2018年医疗支出趋势报告（英文版）_33页-2mb

Summary of "Medical cost trend: Behind the numbers 2018"

Core Content

The PwC Health Research Institute (HRI) report "Medical cost trend: Behind the numbers 2018" provides an analysis of the trends and drivers affecting employer-based healthcare spending in the United States. It outlines the shift from volatile, double-digit growth to a more stable, single-digit "new normal" for medical cost trends. The report highlights both upward and downward pressures on healthcare costs and discusses how these trends affect employers and the broader economy.

Main Points

• Medical cost trend has stabilized at around 6-7%, with a projected 6.5% increase for 2018.
• Net growth rate after benefit design changes is expected to be 5.5%.
• The report distinguishes between inflators (factors increasing costs) and deflators (factors decreasing costs).
• It emphasizes the importance of price in future cost reductions, as utilization growth has been a key counterbalance in recent years.

Key Components of the Report

Medical Cost Trend Overview

• Medical cost trend refers to the projected percentage increase in the cost of treating patients, assuming benefits remain constant.
• This trend is influenced by unit cost inflation (price of services) and utilization (volume and intensity of services used).
• The report notes that healthcare spending continues to outpace the economy, with premiums increasing faster than wages.

"New Normal" in Employer Medical Costs

• The "new normal" is characterized by moderate, single-digit growth in employer medical costs.
• This trend has been in place for over a decade and is expected to persist, with no sign of a return to double-digit growth.
• Structural changes, such as value-based care and increased cost sharing, are key in slowing cost growth.

Factors Influencing 2018 Medical Cost Trend

Inflators

1. Rising general inflation impacts healthcare:

   • The US economy is experiencing growth, leading to higher general inflation.
   • This inflation affects wages and medical prices, contributing to cost increases.
   • The Consumer Price Index (CPI) is expected to rise to 2.6% in 2018, the highest since 2012.

2. Movement to high-deductible health plans (HDHPs) loses steam:

   • The adoption of HDHPs has slowed, with fewer employers offering them as the only option.
   • This reduces the incentive for employees to avoid care, leading to higher utilization and increased costs.
   • Employees enrolled in HDHPs are more likely to skip or delay care, which can lead to long-term health issues.

3. Fewer branded drugs come off patent:

   • Declining sales from branded small molecule drugs going off patent have reduced the availability of cost-saving generics.
   • This has led to faster drug price growth and higher overall healthcare costs.
   • Biosimilars are expected to have a limited impact due to their recent approval and high initial prices.

Deflators

1. Political and public scrutiny puts pressure on drug prices:

   • High drug price increases have drawn public and political attention.
   • This pressure may lead to price controls and greater transparency from drug companies.
   • The report notes that presidential rhetoric and public backlash have influenced the pharmaceutical industry to be more price-conscious.

2. Employers target right people with right treatments to minimize waste:

   • Employers are learning to manage care more effectively.
   • They are using data and analytics to ensure cost-effective treatments and preventive care.
   • This strategy helps reduce unnecessary utilization and waste in the healthcare system.

Future Outlook

• To bring medical cost trend below its "new normal", the industry must focus more on price control than just utilization.
• Employers should explore new contract arrangements with providers to reduce costs without shifting more burden to employees.
• Healthcare providers should focus on care management and cost optimization.
• Health insurers can help by promoting effective treatments and pricing transparency.
• Drug companies should enhance collaboration and provide greater insight into pricing and their role in patient health.

Impact on the Economy

• Healthcare spending is expected to continue growing faster than GDP, which may lead to budget deficits and reduced spending in other areas.
• The gap between healthcare costs and wages is a growing concern for consumers, as it affects their ability to afford other goods and services.
• The "new normal" is not sustainable, and the industry must find new ways to manage costs.

Conclusion

The report underscores the need for a multifaceted approach to managing healthcare costs. While the "new normal" of moderate growth is expected to continue, future cost reductions will require more attention to price control and efficiency improvements across the healthcare system. Employers, insurers, and providers must work together to ensure affordable, high-quality care for employees while managing budget constraints.