Md. care tab: Nearly $16 billion 3.8% increase in 1996 was just below nation's 4% rise

Health care

March 06, 1998|By M. William Salganik | M. William Salganik,SUN STAFF

Nearly $16 billion was spent on health care for Marylanders in 1996, an increase of 3.8 percent over the previous year, according to a report yesterday by a state agency that monitors health costs.

The Health Care Access and Cost Commission reports annually on trends, using data on claims from insurers.

John M. Colmers, the commission's executive director, said the report does not contain any startling findings but "does raise further questions on how spending patterns are changing."

The commission plans a series of more focused follow-up reports on the issues raised, such as access to care and costs by county, Colmers said.

Yesterday's report does point to a number of broad trends in health spending in the state:

Maryland's experience closely parallels the nation's, where cost increases were up 4 percent.

HMO enrollment continued to grow (by 6.6 percent), although more slowly than in the previous year (8.9 percent). HMOs covered about 30 percent of Marylanders in 1996, compared with 24 percent nationally, and that will grow as Medicaid and Medicare programs turn increasingly to managed care models.

HMOs spend considerably less per patient than do traditional insurance plans. For those with private insurance, HMOs spent $1,448 per capita while traditional insurance plans spent $1,810. Ben Steffen, the commission's deputy director for data systems and analysis, said it was not possible to tell how much of the difference resulted from medical management and how much from HMOs attracting healthier people.

Hospital services continued to move from inpatient to outpatient. Spending on inpatient care was actually down 5.7 percent from the previous year, while outpatient spending grew 11.0 percent.

The most rapid growth in spending came in prescription drugs -- up 18.2 percent from 1995 to 1996. Prescriptions now account for 8 percent of health spending in Maryland.

Capitation -- payment of a flat monthly fee to doctors and other providers, rather than paying for services delivered -- grew rapidly, by 30.2 percent. HMOs often prefer capitation since it controls costs and creates incentives for doctors to avoid ordering expensive services.

About 13 percent of residents are uninsured in Maryland, compared with 15.6 percent nationally.

In a separate report, the commission estimated that about 10 percent more Marylanders who work for small employers are now covered by health insurance.

Pub Date: 3/06/98

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