2018年医疗支出趋势报告（英文版）_31页_3mb

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

Core Content

The document provides an analysis of medical cost trends in the United States, particularly focusing on the employer-based healthcare market. It outlines the factors influencing these trends and discusses the shift from high double-digit growth to a more stable "new normal" of single-digit growth. The report also highlights the challenges and opportunities for stakeholders in the healthcare industry to manage costs in the context of these changes.

Main Points

Medical Cost Trend: A "New Normal"

• Medical cost trend has been hovering in the single digits for several years, marking a "new normal" characterized by moderate fluctuations and slower growth.
• In 2018, PwC Health Research Institute (HRI) projects a 6.5% growth rate for medical cost trend, which is a slight increase from the previous year.
• After accounting for benefit design changes, such as higher co-pays and narrow provider networks, the net growth rate is expected to be 5.5%.
• The "new normal" is not sustainable, and future reductions in cost trend will require a greater focus on price control rather than just utilization.

Key Influences on Medical Cost Trend

Upward Pressures

1. Rising General Inflation

   • The U.S. economy is in its third-longest expansion in history, leading to higher general inflation.
   • Inflation affects wages and medical prices, which in turn drive overall cost trend upward.
   • The Consumer Price Index (CPI) is expected to rise to 2.6% in 2018, the highest since 2012.

2. Slowing Shift to High-Deductible Health Plans

   • The growth in high-deductible plans has slowed, reducing the incentive for cost-sharing to curb healthcare utilization.
   • Employers are recognizing the limits of cost-sharing and are less inclined to use it as a tool for cost control.
   • Consumers are increasingly dissatisfied with high-deductible plans and are forgoing preventive care, leading to higher long-term costs.

3. Fewer Branded Drugs Coming Off Patent

   • The decline in branded drug patent expirations has reduced the availability of cost-saving generics.
   • This has led to higher drug price growth, contributing to overall healthcare cost increases.
   • The impact of patent expirations on cost savings is typically seen 12–24 months after the patent expires.

Downward Pressures

1. Political and Public Scrutiny on Drug Prices

   • High drug price increases have drawn public and political attention, pressuring companies to hold back price hikes.
   • President Trump and lawmakers have criticized pharmaceutical companies, calling for price transparency and importation of cheaper drugs from other countries.

2. Employer Strategies to Minimize Waste

   • Employers are learning to manage and deploy new treatments more effectively to ensure access while reducing waste.
   • They are also targeting the right patients with the right treatments to optimize care delivery.

Key Information

• Medical cost trend is the projected percentage increase in the cost to treat patients, assuming benefits remain unchanged.
• The employer-based market covers about half of all Americans and is a key focus of the analysis.
• Healthcare cost growth is influenced by two components: unit price inflation and utilization.
• Pharmaceutical sales associated with patent expirations have declined in recent years, reducing cost-saving opportunities.
• High-deductible health plans have been a key strategy for cost control, but their popularity is waning.
• The document emphasizes that future cost reductions will depend on addressing the price of services, not just utilization.

Supporting Factors

Economywide Drivers

• Income is associated with higher health spending.
• Demographics show an aging workforce, which increases healthcare expenditures.
• Lifestyle factors, such as obesity and opioid abuse, contribute to increased utilization and costs.

Healthcare-Specific Drivers

• Technology and treatment innovation can both increase and reduce healthcare costs.
• Consolidation in the healthcare industry has increased market power, leading to higher prices.
• Government regulation has had a mixed impact, with some regulations reducing costs (e.g., expanding the scope of practice for nurse practitioners).
• Payment models are shifting from fee-for-service to value-based models, which may help curtail cost growth.

Conclusion

• Despite the "new normal", health spending continues to outpace the economy.
• The gap between health spending and wage growth is eroding consumer purchasing power.
• To sustain cost control, stakeholders must address both price and utilization.
• Employers, insurers, and providers need to collaborate on innovative strategies to manage costs effectively.