Health spending growth has been at historically low levels for the past several years. Is the increasingly stratified wealth in the U.S. a big factor?
Yes, according to researchers from Harvard Medical School and Hunter College in New York City. Medical spending per capita among the wealthiest Americans grew at an inflation-adjusted 25 percent between 2004 and 2013, from about $4,000 a year to about $5,000. From the mid-1990s, that spending curve grew about 70 percent, according to the study data published in the most recent issue of the journal Health Affairs.
“The slowdown in medical spending growth between 2004 and 2013 was the sum of disparate trends: Flat spending for the elderly and poor, slow growth for the non-elderly middle class, and exuberant growth for the non-elderly wealthy,” the study concluded.
By contrast, spending growth among the middle-income groups grew from that same time period from about $3,500 a year to about $4,000, or less than 15 percent overall. And among poor people, spending was all but flat, at around $4,000 a year in 2004 and actually dropping slightly by 2013.
That contrast is borne out in myriad ways. Wealthy media figure Steven Brill's discussion of having surgery for his aortic aneurysm at New York-Presbyterian Hospital–which leveraged 90 percent of its chargemaster from his insurer–comes to mind.
The study's authors suggested that the expansion of Medicaid eligibility under the Affordable Care Act–where expenditures are highly constrained compared to Medicare and commercial health plans–may explain the flat spending for the poorest income groups, but not for the middle-class. Indeed, the different is so stark among the groups that if spending trends for the middle and poorer groups had matched those of the wealthiest groups, over healthcare spending in the U.S. would have been higher by $157 billion in 2012 alone.
The study's authors concluded that the trend “could portend a widening of disparities in health outcomes.”
Preferential treatment for “VIP” patients at hospitals has raised concerns that the additional resources they are receiving may be taken away from less wealthy patients.
- read the Health Affairs study