U.S. healthcare spending apparently grew more slowly last year than at
any time in the past half-century—including the Great Recession—as
Medicare squeezed outlays, millions of Americans continued to go without
health insurance and those with health plans spent at a slower pace on
hospitals, clinics and pharmacies.
The nation spent $2.9
trillion on healthcare last year, an increase of 3.6% from the prior
year and the weakest growth since 1960, after federal actuaries and
economists revised recent estimates. That spending remained weak in 2013
was not surprising: U.S. health spending growth fell below 4% in 2009
with the recession that stripped private health insurance from millions
of individuals. But newly revised numbers show an acceleration in 2012
to 4.1% before a slump last year.
The slump is not expected to
last with the start in January of health reform's push to reduce the
number of uninsured, some contend. Indicators of spending so far this
year are mixed, however. Major hospital chains have reported fewer
uninsured and healthier margins, particularly in states that expanded
Medicaid. But quarterly national estimates put health spending growth
below 4%.
As a percentage of the economy, health spending last
year remained at 17.4% of the gross domestic product. Last year's
slowdown can be traced to the recession, changes in health benefits and
the Patient Protection and Affordable Care Act,
federal officials who produced the latest estimate wrote in the journal
Health Affairs, which published the snapshot of 2013 spending on
Wednesday.
Commercial health plan enrollment plunged by 11.2
million with the recession, which ended more than five years ago, and
had barely rebounded as of last year, when it grew 0.7%. Slower growth
in private health insurance spending, aided in part by the growing
prevalence of high-deductible health plans, contributed to the sluggish
health spending growth in 2013, said Micah Hartman, a federal
statistician with the CMS who helped produce the estimate of last year's
spending. High-deductible health plans are 9% to 12% less costly than
preferred provider plans and shift more of the cost of care to
households.
Slower private health plan spending for hospital,
physician and clinical service also contributed to last year's slump,
which federal officials said could be in part due to more patients
grappling with high deductibles.
Spending for private health
insurance premiums decelerated to 2.8% from 4% in 2012. Spending for
private health plan benefits also grew more slowly in 2013, 2.8% from
4.4% the prior year.
Medicare spending cuts contained in the
Affordable Care Act helped slow Medicare spending growth, as did a
smaller number of baby boomers entering the program after an enrollment
rush in 2012. Medicare spending increased less rapidly in 2013, 3.4%
from 4% the prior year.
Healthcare inflation slowed in 2012 as Medicare curbed its spending under the Patient Protection and Affordable Care Act.
Health
reform reduced the amount by which Medicare increases payments each
year to offset the rising cost of running hospitals and clinics and
other services. The cuts began in 2011 and continue through 2019.
Other
legislative cuts to federal spending helped as well. The fiscal fix
known as the sequester added to health reform's Medicare cuts in 2013,
further reducing what Medicare pays hospitals, doctors and other
providers by 2%.
Health spending did not fall with weaker
inflation, however, as demand for medical care began to rebound in 2012
and continued last year.
The use of hospitals, laboratories and
other healthcare plunged with the recession, as did the healthcare
sector's investment in technology and construction to upgrade or expand
services. These costs are a measure of the demand for care and the
intensity of treatment, and such expenses increased 1.1% in 2012 and
again in 2013 after barely perceptible 0.1 percentage point contribution
to the average per capita health spending growth of 3.1% from the year
the recession ended to 2011.
How sharply health spending may
rebound has been intensely debated among economists and policymakers
divided over the influence the weak economy has exerted over health
spending. Some credit the soft economy for the continued slow health
spending; others say pressure on hospitals, doctors and other providers
to increase efficiency and new incentives to do so has lowered the cost
of healthcare.
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