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How PPACA has changed the way we use health care

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People with individual health coverage used more health care in the third quarter of 2014, and people with group coverage used less.

Katherine Hempstead, an analyst at the Robert Wood Johnson Foundation, is reporting that finding in an analysis of insurer data from the National Association of Insurance Commissioners (NAIC). Hempstead compared care utilization data for the individual market and the group market for 2013 and 2014.

The Patient Protection and Affordable Care Act (PPACA) has set up the public exchange system and exchange plan premium subsidies. Other parts of the law have all but eliminated medical underwriting in the individual health insurance market.

See also: Overall private health insurance use rises

Even in the third quarter of 2014, many patients still had coverage written under the rules in effect before Jan. 1, 2014, when exchange plan coverage came to life and the major PPACA underwriting rules took effect. But, by July 1, 2014, PPACA World might have started to gel. Health care providers and insurers may have gotten past the stage of doing whatever they could, however they could, just to keep the health care system going.

Before PPACA came along, workers who could get jobs with health benefits could join their employers’ plans without going through a direct medical underwriting process.

Now that both individual consumers and group plan enrollees can get coverage without facing direct medical underwriting, “the utilization patterns for these markets are clearly converging,” Hempstead writes.

Holders of individual coverage may be using more care both because of a temporary, pent-up need for care and because PPACA rules are letting sicker people get coverage, Hempstead says.

Group plan enrollee utilization may be decreasing because of success employer and insurer efforts to use plan design changes and care management programs to cut utilization, Hempstead says.

But Hempstead says group plan enrollee utilization may also be falling because, even though the number of employers that have dropped their health plans and “sent their workers to the exchange” may be small, the employers that do send their workers to the exchange may be the employers with the oldest, sickest workers.

To learn more about what Hempstead found, read on. 

Doctor

1. Consumers with individual coverage were somewhat more likely to go to the doctor.

Hempstead found that people with individual coverage were about 12 percent less likely than people with group coverage to visit the doctor in 2013. Most of that gap disappeared in 2014.

Median visits per 1,000 coverage holders increased 7.7 percent in the individual market, to 1,186.5, and fell 3.2 percent in the group market, to 1,205.0.

See also: PPACA utilization reports trickle out

Hospital

2. Consumers with individual coverage were much more likely to go to the hospital.

People with individual coverage were about 37 percent less likely than people with group coverage to be admitted to the hospital in 2013. The gap narrowed to about 8 percent in 2014.

Median hospital admissions per 1,000 coverage holders jumped 36 percent in the individual market, to 11.9, and fell 7.6 percent in the group market, to 12.9.

See also: Colorado hospitals report jump in Medicaid patient complexity

Calendar

3. Consumers with individual coverage spent many more days in the hospital.

People with individual coverage spent 35 percent fewer days in the hospital in 2013 than people with group coverage did. That gap shrank to 5 percent in 2014.

Median hospital patient days per 1,000 coverage holders climbed 36 percent in the individual market, to 50.6, and fell 6.7 percent in the group market, to 53.3.

See also: 3 things hospitals are saying about PPACA