Health Care Plan Design and Cost Trends - 1988 through 1998

 

III. Findings

Data from Other Sources

Mutual of Omaha - Current Trends Data - National Average

Each year, Mutual of Omaha produces a report entitled, "Current Trends in Health Care Costs and Utilization." The reports are based on a sample of Mutual of Omaha’s group business and the actual experience of their policyholders. The policies included in the study represent a mixture of groups with and without managed care features.

Hay has found that the Mutual of Omaha reports reflect national trends. The advantage of the reports is that they provide detailed consistent information on use of specific components of health care for a large insured base over a period of years.

The following tables and paragraphs present Mutual of Omaha data from 1988 through 1997. The findings shown differ somewhat from data presented in the initial report. This results from including data prior to 1991 and changes in the Mutual of Omaha reporting practices regarding inclusion of substance abuse utilization with inpatient mental and behavioral utilization. Since the initial report was published we determined that substance abuse data were included with inpatient mental and behavioral care through 1995 but were excluded beginning in 1996. We have excluded substance abuse data for each year in all of the following tables. 

• Office Psychiatric Encounters and Average Claims

An "encounter" is defined as a patient/service date combination. A patient who visits more than one physician in a day will have only one visit counted for the day.

The table below shows the change in outpatient psychiatric encounters and average charge per encounter from 1988 through 1997. From 1988 through 1993, the number of outpatient psychiatric encounters per thousand increased. Since 1993, however, the number per thousand has decreased by 24.6 percent and returned to nearly the 1988 level. After adjusting for inflation, the average charge per encounter decreased by 36.2 percent between 1988 and 1997, but increased by eight percent between 1993 and 1997.

Table 11: Psychiatric Encounters and Average Claims

	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	% Change
											88-97	93-97
Encounters per 1,000 people	276	271	276	313	346	378	360	339	285	285	3.3%	-24.6%
Average Charge Per Encounter	$74	$73	$76	$81	$83	$84	$85	$87	$92	$93	25.7%	10.7%
Average Charge per Encounter in 1998 Dollars	$149	$122	$108	$102	$94	$88	$87	$88	$94	$95	-36.2%	8.0%

• General Office Visit Encounters and Average Claims

The table below shows the change in general office visit encounters and average charge per encounter from 1988 through 1997. The number of general office visit encounters increased by 57.7 percent and the average charge per encounter decreased by 12.1 percent, after adjusting for inflation. The average charge per encounter (adjusted for inflation) has increased 20.8 percent since 1993.

Table 12: General Office Visit Encounters and Average Claims

	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	% Change 1988-1997
Encounters per 1,000 people	1326	1405	1441	1638	1747	1928	1956	2023	2087	2091	57.7%
Average Charge per Encounter	$33	$36	$38	$41	$43	$46	$48	$51	$54	$57	72.7%
Average Charge per Encounter in 1998 Dollars	$66	$60	$54	$52	$49	$48	$49	$51	$55	$58	-12.1%

 

• Inpatient Utilization - Mental and Behavioral (excluding Substance Abuse)
  
  

The tables below show the trends in inpatient utilization for mental and behavioral diagnoses, and for all diagnoses. The data exclude substance abuse treatment. Inpatient utilization has decreased across all categories of care. From 1988 through 1997, the number of inpatient admissions per thousand people declined by 19 percent for mental and behavioral diagnoses. For all diagnoses, the decline was 28.2 percent.

Similarly, lengths of stay have decreased across all categories of care. The decrease is more dramatic for mental and behavioral diagnoses than for all diagnoses (61.9 percent compared to 19.4 percent).

Table 13: Inpatient Utilization – Mental and Behavioral

	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	% Change 1988 - 1997
Inpatient Admissions per 1,000 people	4.2	4.3	4.2	4.0	3.8	3.6	3.3	3.4	3.5	3.4	-19.0%
Average Length of Stay	21.0	21.6	19.0	17.0	16.0	13.2	12.4	10.2	8.5	8.0	-61.9%
Inpatient Days per 1,000 people	87	93	82	68	54	47	41	35	29	27	-69.0%

• Inpatient Utilization - All Diagnoses (including mental & behavioral; excluding substance abuse)

Table 14

	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	% Change 1988 - 1997
Inpatient Admissions per 1,000 people	76.2	73.6	72.8	69.7	68.6	66.2	62.3	63.2	60.5	54.7	-28.2
Average Length of Stay	6.2	6.3	6.2	6.0	5.8	5.7	5.6	5.1	4.9	5.0	-19.4
Inpatient Days per 1,000 people	475	462	449	416	396	378	347	322	294	275	-42.1

 

• Inpatient Utilization - General Health Diagnoses (excluding mental & behavioral & substance abuse)

Table 15

	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	% Change 1988 – 1997
Inpatient Admissions per 1,000 people	72.0	69.3	66.9	65.7	64.8	62.6	59.0	59.8	57.0	51.3	-28.8
Inpatient Days per 1,000 people	388	369	367	348	342	331	306	287	265	248	-36.1

Inpatient admissions per thousand people for mental and behavioral diagnoses declined by 19 percent between 1988 and 1997 while inpatient admissions per 1,000 for general health diagnoses declined by 28.8 percent. However, the number of inpatient days per thousand for mental and behavioral admissions declined by almost twice as much as inpatient days for general diagnoses (68.1 percent for mental and behavioral compared to 36.1 percent for general diagnoses). The greater decline in inpatient days per thousand for mental and behavioral admissions reflects the relative trend in the average length of stay for mental and behavioral compared to general health diagnoses admissions.

The results of the Mutual of Omaha survey confirm the trends shown in the Hay Benefits Report regarding plan design and management.

National Association of Psychiatric Health Systems Annual Survey Reports

Each year NAPHS Surveys its members to examine various aspects fo the behavioral health delivery system. The data reported in the NAPHS surveys show a decrease in average lengths of stay from 1993 to 1996 of 29 percent.

(View Graph 5: Average Lengths of Stay)

(View Figure 6: Average Length of Stay by Psychiatric Program Service)


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