{"id":51553,"date":"2025-07-09T14:02:11","date_gmt":"2025-07-09T14:02:11","guid":{"rendered":"https:\/\/www.europesays.com\/us\/51553\/"},"modified":"2025-07-09T14:02:11","modified_gmt":"2025-07-09T14:02:11","slug":"costs-of-nc-health-care-skewed-in-national-rankings","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/51553\/","title":{"rendered":"Costs of NC health care skewed in national rankings"},"content":{"rendered":"

North Carolina is the most expensive state in the nation for health care, according to a highly cited claim<\/a> made by Forbes magazine, at least. But how true are those claims about costs?<\/p>\n

Not very, according to a new analysis<\/a> that challenges both the methodology and conclusions of the Forbes ranking. The reality, researchers from Ascendient Healthcare say, is much more nuanced.\u00a0<\/p>\n

[Subscribe for FREE to Carolina Public Press\u2019 alerts and weekend roundup newsletters<\/a>]<\/strong><\/p>\n

But Forbes did get something right about health care costs \u2014 just not exactly what they set out to prove. In doing so, the publication revealed an under-researched issue in North Carolina health care policy.\u00a0<\/p>\n

Dubious methodology to judge costs<\/p>\n

Which state has the most expensive health care? The answer depends on how you measure \u201cexpensive.\u201d\u00a0<\/p>\n

That\u2019s where things get complex. And those complexities have important implications.<\/p>\n

The Forbes ranking relies on a weighting system devised by the authors of the study. The system puts 85% of the weight on what folks with employee-sponsored health insurance pay in premiums and deductibles each year.<\/p>\n

Here\u2019s one problem: less than half of North Carolinians have employee-sponsored health care.\u00a0<\/p>\n

\u201cSomebody made some determination about the relative importance of each of these elements to be able to spit out an overall metric,\u201d Brad Wright<\/strong>, former UNC Sheps Center researcher who now works at University of South Carolina, told Carolina Public Press<\/a>.\u00a0<\/p>\n

\u201cWithout seeing a justification for how they did that, that\u2019s concerning. If you gave me the same data set and I just changed those weight percentages, I\u2019d get a different answer, and would be writing a different story.\u201d<\/p>\n

Forbes\u2019s method addresses insurance shopping concerns rather than health care system performance, according to Dawn Carter<\/strong>, a North Carolina health care consultant who co-wrote the Ascendient analysis of health care costs in the state.<\/p>\n

The methodology results in some interesting aberrations. Some of the least-expensive states for health care, according to Forbes, are Hawaii, California, and Massachusetts.<\/p>\n

\u201cThose cheapest states are states I don\u2019t think of as being least expensive in anything,\u201d State Treasurer Brad Briner <\/strong>told CPP. \u201cOnce you see that, you have to ask yourself the questions: What is the methodology here? What is the ulterior motive here?\u201d<\/p>\n

Briner\u2019s skepticism of the Forbes costs ranking is a break from his predecessor.\u00a0<\/p>\n

Former State Treasurer Dale Folwell<\/strong>, a Republican like Briner, <\/strong>frequently cited North Carolina\u2019s ranking to argue against North Carolina\u2019s Certificate of Need laws, which regulate hospital construction.\u00a0<\/p>\n

The politicization of the Forbes data shows how powerful \u2014 and potentially arbitrary \u2014 statistics can be.\u00a0<\/p>\n

\u201cThe issue, of course, is that every data set is filtered through whatever lens the authors choose: pro-insurance, pro-state regulations, etc.,\u201d UNC law professor Joan Krause<\/strong> told CPP.<\/p>\n

Forbes defended its approach when CPP pressed about the methodology.<\/p>\n

Forbes Advisor Editor Michelle Megna<\/strong> wrote: \u201cWe felt access and outcomes were most important, so gave them the most weight in our scoring.\u201d<\/p>\n

Other ways to measure health care costs<\/p>\n

Ascendient\u2019s chosen data points paint a very different picture.\u00a0<\/p>\n

\u201cWhen I saw those headlines, I just thought: \u2018Wait a minute. This is just not this is not consistent with what I know to be true,\u2019\u201d Carter told CPP.<\/p>\n

\u201cLet\u2019s check their data and understand where this is coming from. And then let\u2019s check back with the other data points that we are more familiar with.\u201d<\/p>\n

A common way of measuring health care costs, according to Carter, is to aggregate all health care spending \u2014 think hospitals, nursing homes, doctors \u2014 within the state and divide by total population.<\/p>\n

Using this method, which accounts for people on all kinds of health care plans, North Carolina has the 10th-lowest health care costs in the nation.\u00a0<\/p>\n

North Carolina health care spending per capita comes out at $8,917 annually, while nationally, the average is $10,191.<\/p>\n

Another way to rank costs is to measure hospital prices, since hospitals tend to be the most expensive option for health care. According to Ascendient, North Carolina had the 13th-lowest net price per inpatient discharge nationally.<\/p>\n

Plus, when one looks at total insurance premiums rather than employee contributions, North Carolina drops from second to 45th-most expensive, according to Wright.\u00a0<\/p>\n

But all this does not mean that Forbes didn\u2019t point out something true.\u00a0<\/p>\n

What Forbes got right<\/p>\n

What Forbes proved is this: more than in any other state, NC employers shift higher portions of insurance costs onto employees.\u00a0<\/p>\n

This is a real data point, proven out by Forbes.\u00a0<\/p>\n

\u201cThere\u2019s two different things going on here. One is \u2018How much does health care cost?,\u2019 and then the other is \u2018Who pays?\u2019\u201d Treasurer Briner said.\u00a0<\/p>\n

\u201cIf the question is: \u2018Who pays?,\u2019 that is a very different discussion. In North Carolina, we have made the choice to have the individual pay more than the companies. In Massachusetts, for example, they\u2019ve had the state pay a lot more than the individual.\u201d<\/p>\n

Though this doesn\u2019t necessarily equate to NC\u2019s overall health care costs being the highest, it is a salient point.<\/p>\n

North Carolina employees contributed $1,806 for single coverage, the 14th-highest in the nation, while employers paid $5,937, the 10th-lowest.\u00a0<\/p>\n

If the issue is cost-shifting rather than expensive health care delivery, the potential policy solutions are different.<\/p>\n

\u201cIf you don\u2019t really look at what your data point is and what it\u2019s measuring, then you\u2019re going to look for policy solutions that don\u2019t fix the root cause of the problem,\u201d Carter said. \u201cTo generalize that one correct data point to make a claim about health care costs doesn\u2019t paint a clear picture.\u201d\u00a0<\/p>\n

But why do North Carolina employers do this? The answer isn\u2019t entirely clear, even to experts who study the state\u2019s health care system.<\/p>\n

Carter guesses it might have something to do with North Carolina\u2019s \u201cbusiness-friendly\u201d stance.\u00a0<\/p>\n

Briner views it as a necessary balance to the low taxes and low cost-of-living North Carolina provides to its residents.\u00a0<\/p>\n

More research is needed to understand why companies shift more insurance costs onto their employees in North Carolina than in any other state. It is likely a combination of state policy decisions, labor market dynamics and regulatory choices.\u00a0<\/p>\n

Once that is understood, the real conversation begins.\u00a0<\/p>\n

\n\tRelated\n<\/p>\n

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