Individual health status can be enhanced by having adequate insurance coverage and ready availability of health care services. A new report from the National Center for Health Statistics (NCHS) presents coverage estimates of health for the civilian noninstitutionalized U.S. population based on data from the 2021 National Health Interview Survey (NHIS). These estimates are being published before final editing and final weighting so that access to the most recent information can be provided. Estimates are disaggregated by age group, sex, family income (as a percentage of the federal poverty level [FPL]), race and ethnicity, and state Medicaid expansion status. With three years of comparable data available starting with the redesigned NHIS in 2019, this report is able to provide data on trends, similar to reports using 2018 and earlier data. Estimates of health insurance coverage based on data from 2021 are provided, along with selected trends from 2019–2021.
In 2021, 30.0 million individuals of all ages (9.2%) were uninsured at the time of interview. This amount was lower than, but not significantly different from 2020, when 31.6 million persons of all ages (9.7%) were uninsured. In 2021, among adults aged 18–64, 13.5% were uninsured at the time of interview, 21.7% had public coverage, and 66.6% had private health insurance coverage. Among children aged 0–17 years, 4.1% were uninsured, 44.3% had public coverage, and 53.8% had private health insurance coverage. Among non-Hispanic White adults aged 18–64, the percentage who were uninsured decreased from 10.5% in 2019 to 8.7% in 2021. The percentage of individuals under age 65 with exchange-based coverage increased from 3.7% in 2019 to 4.3% in 2021.
Adverse Events In Hospitals
A separate item in this issue of the newsletter discusses the topic of health care quality. A Report in Brief that became available in May 2022 from the Office of Inspector General of the U.S. Department of Health and Human Services (HHS) indicates that 25% of Medicare patients experienced patient harm during their hospital stays in October 2018. Patient harm includes adverse events and temporary harm events. Among that group of patients, 12% experienced adverse events, which are events that led to longer hospital stays, permanent harm, life-saving intervention, or death. Also, 13% of patients experienced temporary harm events, which required intervention, but did not cause lasting harm, prolong hospital stays, or require life-sustaining measures. Temporary harm events sometimes were serious and could have caused further harm if providers had not treated patients promptly.
The most common type of harm event was related to medication (43%), such as patients experiencing delirium or other changes in mental status. The remaining events related to patient care (23%), such as pressure injuries; to procedures and surgeries (22%), such as intraoperative hypotension; and to infections (11%), such as hospital-acquired respiratory infections. Physician-reviewers determined that 43% of harm events were preventable, with preventable events commonly linked to substandard or inadequate care provided to the patient. Reviewers determined that 56% of harm events were not preventable and occurred even though providers followed proper procedures. Events were determined not preventable for several reasons, including that the patients were found to be highly susceptible to the events because of their poor health status.
Prices Paid To Hospitals By Private Health Plans
Findings from a new report by the RAND Corporation show that in 2020, across all hospital inpatient and outpatient services (including both facility and related professional charges), employers and private insurers paid 224% of what Medicare would have paid for the same services at the same facilities. That percentage is a reduction from the 247% figure reported for 2018 in the previous study owing to an increase in the volume of claims from states with prices below the previous mean price. Prices for common outpatient services performed in ambulatory surgery centers (ASCs) averaged 162% of Medicare payments, but if paid using Medicare, payment rates for hospital outpatient departments (HOPDs) would have averaged 117%. Although relative prices are lower for ASC claims priced according to HOPD rules, HOPD prices are higher than ASC prices. Little variation in prices is explained by each hospital’s share of patients covered by Medicare or Medicaid. A larger portion of price variation is explained by hospital market power. Prices for COVID-19 hospitalization were similar to prices for overall inpatient admissions and averaged 241% of Medicare.