For 2014, PwC’s Health Research Institute (HRI) projects a medical cost trend of 6.5%. This is a full percentage point lower than last year’s projection. What is driving this slowing growth rate? First is the increase in average deductibles. In-network deductibles have increased from $680 in 2009 to $1230 in 2013; out-of-network deductibles have increased from $1000 in 2009 to $2110 in 2013. However, PwC describes other factors that will influence health spending trends in the future.
Four factors deflate medical cost trend in 2014
- Care continues to move outside costly settings such as hospitals to more affordable retail clinics and mobile health. Consumers value the convenience, and costs can be as little as one-third of the bill in a traditional healthcare site.
- Major employers such as Walmart, Boeing, and Lowe’s now contract directly with big-name health systems for costly, complicated procedures such as heart surgery and spinal fusion. The employers are making the move to “high performance networks” far away from the home office in the belief that even with travel costs, these networks still deliver overall savings.
- The federal government’s new readmission penalties take direct aim at waste in the health system, estimated to be as high as 30%. According to government data, hospital readmissions dropped by nearly 70,000 in 2012, and this trend is expected to accelerate through 2014 as hospitals focus on discharge planning, compliance and the continuum of care.
- Seventeen percent of employers in PwC’s 2013 Touchstone survey today offer a high deductible health plan as the only option for employees. And more than 44% are considering offering it as the only option. When consumers pay more for their healthcare, they often make more cost-conscious choices.
Two factors inflate medical cost trend in 2014
- Until recently, widespread adoption of generic medicines helped dampen overall medical inflation, but the rise of expensive complex biologics will nudge spending trends upward. Approvals of new biologics now outpace traditional therapies, and that pattern will continue in 2014 as research efforts target complex cases such as cancer.
- Health industry consolidation has increased more than 50% since 2009—activity that is expected to continue through 2014. Higher prices are sure to follow in some markets. According to a recent report, hospital
- mergers can lead to price increases of up to 20.3% These price increases are especially acute in markets with one dominant system.