Here are the most interesting numbers and graphs from a 2011 Milliman reportrt on high cost medical conditions in employer health benefit plans in 2010.
- In a typical employer group, only 0.2% of people incur annual medical claims over $100,000. Examples of high-cost “routine” events are
- cardiac revascularization at about $72,000 per year,
- stroke at $61,000 per year, and
- cancer patients not receiving chemotherapy or cancer surgery at $14,000 per year.
- High-cost but routine events are rare enough that the average claims cost for that total population is slightly less than $4,000.
High cost or catastrophic conditions, the kind that employers purchase stop-loss coverage for, include stroke, cardiovascular surgery, hemophilia, HIV, transplants, end-stage renal disease, newborns with extreme problems, cancer, and people with respiratory failure on ventilators.
- Of those with catastrophic conditions, about 6 percent of people with these conditions have claims over $100,000.
- Most fall into the $20,000 to $50,000 range.
- In the under-65 population, the number of organ/tissue transplants is about 208 per 1 million people – or about 2 per 10,000.
- Just through random fluctuation, an employer covering 10,000 members might easily experience 4 transplants in a year.
