A recent report from the Centers for Medicare and Medicaid Services (CMS) found that healthcare spending reached $4.3 trillion in 2021. By 2030, CMS projects $6.8 trillion in spending. But still, why does simply going to the doctor cost you thousands of dollars? Why did health care costs get so high in America?
Costs rose as seniors required more treatment, salaries for doctors and nurses increased, and the high cost of drugs. Also, widespread chronic illnesses require regular care, bloated administration, and overhead. Plus, patients cover more out-of-pocket expenses, and people delay preventative care.
To clear things up, we’ll explore the major factors behind the meteoric rise in healthcare costs over recent decades. You’ll get to know about every major factor that is behind this price hike.
Healthcare in the United States
The majority of people in the United States have private health insurance to help pay for medical care. About 9 out of 10 Americans have some kind of health coverage. However, people in other wealthy nations often have nearly 100% coverage.
America’s healthcare system is complex, with costs mainly driven by the market. Factors that influence healthcare costs include very high and unchecked drug prices, and doctors’ and nurses’ salaries that are higher than in other countries.
In fact, hospital stays make up 31% of total healthcare spending nationwide. Billing and paperwork rules also add to what individuals pay.
There are many reasons why medical care and insurance premiums keep rising in the U.S. But even as workers’ pay has gone up over time, take-home salaries stay flat because more and more money goes to expensive health insurance. This shows one major effect of high healthcare costs for many Americans.
Top 8 Reasons for Expensive Health Care Costs
There’s no single reason for the steady climb in US healthcare spending. But some major trends play a role.
The Growing Senior Population
As the Baby Boomer generation ages, America’s 65+ population is ballooning. By 2030, 21% of all US residents will be seniors. And that share will reach nearly 25% by 2060, says the Census Bureau. This greying of America impacts medical costs in a few key ways.
For one, more seniors means more people on Medicare. Today over 65 million Americans get this federal health coverage for age 65 and up. With Boomers aging, Medicare enrollment will skyrocket further.
There’s also the issue of more complex and chronic diseases in old age. Per the National Council on Aging, 80% of seniors have at least one ongoing condition like diabetes or heart disease. And 77% have two or more. Caring for these lifelong illnesses often requires extensive, expensive treatment.
Between Medicare growth and aging’s health effects, analysts forecast national medical spending will climb over 7% yearly through 2028. Reasons why healthcare is so expensive include meeting the needs of this huge incoming wave of older patients.
Higher Pay for Doctors and Nurses
Salaries for American medical professionals exceed those in other wealthy nations. In 2022, the average US family physician earned $235,930 yearly. Emergency room doctors made $310,640. That far exceeds pay in places like Belgium ($202,131) and the Netherlands ($164,155).
Nurses here also make more on average than in most developed countries. At around $77,600 per year, American nurse pay is second only to Switzerland. It beats out Australia ($54,340), and Ireland ($49,504).
Private health plans try lowering costs by requiring approval to see pricey specialists. Having patients see nurse practitioners instead of family doctors can also save money.
Prescription Drug Costs
In 2019, Americans spent about $1,126 per person on prescription meds – more than twice what other wealthy nations spend. These costs could climb further as US prescription drug spending grows 6.1% yearly through 2027, projects CMS.
Pharma companies do invest heavily in developing innovative new drugs, especially for complex conditions. But with high research, marketing, and production expenses, patient costs also rise.
Plus, insurers need to weigh the benefits of costly new meds against affordability for patients.
Reasons for rising costs of healthcare like doctor and nurse salaries and prescription drug pricing contribute to why medical care in the US costs so much.
Hospital Stays Are Pricier in America
Healthcare cost issues like very expensive hospital stays contribute to the country’s soaring medical bills. Patients here pay far more for common surgeries and care than those in other developed nations.
Hospital care makes up 31% of total US healthcare costs – over $1.3 trillion in 2021. That figure even includes extra COVID relief funding. And prices for procedures remain exceedingly high here compared to other nations.
For instance, the average hip replacement runs $28,167 in America. The next price is New Zealand at $16,622. Plus, C-sections cost patients $11,326 on average in the US. The next highest is Switzerland at $7,948.
