Factors Associated With Increases in US Health Care Spending, 1996-2013

Dieleman, Joseph L; Squires, Ellen; Bui, Anthony L.; Campbell, Madeline; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Li, Zhiyin; Matyasz, Taylor; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew; Murray, Christopher J L

doi:10.1001/jama.2017.15927

Cited by 287 publications

(242 citation statements)

References 25 publications

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“…During a similar period, from 2001/2002 to 2009/2010, we find health status and all treated conditions (not just chronic) explained 45.0 percent of expenditure growth, with all other individual characteristics contributing less than one percent. In contrast, Dieleman et al found that age, sex and underlying or true prevalence of conditions together explained less than 10 percent of per capita prescription drug growth between 1996 and 2013.…”

Section: Discussionmentioning

confidence: 92%

“…Roehrig and Daly show that treated prevalence increased more rapidly than underlying or true prevalence for diabetes, hypertension, and hyperlipidemia between 1999/2000 and 2011/2012. More research is needed to assess whether trends such as these explain why Dieleman et al found smaller impacts of underlying conditions compared to studies examining treated conditions—and whether convergence of treated and underlying conditions may now be helping to limit further condition‐driven increases in use to the growth in underlying condition prevalence. A better understanding of these forces may help us to better predict future prescription drug spending growth and to devise policies that would help control that growth.…”

Section: Discussionmentioning

confidence: 99%

“…Socioeconomic factors include age, sex, race-ethnicity, family income, Census region, and MSA status.The relationship we observe between health status and treated conditions and prescription drug spending is quite similar to corresponding results found in the literature decomposing total health care spending. Starr et al12 found that treated conditions explained 36.5 percent of per capita health care spending growth between 1996 and 2006, andThorpe 11 found that treated conditions exwhether trends such as these explain why Dieleman et al43 found smaller impacts of underlying conditions compared to studies examining treated conditions-and whether convergence of treated and underlying conditions may now be helping to limit further condition-driven increases in use to the growth in underlying condition prevalence. A better understanding of these forces may help us to better predict future prescription drug spending growth and to devise policies that would help control that growth.Whereas individual characteristics explain most of the change in drug use, they explain almost none of the changes in average payment per fill and only a third of average expenditures.…”

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confidence: 99%

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Decomposing changes in the growth of U.S. prescription drug use and expenditures, 1999‐2016

Selden

Salam

Miller

2019

Health Services Research

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Objective To analyze factors associated with changes in prescription drug use and expenditures in the United States from 1999 to 2016, a period of rapid growth, deceleration, and resumed above‐average growth. Data Sources/Study Setting The Medical Expenditure Panel Survey (MEPS), containing household and pharmacy information on over five million prescription drug fills. Study Design We use nonparametric decomposition to analyze drug use, average payment per fill, and per capita expenditure, tracking the contributions over time of socioeconomic characteristics, health status and treated conditions, insurance coverage, and market factors surrounding the patent cycle. Data Collection/Extraction Methods Medical Expenditure Panel Survey data were combined with information on drug approval dates and patent status. Principal Findings Per capita utilization increased by nearly half during 1999‐2016, with changes in health status and treated conditions accounting for four‐fifths of the increase. In contrast, per capita expenditures more than doubled, with individual characteristics only explaining one‐third of the change. Other drivers of spending during this period include the changing pipeline of new drugs, drugs losing exclusivity, and changes in generic competition. Conclusions Long‐term trends in treated conditions were the fundamental drivers of medication use, whereas factors involving the patent cycle accelerated and decelerated spending growth relative to trends in use.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Decomposing changes in the growth of U.S. prescription drug use and expenditures, 1999‐2016

Selden

Salam

Miller

2019

Health Services Research

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“…Although lower healthcare expenditures per capita was a predictor of musculoskeletal imaging authority, it cannot indicate causation within the limits of our study. A multitude of factors influence a nation's healthcare expenditures (Dieleman et al, ; J. L. Dieleman et al, ; Johansen, ). Further research is needed to determine if healthcare expenditures per capita are a contributing factor to determining physical therapy legislation or if existing legislation contributes to lower expenditures via an elimination in redundant appointments.…”

Section: Discussionmentioning

confidence: 99%

Physical therapy musculoskeletal imaging authority: A survey of the World Confederation for Physical Therapy Nations

Mabry

Boyles

Brismée

et al. 2019

Physiotherapy Res Intl

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Objectives Medical evidence largely supports PTs in expanded roles, however, healthcare policy within the United States (USA) typically restricts PTs from ordering musculoskeletal (MSK) imaging. It is unknown how MSK imaging policy in the USA compares to other World Confederation for Physical Therapy (WCPT) member nations. The primary objective of our study was to investigate the authority of PTs to order MSK imaging. A secondary objective was to identify factors associated with the authority for PTs to order MSK imaging. Methods 111 WCPT member nations were surveyed over a 2‐month period on the authority of PTs ordering MSK imaging within their nation. A secondary analysis utilizing a step‐wise binary regression compared member nation demographic statistics to MSK imaging authority. Results 81 member nations responded to the survey. 31 (38.3%) of member nations reported having some level of PT MSK imaging authority while 50 (61.7%) did not. Member nations with lower per capita healthcare costs were significantly more likely to allow PTs to order MSK imaging (p = 0.02). Those with direct access authority were 7.4 times more likely to authorize PTs to order MSK imaging (p < 0.01). Entry‐level clinical degree and years of entry‐level collegiate credit were not associated with imaging authority. Conclusion This is the first study to report MSK imaging policy within the WCPT member nations. While many nations within the WCPT allow PTs to order MSK imaging, the majority of nations still restrict PTs from such practice. Lower per capita healthcare costs and direct access authority were significant predictors of MSK imaging authority, however, causation cannot be established within the confines of this study. Future studies should consider issues such as restrictive policy origin (i.e. governmental vs. institutional), insurance reimbursement (i.e. private vs. public sector policy), and limitations on imaging modality

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“…A recent international comparison found that, while Americans visit doctors and hospitals at similar rates to citizens of other high income countries, they pay a higher unit price for each intervention 2. This simple truth—often overlooked in health policy discussions—drives higher overall healthcare spending in the United States 34…”

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confidence: 99%