increases in coinsurance, which grew by 33% during the study period, rather than by copayments,” according to the study.

Coinsurance related to hospitalizations increased from $518 in 2009 to $688 in 2013, and the amount applied to patients' deductibles rose from $145 in 2009 to $270 during the four-year period.

Copayments, on the other hand, fell 26.7% to $55 in 2013 as fewer inpatient hospitalizations required a copayment.