A sweeping analysis of U.S. healthcare trends over the past three decades points to slow progress on health outcomes, such as life expectancy; increased consolidation; jumps in cost-driving rates of chronic illness; and a growing focus on consumer-oriented care.
The paper, published in the Nov. 13 issue of the Journal of the American Medical Association, drew on publicly available data from the CMS' National Health Expenditure Accounts to show changes over time in cost, workforce, quality
and other dimensions of the healthcare system.
The report highlighted a number of surprises, including a steady decline in personal out-of-pocket healthcare spending since 1980, said Dr. Hamilton Moses, a neurologist, head of the North Garden, Va.-based Alerion Institute, and the article's lead author.
“Total payments by individuals have actually declined from 23% in 1980 to 11% in 2011,” Moses said. “That contradicts the idea that out-of-pocket share for premiums and co-payments is higher than it used to be.”
Additionally, Moses and his colleagues found that rapidly increasing prices for healthcare services, medical devices and drugs accounted for more than 90% of all healthcare cost
increases since 2000.
“That's a surprise, too,” Moses said. “It's not intensity of services or an aging population. Price accounts for the lion's share.”
Moses acknowledged that such analyses of public data have been performed in the past, but he argued this iteration is unique because he and his colleagues aren't trying to justify any policy conclusions. “This isn't original analysis, but it's pulled together in a way that leads to easier conclusions, he said.
The paper also noted rapid growth in the use of health information technology
—an investment they say has yet to see a return in quality and decreased administrative costs—as well troubling increases in chronic disease, especially among people younger than 65.
“If chronic disease is to be effectively tackled, physicians and health systems will need to move into territory that is very unfamiliar to them,” he added. “That means not just traditional medicine but also community services. The economics of healthcare have been thus far so severely skewed to procedures, and health systems have not innovated in health services for broad populations.”Follow Maureen McKinney on Twitter: @MHMMcKinney