Buettgens, M., Dorn, S., & Carroll, C. July 2011. Consider Savings as Well as Costs. Urban Institute.
This report compares health care costs for state governments from 2014 to 2019 after the implementation of the Affordable Care Act and costs if health reform is not implemented.
Congress of the United States. Congressional Budget Office. June 2010. The Long-Term Budget Outlook.
The CBO examines budget projections and puts forth recommendations regarding reducing the deficit. Rising health care costs and an aging population’s effects on the budget are components of the GDP and the budget that are examined.
Congress of the United States, Congressional Budget Office. February 2008. Geographic Variation in Health Care Spending.
This report examines the amount of geographic variation in spending, the reasons for that variation, and its implications for evaluating the efficiency of the health care system.
Cutler, D. M., A. B. Rosen, and S. Vijan. August 2006. The Value of Medical Spending in the United States, 1960-2000. New England Journal of Medicine, 355: 920-927.
This article examines the value of increased medical spending by comparing gains in life expectancy with the increased costs of care.
Elmendorf, D.W. March 2011. CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010. Congressional Budget Office.
Testimony before the Subcommittee on Health and the Committee on Energy and Commerce that summarizes the CBO’s analysis of the health reform legislation before and after enactment, especially the projected effects of the law on the federal budget, health insurance coverage, Medicare, premiums for health insurance, and labor markets.
Executive Office of the President Council of Economic Advisers. June 2009. The Economic Case for Health Care Reform.
This report provides a comprehensive analysis of the economic impacts of health reform. An Update was released December 2009.
Farrell, D. et al. December 2008. Accounting for the cost of U.S. health care: A new look at why Americans spend more. McKinsey Global Institute.
The United States spends a greater percentage of its GDP on health care than any other industrialized country. This study takes a holistic view of the health care system to identify the explanations for higher U.S. health care spending.
Rothberg, M.B., Cohen, J., Lindenauer, P., Maselli, J. & Auerback, A. August 2010. Little Evidence of Correlation Between Growth in Health Care Spending and Reduced Mortality. Health Affairs 29(8): 1523-1531.
This article measures changes in mortality and cost for seven common diagnoses at 122 U.S. hospitals from 2000 to 2004 to determine whether additional dollars purchase better health.
Thorpe, K. E. November/December 2005. The Rise in Health Care Spending and What To Do About It. Health Affairs, 24(6): 1436-1445.
This article examines causes for the growth of health spending, such as obesity and stress, over the past twenty years and suggests reform options.
Weinberg, M. February 2011. Issue Brief: The Economic Impact of Health Reform in Colorado. The Colorado Trust, New America Foundation.
This report summarizes the results of an in depth economic study that assessed the effect of health care reform on the Colorado economy.
Altman, D. and L. Levitt. January 2002. The Sad History of Health Care Cost Containment As Told In One Chart. Health Affairs Web Exclusive.
This commentary attempts to explain the factors affecting rising health care costs and how past solutions to solve the expense problem have fared.
Altman, S. and S. Wallack. 1996. Health Care Spending: Can the United States Control it? Baxter Health Policy Review 2:1–32.
This chapter begins with an examination of the problems facing health care, outlines recent trends in health care spending, details reasons why spending is rising so rapidly, and reviews health care reform proposals.
Anderson, G. F., B. K. Frogner, R. A. Johns, et. al. May/June 2006. Health Care Spending and Use of Information Technology in OECD Countries. Health Affairs, 25(3): 819-831.
This paper analyzes the differences in uses of health information technology (HIT) in the United States and other OECD countries and proposes a greater adoption of HIT to lower health care expenditures in the United States.
Chernew, M.E., P.D. Jacobson, T.P. Hofer, et al. November/December 2004. Barriers to Constraining Health Care Cost Growth. Health Affairs 23(6):122–128.
These authors conducted several semi structured interviews and present their discussion of how to slow the growth of health care expenditures, looking specifically at managed care as a method of cost containment.
Davis, K., Schoen, C., & Guterman, S. January 2011. Bending the Health Care Cost Curve: Focusing only on Federal Budget Outlays Won’t Solve the Problem. The Commonwealth Fund.
This is a discussion of recent proposals to reduce health care costs in order to reduce the federal budget deficit.
Engelberg Center for Health Care Reform at Brookings, Bending the Curve Through Health Reform Implementation, October 2010.
This report provides updates to the September 2009 recommendations for significantly slowing spending growth while improving the quality of health care.
