The current epidemic of opioid abuse, involving both prescription pain relievers and heroin, is having a major impact on the US healthcare sector. In its white paper issued in July 2016, The Opioid Crisis among the Privately Insured, FAIR Health reported on the epidemic's impact on healthcare services as evidenced by an increase of 3,203 percent in claim lines with an opioid dependence diagnosis from 2007 to 2014.1 In this second white paper, FAIR Health examines the increasing healthcare costs and demand for specific services attributable to the epidemic. FAIR Health, a national, independent, nonprofit organization dedicated to transparency in healthcare costs and health insurance information, has analyzed data from its database of over 21 billion privately billed healthcare claims to identify trends and patterns in these costs and services. Among the findings: (1) The national aggregated dollar value of charges for opioid-related diagnoses, as well as of imputed allowed amounts for such diagnoses, rose over 1,000 percent from 2011 to 2015; (2) In 2015, private payors' average costs for a patient diagnosed with opioid abuse or dependence were more than 550 percent higher--almost $16,000 more per patient--than the per-patient average cost based on all patients' claims; (3) Opioid abuse diagnoses involve significant emergency department charges, while opioid dependence charges are largely represented by laboratory tests and office outpatient visits; and (4) States' average charges for services associated with opioid abuse and dependence diagnoses vary widely.
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