About the report
This report analyzes medical utilization and cost in the Texas workers' compensation system between 2018 and 2023, including:
- Overall health care costs.
- Professional service cost and utilization.
- Hospital/institutional service cost and utilization.
- Dental service cost and utilization.
- Pharmacy service cost and utilization.
In addition to summarizing major cost and utilization statistics, this report also provides drill-down analyses by claim type, health care provider type, service type, claim maturity, facility type, and drug type.
Published June 2025 by the Workers' Compensation Research & Evaluation Group.
Summary
Health care is one of the major benefits provided to injured employees in the Texas workers’ compensation system. Injured employees receive medically necessary professional, hospital, pharmacy, and dental services for their work-related injuries or illnesses. In a healthy workers’ compensation system, health care should be easily accessible, prompt, appropriate, and cost effective. This report provides medical cost and utilization data, showing trends over time (from 2018 to 2023) and patterns across claim types, health care provider types, service types, claim maturities, facility types, and drug types in the Texas workers’ compensation system.
Key findings
Overall health care costs decreased from 2018 to 2023. Total health care costs declined 14%, from $997 million for services in 2018 to $857 million for services in 2023. The total number of claims decreased 11%, from 296,000 to 264,000. The average cost per claim also dropped 4%, from $3,367 to $3,245.
Professional cost and utilization decreased from 2018 to 2023. Total professional costs decreased 5%, from $556 million in 2018 to $529 million in 2023. The number of claims receiving professional services decreased 11%, from 281,000 to 251,000. The average cost for professional services increased 7% from $1,976 per claim to $2,105.
Hospital/institutional cost and utilization decreased from 2018 to 2023. Total hospital/institutional costs decreased 23%, from $367 million in 2018 to $281 million in 2023. The number of claims receiving hospital/institutional services decreased 25%, from 84,000 to 63,000. The average cost for hospital/institutional services per claim increased about 2%, from $4,392 to $4,482.
Pharmacy cost and utilization decreased from 2018 to 2023. Total cost of pharmacy services decreased 40%, from $69 million in 2018 to $41 million in 2023. The number of claims receiving pharmacy services dropped 35%, from 108,000 to 70,000. The average cost of pharmacy services per claim decreased 7%, from $638 to $595.