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Health costs in Texas comp system see slight drop: Report

Health costs in Texas comp system see slight drop: Report

Total workers compensation health care costs in Texas in 2017 were $1.01 billion, slightly down from $1.06 billion in 2016, according to a report issued Friday by the Texas Department of Insurance, Division of Workers’ Compensation.

Total professional costs decreased by 3.2% from 2016 and by 23% from 2000, according to the new data. Hospital costs in 2017 decreased by 2.7% from 2016, but were 16% higher than in 2000. Total costs for pharmacy services decreased by 22% from 2016 and were 47% lower than in 2005.

The data used in the report consisted of medical billing and payment data submitted by insurers to the Texas Department of Insurance, Division of Workers’ Compensation, covering professional, hospital/institutional, dental and pharmacy services.

Other findings included:

  • The number of claims in 2017 decreased by 0.5% from 2016 and by 31% from 2000. In 2017, 95% of all claims received one or more professional services, 28% received hospital/institutional services and 38% received pharmacy services.
  • The average cost per claim in 2017 decreased by 3% from 2016 for professional services and decreased by 3% for hospital services. Average cost per claim for pharmacy services decreased by 18% from 2016. Since 2000, average professional and hospital costs per claim increased by 12% and 80%, respectively. Average pharmacy cost per claim decreased by 18% since 2005.
  • The combined total cost of professional and hospital services decreased by 11% from 2000 to 2017 in current prices without inflation adjustment. Adjusted for inflation, the total cost decreased by 41%.
  • In 2017, workers compensation health care networks treated 47% of all claims and accounted for 40% of the total health care costs. The average health care costs per claim in networks ($2,488) was 7% lower than that in non-network ($2,660).
  • Total health care costs in the workers compensation system decreased from about 0.14% of the Texas gross domestic product in 2000 to just 0.06% of the Texas GDP in 2017.






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