Fuchs, V. R., & Milstein, A. May 2011. Perspective: The $640 Billion Question- Why Does Cost-Effective Care Diffuse so Slowly? The New England Journal of Medicine, 364: 1985-1987
This article discusses why health care is so expensive and why reform takes so long to take effect.
Ginsburg, P. B. March/April 2007. Shopping for Price in Medical Care. Health Affairs Web Exclusive.
This report analyzes the way in which individuals select health care services based on price and the influence that insurers and the government can have on price selection.
Guterman, S., Schoenbaum, S.C., Davis, K., Schoen, C., Audet, A.J., Stremikis, K., & Zezza, M.A. April 2011. High Performance Accountable Care: Building on Success and Learning from Experience. The Commonwealth Fund.
Hall, M.A., Hwang, W., & Jones, A.S. September 2011. Model Safety-Net Programs Could Care for the Uninsured at One-Half the Cost of Medicaid or Private Insurance. Health Affairs, 30, no. 9 (2011): 1698-1707.
Examines how the 20 million people left uninsured after the implementation of the Affordable Care Act can continue to access low or no cost health care through the safety-net system. Four model safety-net systems are described to promote cost-savings and a sustainable business model.
Hermer, L.D., & Brody, H. February 2010. Defensive Medicine, Cost Containment, and Reform. Journal of General Internal Medicine 25(5): 470-473.
This article discusses potential cost drivers, including defensive medicine and malpractice insurance, and what may be necessary to persuade physicians to accept changes in their practice pattern as part of the larger changes to health care payment and delivery systems that cost containment requires.
Hoffman, A. and S. Pearson. June 2009. Marginal Medicine: Targeting Comparative Effectiveness Research to Reduce Waste. Health Affairs Web Exclusive.
This paper provides a framework for leveraging comparative effectiveness research to maximally improve health care services.
Monheit, A.C. Fall 2010. Can Reform’s Prevention Incentives Help to Bend the Cost Curve? Inquiry 47(3): 179-185.
This perspective piece discusses how health reform will promote preventive care, and whether it will be effective reducing health care costs.
Newhouse, J. November/December 2004. Consumer-Directed Health Plans and the RAND Health Insurance Experiment. Health Affairs 23(6):107–113.
The author compares today’s consumer-directed health plans to the RAND Health Insurance Experiment of the 1970s and 1980s. He suggests policy reforms to address the continual rise in health care costs, including a combination of managed care and cost sharing.
Rosenthal, M.B. May 2009. What Works in Market-Oriented Health Policy? New England Journal of Medicine 360;21.
This perspective piece discusses how best to design and implement market-oriented reforms to improve the medical system.
Russell, L.B. January/February 2009. Preventing Chronic Disease: An Important Investment, But Don’t Count on Cost Savings. Health Affairs 28(1): 42-45.
This article discusses why prevention methods can actually add to medical costs, instead of reducing them, and how the medical community should reform prevention to make it cost-effective and even cost-saving.
Smith, T.J., & Hillner, B.E. May 2011. Sounding Board: Bending the Cost Curve in Cancer Care. The New England Journal of Medicine.
This article discusses ways to reduce the costs for cancer care including reforming research and development and changing treatment and detection strategies.
Woolf, S.H. 2008. Commentary: The Power of Prevention and What it Requires. Journal of the American Medical Association 299(20): 2437-2439.
This perspective piece discusses how the medical community can induce cost savings through prevention.
Also see Dr. Woolf’s commentary A Closer Look at the Economic Argument for Disease Prevention.
Zuvekas, S. H. and J. W. Cohen. January/February 2007. Prescription Drugs and the Changing Concentration of Health Care Expenditures. Health Affairs 26(1): 249-257.
This paper explores the concentration of health care spending in various sectors and possible implications for cost containment.
Health Care Cost Drivers
Bodenheimer, T. 2005. High and Rising Health Care Costs. Annals of Internal Medicine.
In this series, the author examines possible factors contributing to the rise in national health expenditures and cost-containment strategies that emphasize quality improvement as well as lowering spending.
Part One looks at different explanations for rising health care costs;
Part Two looks specifically at technology as a major factor in expenditures;
Part Three looks at how prices and quantities of health care services affect spending; and
Part Four, written with Dr. Alicia Fernandez, looks at quality-enhancing strategies that might help slow the growth of health care costs.
