It's not the patients that are to blame (OK, somewhat, for unnecessary procedures, tests, and drugs). But by far
the biggest driver of medical spending in the US is from price increases
. Hospitals and facilities and pharma/device mfrs are charging wildly inflated prices and raking in record profits. Step away from your personal anecdotes for a moment to look at the facts.
Between 1996 and 2013, US health care spending almost doubled in real dollars, increasing by almost a trillion dollars. Here's how that increase breaks down by changes in contributing factors:
US population size: +23%
Aging of population: +12%
Disease prevalence/incidence: -2%
Utilization of services: 0%Price and intensity of services:+50%
"Services" includes such things as drugs, medical devices, diagnostics, imaging, therapies, doctor (ambulatory care) visits, emergency visits, nursing home stays, and in-patient services. "Service utilization" means such things as the number
of visits and length of stays and number of prescript
ions and number of bed-days. "Intensity of services" means spending more per visit
, per prescript
ion, or per bed-day including such things as additional services that are tacked on per incidence.
While service utilization cost increase netted 0, cost of inpatient stays dropped by 45% per stay, but the cost per bed-day more than made up for it. Ambulatory care visits and cost per visit were up too. ER and dental care spending increases were almost entirely due to price/intensity increases, and not the number of visits. Cost of increased use of pharmaceuticals increased by 67%. We're getting more drugs for each disease/visit and
spending a lot more for each of those drugs.
The disease with the largest price increase was diabetes, which accounted for 11% of all price increases, and 2/3 of that was pharmaceutical price increases. Close behind were low back and neck pain, hypertension, hyperlipidemia, and depressive disorder price increases.
For prostate cancer, ambulatory care spending increases were driven by changing demographics. Inpatient care utilization was markedly lower, but that was more than offset by service price/intensity increases.Factors Associated With Increases in US Health Care Spending, 1996-2013
So some of the increases are unavoidable (population and age-related). Some is avoidable - e.g.,exercise and nutrition to prevent diabetes. But half of it is due to price increases and increases in cost per visit.
In 2015, the US pharmaceutical industry posted record profits of $124 Billion - a return on R&D investment of 134%. Healthcare providers bring in about
$1 Trillion in revenues per year in the US.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog