Healthy Insurance Marketplaces

The Health Care Cost Institute has created an index to evaluate the status of various health care and health care coverage markets around the country.  A report discusses the results.  (HCCI Report)  The report covers 41 core urban areas and integrated counties with at least 100,000 people and uses data from 2011 to 2013 relating to people receiving employer-sponsored insurance benefits.  Three primary dimensions were measured defined geographic area:  price, productivity and competition.  Two price indices were used, one for inpatient services and one for outpatient.  Both were normalized and related to common services.  100 common DRGs were used for inpatient and the 500 most common codes for outpatient services.  These represented 63% of inpatient spending and 75% of outpatient spending.  Means are computed to allow for easy comparison across areas.  Productivity reflects the utilization of services in relation to measures of health.  A utilization index was constructed and measures of morbidity and mortality were used for health as were various diagnosis-based severity measures.  Finally, competition was assessed by measures of hospital concentration.  (Gee, wonder why they didn’t look at health plan concentration too?)

Now the results.  Boulder and Fort Collins, Colorado had high outpatient and inpatient prices.  St. Louis  and Tucson were low on both.  Some areas were high on one and low on the other.  For utilization, more mixed results were seen, with most areas either being high on inpatient and low on outpatient or vice versa.  On the health measure, Omaha and Green Bay were pretty healthy.  Lakeland, Florida, not so much.   Many geographic areas have limited competition by hospital concentration measures.  An interesting report if you take the time to fully digest it.