Soaring Prices, Not Demand, Behind Massive Hike in U.S. Health Spending

Major survey of U.S. health care trends yields surprises

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"We need to move toward incentives for efficiency," Sharfstein said.

Capping health care costs to grow no more quickly than the economy should be a national goal, according to Dr. Ezekiel Emanuel, chair of medical ethics and health policy at the University of Pennsylvania, in Philadelphia.

"It would require us to stretch. It would require us to rethink the current system," said Emanuel, who also wrote a commentary in the same journal issue. But, he added, it would be "feasible" to ensure that per-person health care spending rose no faster than the gross domestic product.

Along with Maryland, Emanuel said, Massachusetts and Arkansas have adopted cost-cutting plans with a goal like that in mind. For it to happen on a national level, he noted, "first people have to agree that it's a worthy goal."

How would it happen? Emanuel said that one way would be to reduce how much care is performed in hospitals, and move it to much less costly settings -- including people's homes.

There is a precedent to such a goal. For a few years in the 1990s, Emanuel noted, U.S. health care spending did grow at roughly the rate of the economy. That was when managed care plans briefly reined in spending. But doctors' and patients' dissatisfaction with managed care's restrictions -- like prior authorization for tests and treatments -- led to a "backlash," Emanuel said.

Still, he said he thinks lessons have been learned since that time, and more is known now about where the key cost controls need to be made. "I don't think we'd have the same kind of backlash," Emanuel said.

More information

The Kaiser Family Foundation has more on U.S. health care costs.

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