In a paper in the Journal of the AMA, the authors point out that, although since 1970 we have significantly increased the amount we spend on healthcare, measurements of various health situations show us trailing many countries.
The authors have looked closely as to what has caused the increases in health care costs here. Surprisingly, they conclude that it is not an aging population or greater demand for healthcare that is the main cost driver. It is the price of health services, which account for 91% of cost increases. Hospital charges have increased 4.2% per year since 2000; professional services 3.6%/year, drugs and devices 4.0%/year, and administrative costs 5.6%/year.
Two other surprises to me: personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly.
Why? Here's what the authors have to say:
Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources of information, and self-management software.
However, the breadth and consistency of the US underperformance across disease categories suggests that the United States pays a penalty for its extreme fragmentation, financial incentives that favor procedures over comprehensive longitudinal care, and absence of organizational strategy at the individual system level.
No comments:
Post a Comment