Congress of the United States, Congressional Budget Office. January 2008. Technological Change and the Growth of Health Care Spending.
This CBO paper describes the historical growth in spending on health care in the U.S. It examines the factors that determine health care spending and how they have contributed to spending growth over time.
Fisher, E., D. Goodman, J. Skinner, and K. Bronner. February 2009. Health Care Spending, Quality, and Outcomes: More Isn’t Always Better. Dartmouth Atlas Project Topic Brief.
This topic brief examines the relationship between regional differences in spending and the quality of care, and implications of this relationship for U.S. health reform.
Keenan, P. S. November 2004. What's Driving Health Care Costs? The Commonwealth Fund.
This paper discusses the causes of rising health care costs and analyzes the results of the increased spending.
Ladapo, J.A., Horwitz, J.R., Weinstein, M.C., Gazelle, G.S. & Cutler, D.M. November/December 2009. Adoption and Spread of New Imaging Technology: A Case Study. Health Affairs 28(6): 1122-1132.
This study examines the spread of medical technology and whether the verified benefits are a factor, specifically in the case of the 64-Slice CT and Coronary CT Angiography.
Laugesen, M.J., & Glied, S.A. September 2011. Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries. Health Affairs 30(9): 1647-1656.
This study compares physicians’ fees paid by public and private payers for primary care office visits and hip replacements in six countries, as well as physician’s incomes, differences in financing the cost of medical education, and the relative contribution of payment per physician and of physician supply in the countries’ national spending on physician services.
Moeller, J., G. Miller, and J. Banthin. September/October 2004. Looking Inside the Nation's Medicine Cabinet: Trends in Outpatient Drug Spending by Medicare Beneficiaries, 1997 and 2001. Health Affairs 23(5):217–225.
The authors examine trends in outpatient prescription drug spending by the Medicare civilian, noninstitutionalized population in 1997 and 2001 using nationally representative data from the Medical Expenditure Panel Survey.
Mullins, C.D., A.R. DeVries, V.D. Hsu, et al. July/August 2005. Variability and Growth in Spending for Outpatient Specialty Pharmaceuticals. Health Affairs 24(4):1117–1127.
This study of ten Blue Cross Blue Shield plans documents large expenditures on select specialty pharmaceutical categories and much variation in spending across plans, age groups, and time.
Reinhardt, U. November/December 2003. Does the Aging of the Population Really Drive the Demand for Health Care? Health Affairs 22(6):27–39.
This essay draws on the research literature and on data from the Medical Expenditure Panel Surveys to explore the impact that the aging of the US population has on the annual growth in the demand for health care and in national health spending.
Roehrig, C.S., & Rousseau, D.M. September 2011. The Growth in Cost Per Case Explains Far More of US Health Spending Increases Than Rising Disease Prevalence. Health Affairs, 30, no. 9 (2011): 1657-1663.
Examines health care spending growth from 1996 to 2006, specifically the relationship between disease prevalence and cost per case. Provides suggestions for how to curb health spending related to cost per case.
Roehrig, C., A. Turner, P. Hughes-Cromwick, & G. Miller. August 2012. When the Cost Curve Bent- Pre-Recession Moderation in Health Care spending. New England Journal of Medicine DOI:10.1056/NEJMp1205958.
The authors analyzed monthly data on health care spending to determine when the moderation in growth began, and how this knowledge can impact future efforts to slow health care spending growth.
Thorpe, K., C. Florence, and P. Joski. August 2004. Which Medical Conditions Account for the Rise in Health Care Spending? Health Affairs Web Exclusive.
This research looks at the level and growth in health care spending attributable to the fifteen most expensive medical conditions in 1987 and 2000. The authors found that a small number of conditions account for most of the growth in health care spending.
Impact on Individuals
Auerback, D.I., & Kellermann, A.L. September 2011. A Decade of Health Care Cost Growth Has Wiped Out Real Income Gains for an Average US Family. Health Affairs, 30, no. 9 (2011):1630-1636.
This article discusses the growth of gross annual income for medical income US families of four from 1999 to 2009 and the simultaneous growth of personal health care expenditures.
Auguste, B.G., Laboissiere, M., & Mendonca, L.T. April 2009. How Health Care Costs Contribute to Income Disparity in the United States. McKinsey Quarterly.
A study by the McKinsey Global Institute (MGI) identifies three divergent categories of workers that are emerging from trends in health care coverage and income growth.
