U.S. spending to treat heart disease, respiratory ailments and endocrine conditions such as diabetes slowed in the second half of the last decade, but not because fewer people sought care, new data show.
Rather, a reduction in the number of doctor visits, drugs and other care to treat heart attacks, asthma, back problems and diabetes cut costs, researchers reported in a Health Affairs paper. Patients also used high-priced care at a slower pace.
The study, by economists and statisticians with the U.S. Bureau of Economic Analysis, is among the first to analyze new federal data that break down the nation's $3 trillion healthcare bill by the cost to treat individual conditions. Policymakers and consumers are watching the new federal data as they seek more information about the cost and quality of treating specific diseases.
“From a patient's perspective, you care about the total cost of treatment,” said Abe Dunn, who authored the study along with BEA colleagues Lindsey Rittmueller and Bryn Whitmire.
The new research looks only at the cost per case across more than a dozen condition categories from 2000 and 2010. It did not look at whether patients got better or worse results. But the data is “a starting point,” and one that has been desired for decades by experts grappling with the nation's high healthcare costs, said Chapin White, a senior policy researcher with RAND Corp.
“I expect there is going to be more and more work done comparing these disease-based spending trends with the quality of care and the outcomes we're seeing,” White said. “There is the potential for this to be very useful.”
U.S. health spending growth has been at historic lows since 2009, rebounding only in 2014 with the expansion of health insurance under the Affordable Care Act. Economists have debated how factors such as the recession and the ACA contributed to record-slow health spending during that period.
The National Bureau of Economic Research determined that the Great Recession officially ended in June 2009 after 18 months of the worst economic downturn since the Great Depression. The recession, however, may have had less of an effect on the spending slowdown through 2010 than might be suspected, authors of the new report said.
That's because historically, a drag on the overall economy does not slow health spending immediately.
Researchers also crunched the numbers a few different ways and results suggest that health spending slowed before the recession that began in December 2007. The recession likely contributed to the slowdown, but it made the biggest impact after 2010, probably as a result of fewer people seeking care.
The analysis used data that combine national survey results, commercial insurance bills and Medicare claims.
Dunn and colleagues proposed a few possible reasons the growth in healthcare spending was faster in the first half of the last decade.
Health insurance trends may have contributed to the uptick in spending from 2000 to 2005 and the slowdown that followed. Spending picked up early in the decade as managed-care companies lost their grip on costs, the authors said. As the decade continued, high deductible health plans grew more common, the authors said.
High deductible health plans introduce an incentive for patients to seek out less costly treatment, such as generic drugs, retail clinics or alternatives to surgery.
Patients had more options for generics, which may have also contributed to the slowdown, the authors said. Patents expired on a number of blockbuster drugs, which contributed to a notable drop in retail prescription drug spending.
Federal estimates show retail drug spending grew 11.2% annually, on average, between 2000 and 2005. But that dropped to 4.3% average annual growth in the second half of the decade. In 2010, retail drug spending growth was largely flat.
New generic drugs slowed the growth in cost per case for treating circulatory conditions—including common chronic diseases such as hypertension and heart failure. Patients also underwent fewer intensive cardiac inpatient procedures as the last decade ended and that contributed to flat costs to treat heart disease between 2005 and 2010. New generics helped save money when treating diabetes and high cholesterol. Use of imaging for back pain patients tapered after growing quickly during the first half of the decade, which helped curb costs for musculoskeletal conditions. That could be a result of new regulations on physician self-referrals, the authors said.
The cost to treat some conditions, such as breast cancer, accelerated.
