AJMC September 3, 2024
Erin L. Duffy, PhD, MPH, Sarah Green, BA, Erin L. Duffy, PhD, MPH, Sarah Green, BA, Samantha Randall, BA, Erin Trish, PhD

ABSTRACT

Objectives: The annual mean spending measures typically used to study longitudinal trends mask distributional and seasonal variation that is relevant to patients’ perceptions of health care affordability and, in turn, provider collections. This study describes shifts in the distribution and seasonality of plan and patient out-of-pocket spending from 2012 through 2021.

Study Design: Analysis of multipayer commercial claims data.

Methods: Medical spending per enrollee was calculated by summing inpatient, outpatient, and professional services, which comprised plan payments and out-of-pocket payments (deductible, coinsurance, co-payment). To account for the long right tail of the spending distribution, enrollees were stratified by their decile of annual medical spending, and annual mean spending estimates were calculated overall and by decile. Mean spending estimates were...

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