Managing Chronic Illnesses Drives Up Costs
Per the CDC, 6 in 10 American adults have some ongoing health condition. The most prevalent include —
- Heart disease
- Kidney disease
Using medical claims data, we can pinpoint diagnosis and comorbidity rates tied to these chronic diseases. This data provides insight into associated procedures, health impacts, and areas with a high volume of chronic patients.
Caring for chronic illnesses long-term is complicated and draining on resources. Besides, patients often need continuing medical care and help with daily living activities. Many also face anxiety, depression, and other mental health issues.
There is a major link between chronic disease and healthcare spending. The U.S. currently spends about $3.7 trillion yearly treating these persistent conditions and lost economic productivity.
Much of this goes to routine costs like doctor visits, prescriptions, outpatient therapies, and emergency care. As prevalence grows, so will the costs of managing chronic diseases.
High Administration Costs
Per a JAMA study, the US spent about $950 billion on healthcare administration in 2019 – making up 25% of total national medical spending that year.
Why so much? America’s multi-payer insurance system is complex, with many entities financing care. This tangled web of stakeholders causes inefficient administration processes.
Excess spending largely goes to billing and insurance-related (BIR) overhead. This includes claims filing, reconciling, payment processing, and related record-keeping.
Insurance profits make up the biggest share of BIR costs. But providers also receive some fees for admin work like notetaking during billing.
Per McKinsey and Company, automating and streamlining could cut administrative costs by 30%. Yet only around 15% of US hospitals currently use claims management software to help.
Patients Paying More of the Bill
Rising insurance premiums are just one piece of the puzzle. Americans now pay more out-of-pocket for medical care than in the past.
The shift toward high-deductible health plans (HDHPs) has added to costs for many families. These plans can require patients to pay up to $14,000 in care expenses before full coverage kicks in.
However, employer contributions can help offset HDHPs’ steep deductibles. One study found enrollees covered 20% of the total premium cost, versus about 27% for those with traditional plans.
Fear of Medical Bills Deters Care
Unpredictable medical bills have long kept some patients from seeking care. A 2019 Physicians Advocacy Institute survey showed people avoiding treatment due to worries over deductible costs under high-deductible plans.
The COVID pandemic exacerbated this “fear factor.” Delaying treatment leads to higher eventual costs, as untreated conditions worsen. One analysis found avoiding or postponing care during the pandemic led to an estimated $180 billion in added healthcare spending.
So concerns over out-of-pocket bills compound over time. Patients wind up needing more intensive, expensive care for preventable complications. This drives up costs for all involved.
Why did health care costs get so high? In essence, there are numerous interconnected reasons for the rapid growth in healthcare costs in the U.S. New medical treatments and prescription drugs continue to drive expenses higher each year.
In the meantime, executive pay contributes to bloat by increasing overheads. Likewise, common chronic conditions necessitate regular patient treatments and procedures. Seemingly, markets lacking pricing transparency enable hospitals and insurers to secretly negotiate rates.
A combination of advancing technologies, unhealthy lifestyles, and flawed policies led to runaway costs. To make healthcare affordable long-term, reforms need to address these varied factors thoroughly.
Frequently Asked Questions
How Much Does the Cost of Healthcare Rise Each Year?
According to the American Medical Association (AMA), healthcare costs are increasing by about 4.5% annually. Spending on healthcare in the United States went up 4.6% in 2019—to $3.8 trillion nationwide or $11,582 per person. This rate of growth is similar to 2018 (4.7%) and slightly faster than in 2017 (4.3%).
What Is the Cost of the Average Health Insurance Premium?
In 2022, the average yearly premium for health insurance was $7,911 for individuals and $22,463 for family coverage. These numbers vary widely depending on location, age, and type of plan. However, no matter what health insurance you have, you will likely see costs rise year after year.
What Type of Healthcare System Does the United States Have?
Healthcare in the United States is very complicated. Unlike many developed countries, it does not provide citizens with universal healthcare. Instead, the system is mixed. Some people have government-subsidized public plans, while others have private insurance through their employers.