Study of medical claims reveals most expensive
The Institute for Health & Productivity Management (IHPM), a nonprofit research and development organization, has released the results of a first-of-its-kind national study of more than 4 million medical claims across eight specific industries. The cost was highest for treating patients with coronary artery disease, while more workers sought medical treatment for ailments of the ears, nose, and throat than other diseases and medical conditions.
The study results were discussed during the IHPM’s recent meeting in Toronto. An analysis of the top 10 conditions for all industries combined, ranked by prevalence, indicated that 628,141 patients (15%) were treated for ear, nose, and throat conditions, at an average payment per patient of $216.
Other most prevalent conditions were:
• sinusitis;
• skin and subcutaneous diseases and disorders;
• hypertension;
• nonstreptococcal pharyngitis;
• gastrointestinal disorders;
• back disorders;
• nutritional, immune, and metabolic disorders;
• inflammation or infection of the middle ear;
• trauma to the spine and the spinal cord.
An analysis of the top 10 conditions for all industries combined, ranked by total payments, revealed that medical claims totaling $467,067,000 for medical treatment sought by 100,682 patients with coronary artery disease without prior cardiac bypass surgery topped the list.
Other most expensive conditions were:
• gastrointestinal disorders;
• hypertension;
• vaginal delivery;
• osteoarthritis;
• back disorders;
• ear, nose, and throat conditions;
• diabetes mellitus;
• cerebrovascular disease;
• cholecystitis (inflammation of the gallbladder);
• cholelithiasis (interruption in bile flow).
The study data reflect both the most frequent and expensive medical conditions for each specific industry group and for all industries combined. Together, the data are intended to become a standard for comparison that companies may use when beginning analyses of their medical cost and utilization experience.
The study also reveals that frequency and cost of medical conditions vary widely by industry. For example, breast cancer ranks as the third most costly condition for the retail trade industry, while not appearing in the top 10 for manufacturing.
Sean Sullivan, IHPM president, says the data support IHPM’s case that disease management must be done on an industry-specific — if not company-specific — basis and address the particular needs of each work force.
"This study provides purchasers, providers, and health plans with their first comprehensive information on condition-specific medical and health care costs segmented by industry," he says. "It will help focus attention on the most prevalent and costly diseases for employers and show business leaders from different industries how to concentrate resources on health conditions most relevant to their employee population. Targeting interventions this way will pay off in better overall health and productivity in the workplace."
Data drawn nationally
The study, titled Industry-Specific Medical Care Utilization and Expenditures, was conducted by the MEDSTAT Group, a Medical Economics company, and funded by an unrestricted grant from Schering Plough Corporation. The data for the study was drawn from the MEDSTAT Group’s Marketscan private pay fee-for-service database, which represents the inpatient and outpatient health care service use of individuals nationwide covered by over 160 noncapitated benefit plans.
The plans are offered by 61 large employers across the country in the following eight industries: oil and gas extraction and mining; manufacturing/durable goods; manufacturing/nondurable goods; transportation; communication and utilities; retail trade; finance, insurance, and real estate; services; and the government sector.
The nonprofit IHPM is dedicated to establishing the value of employee health as a business asset and investment in corporate success. The institute works with all the major stakeholders in health care for this purpose — employers, providers, health plans, insurers, and employees — to assemble and analyze databases; develop and refine key metrics and measurement tools; organize pilot projects to build the business case for health and productivity; and carry the message and the evidence to all stakeholders.
The IHPM operates from offices in Dallas and Richmond, VA.
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