Working Paper: NBER ID: w21501
Authors: Alice Chen; Dana Goldman
Abstract: Over the last five decades, broad changes in the US health care system have dramatically influenced growth in health care expenditures. These structural changes have also influenced the trajectory of the health economics research. This paper reviews some of the seminal health economics papers (measured by citations) and identifies the salient factors driving the growth of medical expenditures. We find that the research identified – and was strongly influenced by – four eras of expenditure growth: (1) coverage expansion; (2) experimentation with financial incentives; (3) the managed care backlash; and (4) a golden era of declining expenditure growth. We conclude by discussing some themes from this research suggesting optimism that, going forward, we can curb excess expenditure growth above GDP growth without harming population health.
Keywords: No keywords provided
JEL Codes: I1; I11; I12; I13; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Increased access to care (I11) | Increase in health expenditures (H51) |
| Technological innovations in medical care (O39) | Increase in health expenditures (H51) |
| Policy experimentation with financial incentives (C93) | Fluctuations in health expenditure growth rates (H51) |
| Backlash against managed care (I13) | Increase in health expenditures (H51) |
| Expansion of health insurance coverage (I13) | Increase in health expenditures (H51) |
| Reduced patient cost-sharing (G52) | Increase in health expenditures (H51) |