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  • ACA Data: Newly Insured Have 'Pent-Up Demand' for TKA, LBP Surgery

    A new study from the Society of Actuaries (.pdf) (SOA) reveals what may not be a huge surprise: previously uninsured individuals who became insured through the Affordable Care Act (ACA) tended to pursue so-called "preference-sensitive" treatment—health care that can be delayed without a crisis—at a significantly higher rate than the continuously insured.

    Topping the list of preference-sensitive treatment? Total knee arthroplasty (TKA) and surgery for low back pain (LBP).

    According to SOA, the use of these treatments "exceeded the expectation of differences due to demographics alone, such as those used in actuarial rating calculations."

    Among the preference-sensitive treatments reviewed, TKA showed the most marked difference in use, with new enrollees showing an estimated member month use rate per-1,000 that is 6.19 times that of the continuously enrolled. That rate was significantly above the next-highest treatment differential, surgery for LBP, which showed an estimated use rate of 2.14 times the rate of the continuously enrolled.

    The SOA study was focused on usage in the first quarter of 2014, and limited to 87,000 individuals in Kansas—17,000 newly insured and 70,000 continuously insured. Actual numbers of procedures performed were small.

    Still, according to an article in the National Journal, the SOA study could offer "a glimpse into where the pent-up demand is within the health care system."

    The SOA report states that these data are similar to studies conducted after Medicaid expansions, "which show that there is an initial high use of services that tapers off over the year," but that a definitive pattern can't be established until all 2014 data are in.

    In the National Journal article, Kaiser Family Foundation Vice President Larry Levitt described the rates as a temporary spike.

    "Just because new enrollees used more services initially doesn't mean that will necessarily be true looking ahead," he told the National Journal. "This study may give insurance regulators some evidence to push back on insurers that are proposing big rate increases for 2016 based on how much enrollees used in 2014."

    Comments

    • Surgery for low back pain???? Who would OK surgery for a non-specific symptom?? I suppose that if you have had a lot of non-effective treatment for this non-specific symptom you might be desperate for non-specific surgery. But what if the non-specific surgery is not effective... of makes you worse? I invite you to visit my website for specific help for the specific cause of low back pain at www.thelowback.com Professionals might have some interest in a program that provides immediate specific relief for the specific cause of most low back pain. http://www.greatseminarsonline.com This is the least invasive and least traumatic and most effective method available. DonTigny, RL: Sacroiliac 101; Form and Function; A biomechanical study. Journal of Prolotherapy 3:561-567, 2011 Available in full text from https://www.researchgate.net DonTigny, RL: Sacroiliac 201; Dysfunction and Management: A biomechanical solution. Journal of Prolotherapy 3:644-652, 2011 Available in full text from https://www.researchgate.net

      Posted by Richard DonTigny, PT on 5/20/2015 6:23 PM

    • In the words of PJ O'Rourke "If you think Health Care is expensive now, wait until it is free."

      Posted by Glen on 5/21/2015 10:35 AM

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