The five most expensive health insurance claims for individuals, employers, and insurers are attributed to cancer, musculoskeletal, cardiovascular disease, gastrointestinal, and neurological conditions. These five medical conditions represent 50% of all healthcare dollars spent each year.
Cancer
Females have a 52% greater chance of having a cancer claim, primarily driven by breast cancer. Overall, the older the population, the higher the claims. Those making over $75,000 a year have more cancer claims, and this can be attributed to the older population having more claims… they are further along in their chosen profession. Phoenix, L.A., and North Carolina (surprisingly) have higher than normal skin cancer claims.
There are over 200 types of cancer. The average total spend per claim is between $100,000 and $200,000! Chemotherapy specialty medications play a large part (18%) in total cost, as does where you live. Administering chemotherapy costs three times more in Phoenix and Atlanta than in Milwaukee. Innovative cancer drug therapies are being produced at a rate never seen before, with meaningful survival rates increasing. The price mark-up from large academic cancer centers is the main driver of price increases.
Musculoskeletal (MSK)
Females have 22% more claims for musculoskeletal issues. Children 13-17 years old have many claims due to sports injuries. As for adults, the older we get the more claims from falls and slips. The connection between obesity and joint replacement is striking. Those that are obese (BMI above 30) have joint replacement surgery up to 33 times higher than average. Increased blood loss during surgery, and troubles with the implant itself are common with obese patients. Knee surgery is the most common claim. Knee imaging costs five times more in Houston than Cleveland.