Dive Brief:

• Average healthcare spending for people with employer-sponsored insurance rose to an all-time high in 2018, costing $5,892 per person annually, according to a study released Thursday from the Health Care Cost Institute. Average out-of-pocket spending increased to $907 per person annually.
• Between 2014 and 2018, total annual spending per person increased 18.4%. Higher prices for medical services were largely responsible for the spending increase during that time period, according to HCCI, a research organization founded by major payers.
• The report found the price increases were more responsible for the overall increase in cost than usage, which rose 3.1% in the years studied. The increase in use was highest between 2017 and 2018 at 1.8%.

Dive Insight:

The vast majority of Americans receive health coverage through their employer and HCCI's annual report found health spending growth exceeded 4% for the third consecutive year. The report comes as the presidential election brings more focus on the healthcare industry and rising costs.

The New Hampshire primary contest this week once again shined a light on Democratic proposals to shift more people to government insurance programs. Healthcare was the top issue for primary voters in the state, just as it was for those caucusing in Iowa earlier this month, according to exit polling.

Drawing on data from Aetna, Humana, Kaiser Permanente and UnitedHealthcare between 2014 and 2018, the HCCI report looks at more than 2.5 billion medical and prescription drug claims from people under 65 with employer-sponsored coverage.

It's the last year UnitedHealthcare's data will be included in the report, as the payer said in January 2019 it would no longer share data with the group. In this year's report, the institute thanked the other payers for continuing to contribute and noted a new agreement with Blue Health Intelligence it said will "add significantly" to the existing data arrangements.

HCCI found that in 2018, per-person spending for those with employer-sponsored insurance increased 4.4%, compared to 4.2% in 2017.

While higher prices for medical services accounted for three-quarters of spending growth between 2014 and 2018, average prices grew at 2.6% in 2018 — the slowest rate during that time period. 

Consistent year-over-year increases, however, mean that prices were still 15% higher in 2018 than 2014.

Professional services accounted for the largest category of spending in 2018, followed by facility payments for outpatient visits and procedures and facility payments for inpatient admissions and prescription drugs. Office visits, psychiatry, radiology and immunizations make up some payments made for professional services.

Drugs administered by a physician accounted for 39% of the increase in spending on professional services over the five-year period.

Spending per person on outpatient services — including emergency room visits and outpatient surgeries — increased 5.5% in 2018, following steady increases in prior years.

Spending on inpatient services rose slightly in 2018, but less than it did in 2017 or 2016. Spending on prescription drugs fared similarly.

Notably, within those categories was a 34% price increase for inpatient substance use admission over the study period. Co-author Jeannie Fuglesten Biniek, a researcher at HCCI, attributed the increase to the drug overdose epidemic during a press call Thursday.

Prescription drug data also exhibited some diverging trends, mainly among the most-common types of medication — although manufacturer rebates were not taken into account. The largest subcategory of prescription drug spending is hormones (20%), followed by central nervous system (14%) and rheumatoid arthritis (13%).

Since 2014, spending per person on rheumatoid arthritis treatments has grown 130%, and spending on hormonal treatments has increased 48%. Per-person spending on central nervous system prescriptions, however, declined 11%.