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Trends in Health Care Utilization and Expenditures in the United States Across 5 Decades

医疗保健 住院治疗 付款 医学 门诊护理 代理(哲学) 药方 人口健康 人口 急诊科 药店 医疗保健质量 业务 环境卫生 家庭医学 护理部 经济增长 财务 经济 哲学 认识论
作者
Karoline Mortensen,Emma Boswell Dean,Michael T. French,Nianyang Wang,Jie Chen
出处
期刊:Medical Care [Ovid Technologies (Wolters Kluwer)]
卷期号:59 (8): 704-710 被引量:8
标识
DOI:10.1097/mlr.0000000000001557
摘要

Background: Health care expenditures in the United States are high and rising, with significant increases over the decades. The delivery, organization, and financing of the health care system has evolved over time due to technological innovation, policy changes, patient preferences, altering payment mechanisms, shifting demographics, and other factors. Objective: The objective of this study was to examine trends over time in health care utilization and expenditures in the United States. Research Design: This analysis employs descriptive statistics to examine 5 decades of health care utilization and expenditure data from the Agency for Healthcare Research and Quality (AHRQ) for 1977–2017. Measures: Measures include utilization and expenditures (not charges) for inpatient, emergency department, outpatient physician, outpatient nonphysician, office-based physician, dental, and out-of-pocket retail prescription drugs. Results: We demonstrate that while health care expenditures have increased significantly overall and by type of care, utilization trends are less pronounced. The population of the United States grew 53% between 1977 and 2017, while annual total expenditures on health care increased by 208%. Amidst attention to out-of-pocket exposure for unexpected medical care bills, out-of-pocket payments for care have declined from 32% in 1977 to 12% in 2017 but increased in amount. Conclusions: This article provides the first extended snapshot of the dynamics of health care utilization and expenditures in the United States. Aspects of health care are much different today than in previous decades, yet the inpatient setting still dominates the expenditures.

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