CHIA Standard Statistics


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Comparative Statistics:
Massachusetts and the United States

This page was last updated: June 10, 2021.

CHIA identifies, calculates, disseminates, and maintains a specific set of standard statistics that measure the performance of the Massachusetts health care system. The information in the table below is derived from CHIA's unique data sets or other Massachusetts-specific reliable sources.

CHIA’s standard statistics information includes data from two focus areas:

 

 


 

Spending and Insurance Coverage

 

Measure
Current
Data
Antecedent Data
Prior Data
Fact Sheet

Total Health Care Expenditures
(THCE)
(Learn More)

$64.1 billion in 2019
$9,294 per capita
+ 4.3% from 2018
(exceeds health care benchmark)
$61.3 billion in 2018
$8,908 per capita
+ 3.6% from 2017
(exceeds health care benchmark)
$59.0 billion in 2017
$8,599 per capita
+ 2.8% from 2016
(below health care benchmark)
Link to fact sheet

Total Medical Expenses for
Commercially-Insured Members

(Learn More)
$520 PMPM in 2019
+3.5% from CY2018 to CY2019
$502 PMPM in 2018
+3.3% from CY2017 to CY2018
$486 PMPM in 2017
+2.7% from CY2016-2017
Link to fact sheet

Insurance Rate of
Massachusetts Residents
(Learn more)
97.1% in 2019
96.3% in 2016
96.4% in 2015
Link to fact sheet

Percent of Massachusetts Employers Offering Health Insurance
(Learn More)

71% in 2018
65% in 2016
(See footnote) *
Link to fact sheet

Average Cost of
Commercial Coverage

(Learn More)

Fully-Insured Premiums
$516 PMPM in 2019
+2.2% from
CY2018 to CY2019
$505 PMPM in 2018
+5.7% from
CY2017 to CY2018
 $483 PMPM in CY2017
+4.9% from
CY2016 to CY2017
Link to fact sheet

Commercial Health
Insurance Benefit Levels
(Paid-to-Allowed
Claims Ratio)

(Learn More)


Fully-
and Self-Insured
0.893 in 2019
0.892 in 2018
0.879 in 2017
Link to fact sheet

Fully-Insured
0.875 in 2019
0.877 in 2018
0.880 in 2017

Self-Insured

0.908 in 2019
0.905 in 2018
0.879 in 2017

Average Commercial
Member Cost-Sharing
Level

(Learn More)

Fully-
and Self-Insured

$53 PMPM in 2019
+2.8% from
CY2018 to CY2019

$52 PMPM in 2018
+6.3% from
CY2017 to CY2018
 $52 PMPM in 2017
+5.7% from
CY2016 to CY2017
Link to fact sheet
Fully-Insured

$65 PMPM in 2019
+6.4% from
CY2018 to CY2019

$61 PMPM in 2018
+7.6% from
CY2017 to CY2018
 $57 PMPM in 2017
+7.6% from
CY2016 to CY2017
Self-Insured

$45 PMPM in 2019
+0.2% from
CY2018 to CY2019

$45 PMPM in 2018
+4.6% from
CY2017 to CY2018
$47 PMPM in 2017
+4.2% from
CY2016 to CY2017 

Enrollment in
Health Insurance

(Learn More)

Private Commercial
3,937,651 in Sept. 2020
(-2.3% Sept. 2018
to Sept. 2020)


4,055,344 in Sept. 2018
(-0.7% Sept. 2017
to Sept. 2018)


4,110,535 in Sept. 2017
(+0.7% Sept. 2016
to September 2017)

Link to fact sheet
MassHealth (Direct)

1,287,493 in Sept. 2020
(+3.5% Sept. 2018
to Sept. 2020)


1,237,091 in Sept. 2018
(-1.0% Sept. 2017
to Sept. 2018)


1,240,848 in Sept. 2017
(-6.1% Sept. 2016
to Sept. 2017)

SCO, One Care, PACE
98,365 in Sept. 2020
(+18.8% Sept. 2018
to Sept. 2020)


82,817 in Sept 2018
(+13.8% Sept. 2017
to Sept. 2018)


72,775 in Sept. 2017
(+19.0% Sept. 2016
to Sept. 2017)

Medicare



1,128,063 in Sept. 2020
(+2.8% Sept. 2018
to Sept. 2020)


1,097,691 in Sept. 2018
(+1.5% Sept. 2017
to Sept. 2018)


1,098,011 in Sept. 2017
(+1.5% Sept. 2016
to Sept. 2017)


Percent of Members
Whose Care is Covered
by Alternative
Payment Methods

(Learn More)

Commercial

41.3%
- 0.6 pp from
CY2018 to CY2019


41.9%
+ 0.7 pp from
CY2017 to CY2018

42.0%
+6.3 pp from
CY2015 to CY2016 
Link to fact sheet
MassHealth MCOs

84.6%
+17.2 pp from
CY2018 to CY2019

67.4%
+ 37.8 pp from
CY2017 to CY2018

35.7%
-0.9 pp from
CY2015 to CY2016 
MassHealth PCC

48.9%
-1.9 pp from
CY2018 to CY2019

50.8%
-4.0 pp from
CY2017 to CY2018

 23.5%
+0.5 pp from
CY2015 to CY2016

 

 
 

 

Massachusetts Provider Utilization and Performance

 

Measure
Current Data
Antecedent Data
Prior Data
Fact Sheet

Total Number of
Inpatient Discharges

(Learn More)

810,357 in FY2019
-0.4% from FY2018 to FY2019
813,618 in FY2018
-0.2% from FY2017 to FY2018
815,131 in FY2017
+0.9% from FY2016 to FY2017 
Link to fact sheet

Most Frequent Inpatient Discharges by Diagnostic
Related Group (DRG)

(Learn More)

FY19

Normal Neonate Births
(60,625 / -0.2%)

Vaginal Delivery
(44,843 / -1.1%)

Septicemia & Infections
(35,425 / +0.2%)

Heart Failure
(27,700 / +3.0%)

Cesarean Delivery
(21,286 / -2.2%)

FY18

Normal Neonate Births
(60,761 / -0.8%)

Vaginal Delivery
(45,348 / -1.3%)

Septicemia & Infections
(35,371 / +6.0%)

Heart Failure
(26,893 / +4.0%)

Cesarean Delivery
(21,757 / -0.3%)

FY17

Normal Neonate Births
(61,267 / -0.8%)

Vaginal Delivery
(45,951 / -1.4%)

Septicemia & Infections
(33,369 / -1.4%)

Heart Failure
(25,863 / +7.9%)

Cesarean Delivery
(21,831 / +0.3%)

Link to fact sheet

Statewide Number of
Emergency Department Visits

(Learn More)

3,150,303
in FY2019
3,146,507
in FY2018
 3,144,308
in FY2017
Link to fact sheet

Statewide Unplanned
Readmission Rate

(Learn More)

15.4%
in 2018
15.4%
in 2017
 15.3%
in 2016
Link to fact sheet

Median Hospital
Total Margin
(Statewide)
(Learn More)

3.5%
in 2019
4.5%
in 2018
3.2%
in 2017
Link to fact sheet

Relative Price
Statewide Relative Price
(S-RP) Results

(Learn More)

Note: RP values are not
comparable year to year.

CY2019

Range of S-RP Values: 0.7171.870

Median S-RP: 0.920

- - Link to fact sheet

 

       



 * In 2016, the Massachusetts Employer Survey sample was redesigned to capture responses from firms (e.g., CVS Pharmacy as an organization) rather than establishments (e.g., an individual CVS Pharmacy worksite), as decision making about health benefits is almost always made at the firm rather than the establishment level. Such change has made comparisons to data from previous surveys more complex. For details, please see the 2016 Summary of Results  and the 2016 Field Report.