About the report
This report analyzes medical utilization and cost in the Texas workers' compensation system between 2012 and 2022, 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, maturity, facility type, and drug type.
Published December 2023 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, dental, and pharmacy services for their work-related injuries or illnesses. In a healthy workers’ compensation system, health care should be easily accessible, prompt, and appropriate. This report provides medical cost and utilization data, showing trends over time (from 2012 to 2022) 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 2012 to 2022. Total health care costs declined 30%, from $1.15 billion in 2012 to $812 million in 2022. The total number of claims decreased 20% from 319,000 to 256,000. The average cost per claim dropped 12%, from $3,611 to $3,169.
Professional costs and utilization decreased from 2012 to 2022. Professional services include physician and therapy services, durable medical equipment, and ambulatory surgical center services. Total professional costs decreased 26%, from $657 million in 2012 to $483 million in 2022. The number of claims receiving professional services decreased 19%, from 301,000 to 244,000. The average cost for professional services declined 9% from $2,181 per claim to $1,982 in 2022.
The total cost of professional and hospital/institutional services in 2022 was 24% lower than the cost in 2012 using current prices, but it was 41% lower if adjusted for inflation.
Hospital/institutional cost and utilization decreased from 2012 to 2022. Hospital/institutional services include hospital inpatient and outpatient services, services in skilled nursing facilities, home health care, and other services provided at special facilities. Total hospital/institutional costs decreased 20%, from $355 million in 2012 to $285 million in 2022. The number of claims receiving hospital/institutional services decreased 32%, from 90,000 to 62,000. The average cost for hospital/institutional services increased about 17%, from $3,932 per claim to $4,601 in 2022.
The total cost of professional and hospital/institutional services in 2022 was 24% lower than the cost in 2012 using current prices, but it was 41% lower if adjusted for inflation.
Pharmacy cost and utilization decreased from 2012 to 2022. Total cost of pharmacy services decreased significantly by 71% since 2012 from $136 million to $39 million in 2022. The number of claims receiving pharmacy services dropped 54% from 150,000 to 69,000. The average cost of pharmacy services decreased 38% from $908 to $563 per claim.