US health care. II: The cost problem.

Abstract

The third and final part in this series will appear in next week 's issue. Part I appeared last week Last week we examined access to health care in the United States and how it has changed in recent years. This paper looks at the costs of American health care and the impact of important cost containment strategies. Health care spending has risen faster in the United States than in any other member nation of the Organisation for Economic Cooperation and Develop? ment (see figure). During 1970 to 1990 the rise was almost 12% a year.1 In 1990 the United States spent a staggering $666-2 billion or 12-4% of its gross domestic product on health care?$2566 per head of popula? tion.2 Concern is mounting because costs are digging deeper into the pockets of those who foot the health care bill?mainly businesses, the government, and the public?all of which have been hard hit by the recession and current slow economic growth. Meanwhile almost 36 million people have no health insurance at all,3 many going without even basic care. Most agree that any reform of health care in the United States must include serious cost containment measures if the paradox of excess and deprivation4 is to be addressed. This article examines why the costs of health care have risen, their effects, and the efforts to contain costs in relation to four groups of Americans?those with no health insurance, those with government funded health insurance through Medicare (the health pro? gramme for the elderly) and through Medicaid (the health programme for the poor), and those with private health insurance.