Cylus, J., Hartman, M., Washington, B., Andrews, K. & Catlin, A. December 2010. Pronounced Gender and Age Differences Are Evident in Personal Health Care Spending per Person. Health Affairs 30(1): 153-160.
This paper examines the differences in national health care spending by gender and age.
Kaiser Commission on Medicaid and the Uninsured, Snapshots from the Kitchen Table: Family Budgets and Health Care, February 2009.
Reports interviews with 27 heads of households from diverse working families across the U.S. and provides a window into the family finances and concerns of low- and middle-income Americans trying to make ends meet.
Ketsche, P, Adams, E.K, Wallace, S, Kannan, V.D, & Kannan, H. September 2011. Lower-Income Families Pay a Higher Share of Income Toward National Health Care Spending Than Higher-Income Families Do. Health Affairs, 30, no.9 (2011): 1637-1646.
This study examines out of pocket expenses between lower-income families and higher-income families.
Merlis, M., Gould, D., & Mahato, B. February 2006. Rising Out-of-Pocket Spending for Medical Care: A Growing Strain on Family Budgets. The Commonwealth Fund.
This report discusses trends in health care costs and burdens on family budgets.
Remler, D. K. and S. A. Glied. July/August 2006. How Much More Cost Sharing Will Health Savings Accounts Bring? Health Affairs, 25(4): 1070-1078.
This paper examines the impact of health savings accounts on out-of-pocket medical expenditures.
Medicaid and Medicare
Centers for Medicare and Medicaid Services. May 2011. 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
The annual report by the Board of Trustees for Medicare to the Congress contains information on the past and estimated future financial operations of the Hospital Insurance and Supplementary Medical Insurance Trust Funds.
Coughlin, T., T. Waidmann, and M. O. Watts. May 2011. Where Does the Burden Lie?: Medicaid and Medicare Spending for Dual Eligible Beneficiaries. Kaiser Commission on Medicaid and the Uninsured; Henry J. Kaiser Family Foundation.
This issue brief examines Medicare and Medicaid spending on “dual eligibles,” those who are simultaneously enrolled in both programs.
Garrett, B. et al. May 2009. The Coverage and Cost Impacts of Expanding Medicaid. Kaiser Commission on Medicaid and the Uninsured; Henry J. Kaiser Family Foundation.
This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates.
Fronstin, P. January 2010. Implications of Health Reform for Retiree Health Benefits. Employee Benefit Research Institute, Issue Brief No. 338.
This issue brief examines how current health reform legislation will impact the future of retiree health benefits.
Hadley, J., Waidmann, T., Zuckerman, S., & Berenson, R.A. May 2011. Medical Spending and the Health of the Elderly. Health Services Research web exclusive.
This study discusses the relationship between variations in medical spending and health outcomes of the elderly.
Iglehart, J.K. September 2011. Desperately Seeking Savings: States Shift More Medicaid Enrollees to Managed Care. Health Affairs, 30, no. 9 (2011): 1627-1629.
Many states are reducing Medicaid benefits and shifting to managed care plans to save costs in these tight economic times. This article discusses the various strategies states are taking to save money and the effects these changes will have on the Medicaid population.
Henry J. Kaiser Family Foundation. July 2011. Comparison of Medicare Provisions in Deficit and Debt Reduction Proposals.
This side-by-side summary compares the key Medicare provisions found in five major debt-reduction plans put forward by the White House, Congress and independent, bipartisan commissions.
Henry J. Kaiser Family Foundation. September 2011. Medicare Spending and Financing Fact Sheet.
This fact sheet provides an overview of spending on the Medicare program, how the program is financed, and Medicare’s future financial outlook.
Kaiser Commission on Medicaid and the Uninsured. February 2011. Medicaid Spending Growth over the Last Decade and the Great Recession, 2000-2009. The Henry J. Kaiser Family Foundation.
This report examines Medicaid spending growth nationally during the last decade, with a focus on growth during the recession of 2007 to 2009.
Kronick, R. and D. Rousseau. March/April 2007. Is Medicaid Sustainable? Spending Projections for the Program's Second Forty Years. Health Affairs 26(2): 271-287.
This article examines the long-term fiscal sustainability of the Medicaid program.
MedPAC. March 2011. Report to the Congress: Medicare Payment Policy.
This report summarizes the Medicare program, payment policies, and issues affecting the program.
The Oregon Health Study Group. July 2011. The Oregon Health Insurance Experiment: Evidence From the First Year. National Bureau of Economic Research.