Exhibit 2.
Levels of and trends in out-of-network spending and cost sharing, 2008–16
| Allowed out-of-network spending (unadjusted %) | Adjusted average annual change | ||||
|---|---|---|---|---|---|
| 2008–10 | 2011–13 | 2014–16 | Percentage point |
p value |
|
| All spending | 7.0 | 6.7 | 6.1 | −0.098 | 0.015 |
| Provider specialty | |||||
| Anesthesiology | 5.6 | 4.3 | 3.8 | −0.245 | <0.001 |
| Emergency medicine | 8.4 | 7.4 | 5.7 | −0.458 | <0.001 |
| Hospitalist medicine | 3.3 | 2.5 | 5.9 | 0.543 | 0.012 |
| Internal medicine | 3.3 | 2.9 | 3.0 | −0.007 | 0.826 |
| Pathology | 5.3 | 6.4 | 8.3 | 0.305 | <0.001 |
| Pediatrics or OB-GYN | 2.0 | 1.7 | 1.4 | −0.082 | <0.001 |
| Primary care | 5.2 | 4.5 | 4.2 | −0.122 | 0.005 |
| Psychiatry | 25.8 | 26.9 | 25.6 | −0.165 | 0.400 |
| Radiology | 3.6 | 3.0 | 2.7 | −0.074 | 0.071 |
| Surgery | 5.6 | 5.5 | 4.7 | −0.134 | <0.001 |
| Category of service | |||||
| Chemotherapy | 3.4 | 3.9 | 2.7 | −0.163 | 0.019 |
| Consultations | 3.7 | 2.9 | 2.1 | −0.221 | <0.001 |
| Durable medical equipment | 11.8 | 11.6 | 9.2 | −0.279 | <0.001 |
| ED visits | 4.9 | 3.7 | 3.0 | −0.328 | <0.001 |
| Laboratory tests | 5.2 | 7.7 | 11.5 | 0.803 | <0.001 |
| Obstetrics | 6.4 | 6.9 | 5.2 | −0.262 | <0.001 |
| Office visits | 3.4 | 3.0 | 2.9 | −0.038 | 0.082 |
| Procedures | 7.9 | 8.0 | 6.4 | −0.178 | <0.001 |
| Psychiatric services | 29.2 | 30.2 | 29.7 | −0.179 | 0.481 |
| Radiology | 3.7 | 3.1 | 2.4 | −0.135 | <0.001 |
| Specialty drugs | 6.5 | 5.4 | 4.7 | −0.187 | 0.016 |
| Vascular interventions | 2.5 | 2.8 | 2.0 | −0.031 | 0.514 |
| Cost sharing | 13.6 | 11.6 | 10.6 | −0.117 | 0.137 |
SOURCE Authors’ analysis of data for 2008–16 from the Truven MarketScan Commercial Claims and Encounters Database. NOTES Estimates of the average annual change were from an ordinary least squares regression model that adjusted for age categories, age categories interacted with sex, risk score, region, and plan fixed effects, with standard errors clustered by plan. Spending by provider specialty included inpatient and outpatient professional fees but not facility fees. Spending by category of service used only outpatient claims, with both professional and facility fees. OB-GYN is obstetrics-gynecology. ED is emergency department.