The Health Care Cost Institute issued the "Healthy Marketplace Index: Medical Service Category Price Index" report for 2017 in April. The report calculates metrics comparing aspects of price, competition and productivity of healthcare markets over time, which shows trends for potential future research.
The report includes data for inpatient, outpatient and physician medical services; the physician services category encompasses professional service claims from physicians, nurse practitioners and physician assistants. The researchers gathered and analyzed the 2012 to 2014 data of employer-sponsored insurance members who are younger than 65 years old.
The researchers used U.S. Census Bureau's 61 Core-Based Statistical Areas to compare prices in different cities and regions of the nation.
Here are the key trends from the report:
Overall
1. Prices in all service categories increased from 2012 to 2014. Outpatient facility prices experienced the biggest increase over the three years studied at 15.7 percent while inpatient prices remained at approximately 5 percent growth each year. However, there was variation in price change based on geographic areas for all three service categories.
2. The geographical coverage areas with higher prices reported consistently higher prices while the coverage areas with lower prices consistently reported lower prices over the study period for all medical service categories.
3. There was a moderate correlation between the inpatient and outpatient price levels, but no systematic relationship between the physician prices and either outpatient or inpatient prices.
4. As a tool to identify research topics for the future, the report's authors suggest investigating areas where outpatient prices are substantially higher than the national average. "Knowing how inpatient and physician price levels in the same CBSA compare to the respective national averages would help focus the investigation on outpatient prices as well as help direct resources toward specific policy interventions within the CBSA," concluded the study authors.
Inpatient
5. Around 61 percent of the coverage areas reported inpatient prices lower than the national average. Knoxville, Tenn., reported the lowest inpatient price index at 0.61 in 2013, which was 39 percent less than the national average. At its highest point, Knoxville's index price was 0.66, 37.5 percent less than the national average in 2014.
6. El Paso, Texas, reported the highest inpatient price index all three years studied, reaching its peak index of 1.36 — 29 percent higher than the national average — in 2014.
7. In more than half of the coverage areas studied, the inpatient price index increased more than 10 percent from 2012 to 2014. Dayton, Ohio, reported the largest change at 23.2 percent over the study period. Eight of the coverage areas reported index price net change of less than 5 percent.
8. At the state level, Connecticut's four coverage areas reported the highest inpatient price levels of between 7 and 19 percent greater than the national average. On the other hand, Kentucky, Arizona and Louisiana all reported low inpatient price levels, according to the report.
Outpatient
9. Overall, outpatient services prices grew 8.9 percent from 2012 to 2013 and another 6 percent from 2013 to 2014.
10. While all cities reported increases in their outpatient price index over the study period, Peoria, Ill., had the lowest growth, with prices being 4.6 percent greater in 2014 than they were in 2012. All other cities experienced more than 5 percent price index growth over the three years studied.
11. Fifty-two of the coverage areas reported outpatient price growth of more than 10 percent. Green Bay, Wis., reported the highest outpatient price index growth, jumping from 0.87 in 2012 to 1.09 in 2014, a 24.3 percent increase.
12. Baltimore-Columbia-Towson, Md., reported the lowest outpatient price index for each year studied, at 36 percent lower than the 2013 baseline on average. Trenton, N.J., reported the highest outpatient index each year, hitting its zenith at 1.64 in 2014, which was 55 percent higher than the national average.
13. Louisiana reported particularly low outpatient price indices, with both cities studied reporting at least 10 percent below the 2013 national average. Texas' seven coverage areas reported particularly high outpatient price indices, with their three year average index value greater than 1.
14. Florida reported the largest difference between coverage areas in the same state; Jacksonville's outpatient price index was 17 percent lower than the national average while Miami's outpatient price index was around 12 percent higher than the national average for all three years.
Physician
15. Overall, physician services prices remained flat from 2012 to 2013 and grew 3.3 percent from 2013 to 2014.
16. Changes were minimal for physician price index values, with 50 coverage areas experiencing a change of less than 5 percent between 2012 and 2014. None of the coverage areas reported a change higher than 10 percent in physician service prices over the study period. Six coverage areas reported a physician price index decline over the study period.
17. New Haven-Milford, Conn., reported the biggest net change in physician price index in 2014, at 8.5 percent higher than in 2012. On the other end of the spectrum, the largest decline occurred in Oklahoma City, where the physician price index dropped more than 1 percent from 2012 to 2013.
18. Thirty-six coverage areas reported a physician price index less than 1, and Louisville-Jefferson County, Ky., reported the lowest index value for each study year. Louisville's average physician prices were 17 percent lower than the national average from 2012 to 2014.
19. Twenty-five coverage areas reported average index values above 1, and Sheboygan, Wis., reported the highest physician index for all three study years. Sheboygan reached its high point in 2014 when its physician index was 1.69, 65 percent higher than the national average.
20. States with cities consistently below the national average included Arizona, Florida, Kentucky, Ohio and Oklahoma. Connecticut and Wisconsin were among states with cities with consistently higher physician services prices. In Wisconsin, all five cities reported an average price index 42 to 64 percent above the national average.