New Evidence on the Persistence of Health Spending

Richard A. Hirth, Teresa B. Gibson, Helen G. Levy, Jeffrey A. Smith, Sebastian Calónico, Anup Das

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Surprisingly little is known about long-term spending patterns in the under-65 population. Such information could inform efforts to improve coverage and control costs. Using the MarketScan claims database, we characterize the persistence of health care spending in the privately insured, under-65 population. Over a 6-year period, 69.8% of enrollees never had annual spending in the top 10% of the distribution and the bottom 50% of spenders accounted for less than 10% of spending. Those in the top 10% in 2003 were almost as likely (34.4%) to be in the top 10% five years later as one year later (43.4%). Many comorbid conditions retained much of their predictive power even 5 years later. The persistence at both ends of the spending distribution indicates the potential for adverse selection and cream skimming and supports the use of disease management, particularly for those with the conditions that remained strong predictors of high spending throughout the follow-up period.

Original languageEnglish (US)
Pages (from-to)277-297
Number of pages21
JournalMedical Care Research and Review
Issue number3
StatePublished - Jun 10 2015
Externally publishedYes


  • comorbidities
  • economics
  • health care expenditures
  • health care reform
  • health insurance

ASJC Scopus subject areas

  • Health Policy


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