US and International Health Care: Trends in Spending, Costs and Prices Presentation to Society of American Business Editors and Writers By Susan Dentzer October 27, 2014

2 International Comparison of Spending on Health Average spending on health per capita ($US PPP) Source: OECD Health Data 2010 (June 2010). Total expenditures on health As a share of GDP

International Slowdown in Health Cost Growth ? Source: Lorenzoni L, Belloni A, Sassi F, “Health-care expenditure and Health Policy In the USA versus other high-spending OECD Countries,” The Lancet, 2014; 384:83-92

Annual Growth Rates, Gross Domestic Product (GDP) And National Health Expenditures (NHE), Calendar Years 1990–2023. Sisko A M et al. Health Aff doi: /hlthaff Health Spending Projections, CMS Exchanges, subsidies and Medicaid expansion 2% gap remains; cost curve not bent

The Role of Prices Since 2000, rising prices of hospital charges, professional services, drugs, devices, and administration costs have produced 91 percent of the increases in health spending US prices for almost every aspect of health care greatly exceed those in all other high-income countries Sources: Moses H et al, “The Anatomy of Health Care in the United States,” JAMA 2013; 310(18): ; International Federation of Health Plans

International Price Variation: An Example

“ At $84,000, Gilead Hepatitis C Drug Sets Off Payer Revolt” Bloomberg.com, Jan. 27, 2014 Specialty Pharmaceuticals: The Case of Sovaldi

High Cost-Sharing in Exchange Plans  Exchange plans at lower tiers impose high cost-sharing requirements on individuals before they reach their out-of-pocket maximums. Source: Avalere Health More than double the average deductible in an employer-provided plan

All-Payer Claims Databases

States Move To Require Health Care Price Transparency

Cost estimator tool allows patients to calculate what they will pay out-of-pocket e.g., for a Medicare patient receiving a hip replacement, $5207

Disruptive Technologies: Potential to Lower Spending? Digital health, mhealth (mobile), apps Pushing care out of institutions and into homes and offices Enabling more self care Engaging patients and enhancing sense of knowledge, confidence, activation

New entrants into health care: Apple Apple Health dashboard allows consumers to compile and view health care information Apple’s HealthKit: new platform for health apps Apple Watch has heart rate sensors; annual sales of 485 million predicted Link with Epic EHR Exploring incorporation of blood pressure and glucose monitoring into iPhone

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