Recently the Bipartisan Policy Center released a report entitled “What Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth.” The paper highlights the items that the group posits are responsible for healthcare spending in the United States. Three of the factors – population, utilization rates and prices – are expected to continue (or resume) their upward paths and a range of complex “drivers” are responsible for the high levels of health spending today. Some drivers will continue to push population, utilization rates, and prices, and thereby national healthcare costs, ever higher. In addition, the authors note that the drivers listed below represent both additional barriers to reducing healthcare spending. Broadly, these healthcare cost drivers include:
- Fee-for-service reimbursement;
- Fragmentation in care delivery;
- Administrative burden on providers, payers and patients;
- Population aging, rising rates of chronic disease and comorbidities, as well as lifestyle factors and personal health choices;
- Advances in medical technology;
- Tax treatment of health insurance;
- Insurance benefit design;
- Lack of transparency about cost and quality, compounded by limited data, to inform consumer choice;
- Cultural biases that influence care utilization;
- Changing trends in healthcare market consolidation and competition for providers and insurers;
- High unit prices of medical services;
- The healthcare legal and regulatory environment, including current medical malpractice and fraud and abuse laws; and
- Structure and supply of the health professional workforce, including scope of practice restrictions, trends in clinical specialization, and patient access to providers.
While this list properly identified medical liability and defensive medicine as a cost driver, it struck us here at Neurosurgery Blog that (as is often the case with discussions related to healthcare costs) while the authors acknowledge that the current third party payment system masks the true cost of healthcare from patients, they then go on to blame the fee-for-service system for this problem.
Additionally, though perhaps not a panacea, giving patients more skin in the game by having them control their healthcare dollars, would empower them to make better decisions that ultimately would bring down healthcare costs. At the AANS, we have a health savings account (HSA) and believe this has allowed our employees to prioritize their own healthcare spending. Recently, for example, one employee did not rush out to immediately get an MRI scan when her son possibly tore his meniscus. Instead, they waited 2 weeks and the problem resolved with less-costly conservative treatment.
Certainly, we are not suggesting that this is a one-size-fits-all answer, but increasing patients’ responsibility is a critical element of the healthcare cost conundrum. Just a little food for thought as policymakers contemplate healthcare reform 2.0.