DWC Research Group Releases Health Care Cost and Utilization Report
The Workers’ Compensation Research and Evaluation Group released a new report on health care cost and utilization in the Texas workers’ compensation system between 2012 and 2022.
This report shows that total health care costs declined 30% during this time, from $1.15 billion to $812 million. It also provides drill-down analyses by claim type, health care provider type, service type, maturity, facility type, and drug type.
Key Findings:
Overall health care costs decreased from 2012 to 2022. Total health care costs declined 30%, from $1.15 billion in 2012 to $812 million in 2022. The total number of claims decreased 20% from 319,000 to 256,000. The average cost per claim dropped 12%, from $3,611 to $3,169.
Professional costs and utilization decreased from 2012 to 2022. Professional services include physician and therapy services, durable medical equipment, and ambulatory surgical center services. Total professional costs decreased 26%, from $657 million in 2012 to $483 million in 2022. The number of claims receiving professional services decreased 19%, from 301,000 to 244,000. The average cost for professional services declined 9% from $2,181 per claim to $1,982 in 2022. The total cost of professional and hospital/institutional services in 2022 was 24% lower than the cost in 2012 using current prices, but it was 41% lower if adjusted for inflation.
Hospital/institutional cost and utilization decreased from 2012 to 2022. Hospital/institutional services include hospital inpatient and outpatient services, services in skilled nursing facilities, home health care, and other services provided at special facilities. Total hospital/institutional costs decreased 20%, from $355 million in 2012 to $285 million in 2022. The number of claims receiving hospital/institutional services decreased 32%, from 90,000 to 62,000. The average cost for hospital/institutional services increased about 17%, from $3,932 per claim to $4,601 in 2022. The total cost of professional and hospital/institutional services in 2022 was 24% lower than the cost in 2012 using current prices, but it was 41% lower if adjusted for inflation.
Pharmacy cost and utilization decreased from 2012 to 2022. Total cost of pharmacy services decreased significantly by 71% since 2012 from $136 million to $39 million in 2022. The number of claims receiving pharmacy services dropped 54% from 150,000 to 69,000. The average cost of pharmacy services decreased 38% from $908 to $563 per claim.
The full report can be accessed via the DWC website:
https://www.tdi.texas.gov/reports/wcreg/documents/hccu2023.pdf.
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