2025年塑造健康经济的六大趋势

Introduction3 Trend 1:Price and Affordability12 Table ofContents Trend 2:Demographics and Lifestyle22 Trend 3:Neglecting the Fundamentals35 Trend 4:Fraud, Waste and Abuse53 Trend 5:Care Settings and Therapies72 Trend 6:Value for Money or Price Controls?89 Conclusion109 Methodology112 I N T R O D U C T I O N I N T R O D U C T I O N The Laws of Economics Necessitate Change in the Health Economy The inputs of the U.S. healthcare system vastly exceed its outputs, as measured by the health of the American public. And yet, over the next10 years, health expenditures are expected to continue to grow faster than the rest of the economy, projected to reach 20.3%ofGDP, or$24,200 per person, by 2033. The current trajectory of the U.S. healthcare system, one which increasingly depletes societal wealth withoutgenerating commensurate health gains, is unsustainable for patients, payers, employers and providers alike. The fact that thehealtheconomy continues to defy the laws of economics confirms that it is not a free market. This fifth installment of theTrends Shaping the Health Economy Reportprovides insight into six data-driven trends that are eitherintensifying or emerging. The Transparency in Coverage initiative promulgated by the Centers for Medicare and Medicaid Servicesmakesobviousthat the U.S. health economy finds itself at a crossroads; the choice for health economy stakeholders iswhether to implementradical and transformational change from the inside or whether to be subjected to such change by external forces, namely Federaland stategovernment. Said differently, the question for health economy stakeholders is this: do you want to make it happen or have ithappen to you? In either scenario, every health economy stakeholder will be required to deliver demonstrable value for money, rather than perpetuatinginefficiencies that compound systemic waste. To do so, stakeholders must be willing to reassess the very foundation of the U.S.healthcaresystem. Rather than thinking about what already exists, the fundamental question is this: what is essential? This report does not claim to provide all the answers, but it offers a framework for asking the right questions. What trendshave you notconsidered, and how will they impact the markets that your organization serves? What changes must your organization make to deliver morevalue for money relative to your current and future competitors? What changes are necessary for your organization to competeeffectivelyin a system that can no longer sustain the status quo? I N T R O D U C T I O N The U.S. Cannot Afford Its Healthcare System In 2023, U.S. healthcare spending reached $4.9T, or $14,570 per person, representing 17.6% of the nation’s GDP. Employersunderwrite the largest share of that spending, accounting for nearly $1.4T, or 30.0% of total NHE. How long can the U.S. allocatemore than $1T each to Medicare, Medicaid and interest on the Federal debt? I N T R O D U C T I O N The Most Expensive 10% of Patients Account for Two-Thirds of Spending U.S. healthcare spending follows the Pareto Principle, also known as the 80/20 rule, in which a small proportion of patientsare responsible for the majority of spending. Specifically, the most expensive 5% of the population is responsible for 49.7%of spending, while the least expensive 50% only accounts for 2.8% of spending, or $374 per person. I N T R O D U C T I O N The U.S. Healthcare System Delivers Poor Comparative Value In economics, value is a measure of the benefit provided by a good or service to an economic agent. By definition,spendingmore on healthcare with worse results is emblematic of poor value. Based on the comparative value of healthcare systems inpeer countries and the comparative effect of medical and non-medical factors on overall health, the reasonable personmust question the level of investment in the U.S. healthcare system. I N T R O D U C T I O N The Performance of the U.S. Healthcare System Is a Function of Its “Design” The U.S. healthcare system is peerless in its financial, administrative and regulatory complexity, characterized by abyzantine web of stakeholders that make the system inscrutable to the average American. Although the performance of theU.S. healthcare system has long been suboptimal, current macroeconomic conditions dictate a redesign. I N T R O D U C T I O N Demanding Value and Returning to First Principles Since World War II, the U.S. health economy has not operated as atrue market. For decades, the full extent of the pricing problemremained only partially understood because data on negotiatedcommercial rates were obfuscated by Federal antitrust restrictionsand contractual agreements. At the same time, employers–whofund nearly 30% of national health expenditures–have consistentlyfailed to demand value for money, opting to preserve the status quorather than pursue meaningful changes to benefit design.Theadvent of health plan price transparency removes thesehistorical ba