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Health Care Cost and Access Challenges Persist Across the Country
Rising Costs, Declining Coverage, Widening Access Inequalities Unchecked
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Two years ago, HSC researchers identified several troubling trends warning of growing cost and access problems, including a hospital building boom; intense competition among hospitals and physicians to expand profitable specialty services; growing stress on community safety nets; and few cost-control strategies on the part of employers and health plans.
For the most part, those trends continued into 2007, although employers and health plans have stepped up efforts to engage consumers and the hospital building boom appears to have abated somewhat, according to the study. Nonetheless, already-planned expansions of medical-surgical capacity, especially in profitable specialties and in affluent suburbs with well-insured populations, continue to come on line. Competition among hospitals and between hospitals and physicians for profitable service lines, such as cardiac and orthopedic care, remains intense in most markets, raising concerns about increased use of health care services and rising costs.
To help curb rising costs, employers and health plans are looking to consumers to take more responsibility for medical costs, lifestyle choices and treatment decisions, the study found. While consumer-directed health planshigh-deductible plans with a tax-preferred savings accounthave not gained widespread adoption, other developmentsincluding a heightened emphasis on prevention and wellness, along with nascent provider cost and quality informationare advancing health care consumerism.
"Its an open question whether the heightened focus on consumer engagement can slow cost growth enough to keep care affordable or whether the growing problem of affordability will derail efforts to decrease the rising number of uninsured Americans and stymie meaningful health care reform," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded primarily by The Robert Wood Johnson Foundation.
"The emphasis on prevention and wellness activities, along with growing availability of provider cost and quality information, arguably was the most striking development observed across the 12 communities in 2007," said Debra A. Draper, Ph.D., HSC director of site visits. "But whether the so-called health care consumerism movement can produce resultsimproved health and cost savingsremains to be seen."
The studys findings are detailed in a new HSC Issue BriefHealth Care Cost and Access Challenges Persist: Initial Findings from HSCs 2007 Site Visitsby Draper and Ginsburg. The Issue Brief is available here.
Every two years, HSC researchers visit 12 nationally representative metropolitan communities, conducting interviews with local health care leaders, including health plans, providers, policy makers, employers and consumer advocates. The 12 communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.
Other key initial findings from the 2007 HSC site visits include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.