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Is This Time Different? The Slowdown in Healthcare Spending

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  • Amitabh Chandra
  • Jonathan Holmes
  • Jonathan Skinner

Abstract

Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population. A more difficult question is: Will this slowdown continue? Here we are more pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in the technology pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000) is projected to grow rapidly. Accountable care organizations (ACOs) and emboldened insurance companies may yet stifle health care cost growth, but our best estimate over the next two decades is that health care costs will grow at GDP plus 1.2 percent; lower than previous estimates but still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums.

Suggested Citation

  • Amitabh Chandra & Jonathan Holmes & Jonathan Skinner, 2013. "Is This Time Different? The Slowdown in Healthcare Spending," NBER Working Papers 19700, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:19700
    Note: AG HC HE PR
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    File URL: http://www.nber.org/papers/w19700.pdf
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    References listed on IDEAS

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    1. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
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    Cited by:

    1. Eric Nauenberg, 2014. "Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 339-353, December.
    2. Amanda Kowalski, 2014. "The Early Impact of the Affordable Care Act, State by State," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 45(2 (Fall)), pages 277-355.
    3. Mário Amorim Lopes & Carlos Soares & Álvaro Almeida, 2015. "Comparing Comparables: An Approach To Accurate Cross-Country Comparisons Of Health Systems For Effective Healthcare Planning And Policy Guidance," FEP Working Papers 563, Universidade do Porto, Faculdade de Economia do Porto.
    4. Eric Nauenberg, 2014. "Changing Healthcare Capital-To-Labor Ratios: Evidence and Implications for Bending the Cost Curve in Canada and Beyond," Working Papers 140002, Canadian Centre for Health Economics, revised Jul 2014.

    More about this item

    JEL classification:

    • H50 - Public Economics - - National Government Expenditures and Related Policies - - - General
    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy

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