In a very interesting recent post to the Health Affairs blog, Ken Kaufman challenges the widely repeated assertion that the current low level of health care cost growth can be attributed to the recession. After decades of double digit trend, the rate slowed in recent years down to a mere 3.9% in 2010. The conventional wisdom is that recessions cause decreases in employment by employers offering good insurance and general recessionary belt-tightening includes reductions in utilization of discretionary health care services.
Kaufman noted that inpatient hospital utilization by Medicare patients dropped 8% from 2006 to 2010 — patients that are presumably retired and therefore not affected by recessionary unemployment. He also noted that states with a larger drop in Medicare utilization were the ones with the smallest drop in employment rates, the opposite of what one would expect if the recession was the driver of the drop. From these observations, Kaufman proposes that we should look for other factors at play. He suggests an initial list of five other factors:
- As doctors move from entrepreneurial self-employment to employment by hospitals and large groups, they come under the influence of care protocols, disease management and other clinical programs that attempt to drive down avoidable utilization
- As hospitals’ revenue growth slowed, they changed from an “all things to all people” philosophy to a policy of eliminating unprofitable programs
- New “care models,” including new approaches to physician incentives and reimbursement, are starting to have an effect
- Dramatic shift from brand name to generic drugs
- Health care utilization may have reached the point of “diminishing marginal utility,” where people’s appetite for more is diminished and other alternatives for resource allocation are relatively more appealing than more health care
As we (hopefully) continue to recover from the recession, everyone expects health care trends to creep back upward. But, perhaps they won’t creep all the way back up to the teens due to these forces keeping cost growth in check.