title: Common and Costly Hospitalizations Among Insured Young Adults Since the Affordable Care Act.
abstract: To describe the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the Affordable Care Act.
  
  
  
  Cross-sectional study of a national administrative data set of privately insured young adult (18-30 years) beneficiaries hospitalized from January 2012 to June 2013. The most prevalent diagnosis categories for young adult hospitalizations are presented as percentages of all young adult hospitalizations by gender and age group (18-21, 22-25, and 26-30 years). Mean and median out-of-pocket costs by diagnosis category and gender are calculated based on deductible, copay and coinsurance payments.
  
  
  
  We analyzed 158,777 hospitalizations among 4.7 million young adult beneficiaries; young adults accounted for 18.3% of privately insured hospitalizations across all ages. Top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). Top diagnoses for young adult male hospitalizations were mental illness (39.3%) and injuries and poisoning (14.0%). Mean and median total out-of-pocket costs for any young adult hospitalization were $1,034 and $700, respectively (mean deductible payment = $411). The most expensive out-of-pocket hospitalizations were for dermatologic diseases (e.g., skin infections) with means of $1,306 for females and $1,287 for males.
  
  
  
  This study establishes a baseline for the ongoing assessment of the most common and costly hospitalizations among privately insured young adults in the United States under the Affordable Care Act. The substantial burden of potentially avoidable hospitalizations (e.g., mental health, injury, and poisonings) supports resource allocation to improve outpatient services, mental health access, and public health prevention strategies for young adults.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bain
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: charwong@upenn.edu.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Wong
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gail
authors.initials: G
authors.lastname: Slap
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Raina M
authors.initials: RM
authors.lastname: Merchant
authors.affiliation: Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors.forename: Yaa
authors.initials: Y
authors.lastname: Akosa Antwi
authors.affiliation: PolicyLab, Division of General Pediatrics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Rubin
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ford
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000465:Algorithms; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data*; D011247:Pregnancy; D017678:Sex Distribution; D014481:United States; D055815:Young Adult
keywords: ACA; Health care costs; Hospitalizations; Mental health; Pregnancy; Young adults