I was struck by two articles this week about healthcare expenditures and costs. The first, in this week’s Health Affairs, details the various trends and components for measuring our nation’s healthcare expenditures. The authors attribute the slower growth to several factors, including the sluggish economy and greater out-of-pocket expenses for those covered by commercial insurers. The growth in national health spending was 3.9% in 2012 and an estimate of less than 4% in 2013. The projected rate for 2014 and 2015 is about 6% based on the anticipated expansion of health insurance under the Affordable Care Act and increased Medicaid spending. Beyond 2015, the estimated growth in healthcare spending may level off or drop slightly for a few years only to increase again as more baby boomers enroll in Medicare.

The next was a report from the U.S. Department of Health and Human Services about the Health Insurance Marketplaces, also known as the Exchange. Nationally, the Marketplaces seem to have effectively provided individuals with more choices in insurance and lower premiums. Individuals nationally will have a choice of two or more insurers and an average of 53 qualified health plans. Premiums before tax credits are 16% lower than initially projected. Not surprisingly, rates are lower in states where there is more transparency and competition. Unfortunately, in New Hampshire we only have one insurer with 11 options in our Marketplace and we are not seeing the benefit of transparency and competition in the insurance market … yet.

Perhaps with lower expenditures, lower insurance rates and focusing on improving the quality of care, we can start to bend the cost curve.

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