US health care spending shows dramatic reduction in growth

The USA spends more money on health care per person than any country in the world. Though health care expenditure previously grew at a high annual rate, a new study published in The Lancet has reported that this growth in spending has slowed down greatly over the past decade.

This may seem surprising considering that several reforms have been made recently to expand health care coverage across the US population, leading to a drop in the number of people without medical insurance of 1.3 million people in 2011.

The Organisation for Economic Co-operation and Development (OECD) compared the spending and policies of the USA and five other high-spending countries - Canada, France, Germany, the Netherlands and Switzerland - and found that the US's spending growth had fallen to 1% over the last decade; around the same as the average growth rate in the other countries.

Previously in 2002, the US's health expenditure growth was around 7%, much higher than the approximate 3% which was the average for the other countries examined in the study

Disparity in spending

The Centers for Disease Control and Prevention (CDC) report that the US's total national health expenditures are $2.7 trillion a year. This figure breaks down as $8,680 per person, and makes up 17.9% of the country's Gross Domestic Product.

The US spends more on health care per capita than any country in the world.

Luca Lorenzoni, lead author of the study, notes that the US stands apart from other countries when it comes to health care:

"The USA are an outlier in the scenery of OECD health care systems, for their staggering levels of expenditure, the extent of fragmentation of their system and the sheer complexity of its administration, the power of vested interests, and the large number of people left without adequate health insurance coverage."

It is believed that the main reason for the disparity in health care expenditure between the USA and the other high-income countries studied by the OECD is that health sector prices, for hospital care and prescription drugs, for example, are higher in the US.

The authors believe that the gains made in reducing health care spending can be attributed to price dynamics, such as the increased utilization of cheaper drugs, and reduction or lack of growth in physician reimbursement rates.

Future expenditure

The OECD are an international group who aim to "promote policies that will improve the economic and social well-being of people around the world."

They warn that further future economic recovery could have an adverse effect on this reduction of health care spending. Lorenzoni says that the progress that their study has found is no reason for complacency:

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Affordable Care Act: insurance coverage has improved for young adults

Researchers analyzing the impact of the Patient Protection and Affordable Care Act have found that it has led to increased health insurance coverage among young adults aged 19-25. This increase has not been linked, however, with any significant changes in health care affordability or health status. Health care reform The Patient Protection and Affordable Care Act was signed into law in 2010, with the aim of widening health coverage to more Americans. The study, published in the journal JAMA Pediatrics, evaluated individuals' health, access to care and use of health care both before and after the implementation of the Patient Protection and Affordable Care Act (PPACA).




 The PPACA was implemented in September 2010, and part of its mandate was that insurance companies had to allow adults younger than 26 years of age to remain covered by their parents' health insurance policy. Prior to this change, the authors report that nearly 1 in 3 young adults aged 19-25 lacked any form of health insurance provision. Since then, the percentage of uninsured Americans fell in 2011 - a decrease attributed in part to the expansion of insurance coverage among this age group. While many have presumed that increased insurance coverage leads to positive health outcomes for the population, the impact of the PPACA on the health of young adults and their access to health care is unknown. 
A team of researchers from the University of Washington in Seattle, led by Dr. Meera Kotagal, analyzed data from two nationally representative surveys in order to better assess the influence of the PPACA on the access to care and health of young adults aged 19-25. Increased coverage The researchers used data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), comparing results data from 2009 with data from 2012. From these surveys, the researchers compared a cohort of young adults (19-25 years) with an older group (26-34 years). The authors found that between 2009 and 2012, health insurance coverage for the 19- to 25-year-olds increased from 68.3% to 77.8%. For the 26- to 34-year-old cohort, coverage fell from 77.8% to 70.3%. The researchers found that there was an overall decline in the likelihood of having a usual source of health care, but this decline was more pronounced in the 26- to 34-year-old participants. From 2009 and 2012, there was very little change in health status between the two cohorts. The number of participants who reported receiving a routine checkup in the past year and being able to afford dental care, medicine and physician visits did not change significantly in either age group. The study also found that individuals with health insurance coverage were more likely than those without to have a usual source of care, get routine checkups and flu shots and to be able to afford various forms of health care, such as dental care and prescription medication. Important to 'address access and quality'


The authors state that their study "confirms that health care coverage for young adults has increased but that young adults do not report improved health status, affordability of health care, or use of flu vaccinations compared with their older counterparts." The study is limited in that all of the data from the NHIS and BRFSS were self-reported and therefore may not accurately reflect the health of the participants. The researchers also question whether the comparison group of 26- to 34-year-olds was the most apt for the study. "Understanding the PPACA's full impact on young adults may require focus on those who consume more health care, such as those with chronic disease," say the authors. The finding that increased coverage has not resulted in improved health status for young adults aged 19-25 years leads the authors to conclude that "health policy must continue to address access and quality in addition to coverage."

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The health insurance market: new survey of employers

Healthcare Providers:  A new nationally representative survey of employers--the largest purchasers of health care in the country-- shows that most are unfamiliar with objective metrics of health plan quality information. The survey, conducted by The Associated Press-NORC Center for Public Affairs Research, also found that employers are looking to the Affordable Care Act (ACA) as they make significant decisions on the benefits they offer, with the costs of health plans as a key consideration. Funding for the survey was provided by the Robert Wood Johnson Foundation. "There appears to be a serious information deficit among employers when it comes time for them to assess the quality of health insurance plans," said Trevor Tompson, director of the AP-NORC Center. "Nine in 10 of the employers who offer health insurance to employees are unfamiliar with objective sources of quality information, such as Consumer Assessment of



Healthcare Providers and Systems data and Health Effectiveness Data and Information Set Scores even though they think quality ratings are important." Further, the survey shows that in the context of the implementation of the ACA, most employers think the law will impact businesses' ability to scale back benefits--though they are divided over whether scaling back will be easier or harder. And as employers change their purchasing behaviors to accommodate ACA requirements, the amount organizations will pay for health insurance plans emerges as highly important for employers--but so are the costs to their employees. Here are some of the key findings from the AP-NORC Center poll: Among Private Sector Employers with at Least Three Employees Most employers think the ACA will have an impact on businesses' decisions about the health benefits they offer, though some say it will make scaling benefits back easier and others say harder. One in 5 employers say their organization is examining the design of health insurance exchange plans as they work on updating or changing the insurance benefits they offer. Six in 10 employers offering insurance think plan quality ratings are important, but 9 in 10 are unfamiliar with objective quality metrics. When selecting health plans, employers' top consideration is their own bottom line, but the cost to their employees is also important. Only 4 percent of companies offering insurance that employ 100 or more workers plan to change employee schedules to reduce the number of full-time employees to comply with the ACA.

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