Rural hospitals relied on patient cost-sharing for 34% of allowed amounts in 2019, according to an April study in Health Affairs.
University of Southern California researchers in Los Angeles reviewed in-network commercial insurance claims over the course of 11 years — from 2012 through 2022 — from the Health Care Cost Institute in Washington, D.C. Data from the American Hospital Association’s annual survey was used to determine facility characteristics.
Here are four notes from the study:
1. The inpatient incidence rate dropped to 2.6 from 3.2 per 100 enrollees over the time period, and outpatient rates remained stable (with the COVID-19 pandemic as a notable exception). However, average allowed amounts per enrollee increased 54%, reaching $1,616 in 2022.
2. While there has been a rise in no cost-sharing encounters, now accounting for 50% of all episodes, there has also been an increase in high cost-sharing encounters that are more than $1,000. The category in between — reflecting cost-sharing amounts between zero and $1,000 — dropped by 7 percentage points.
3. Including episodes with no cost-sharing, patient cost-sharing contributed to between 4% and 6% of annual facility allowed amounts for inpatient care and 13% and 15% of annual facility allowed amounts for outpatient care on average.
4. Compared to metropolitan and micropolitan facilities, rural hospitals were owed the greatest share of allowed amounts from cost-sharing. At the peak of cost-sharing in the studied period (2019), rural hospitals had 34% of allowed amounts per encounter covered by cost-sharing, while metropolitan hospitals had 25%. The cost-sharing gap between rural and metropolitan hospitals widened over time, peaking just before the pandemic but still landing at a 7-percentage-point gap in 2022.
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