Home Health Care Spending Rose Modestly in 2016

House Speaker Paul Ryan of Wis. speaks after House Republicans held a closed-door strategy session on Capitol Hill in Washington

In 2014 and 2015, spending increased 5.1 percent and 5.8 percent, respectively, as the ACA provided subsidies to help people get private coverage and most states expanded Medicaid. Another factor was a slowdown in the growth of spending on insulin, a lifesaving drug for people with diabetes, in Medicare. There was a historic slowdown in growth due to the Great Recession, and then the Affordable Care Act's expansion of health insurance coverage fueled spending. The rate of spending growth in 2016 was more in line with the average annual rate of 4.2 percent during the period 2008-15, according to the CMS actuaries' analysis.

But out-of-pocket spending, or spending directly by individuals instead of by their insurance plans or programs, grew at a faster rate than in recent years. Changes in the age and gender mix of the population accounted for 0.6 percentage point of the growth in per capita health spending. Hospital spendingHospital spending increased 4.7%, reaching $1.1 trillion, and represented 32% of overall healthcare spending. Despite the slower growth in 2016, healthcare spending still increased faster than the GDP growth rate. In 2015, spending for the sector accelerated 5.8%.

Together, Medicare and Medicaid made up 77% of home health spending in 2016.

The 8.2% spending growth for clinical services almost doubled the 4.6% growth in spending for physician services for the twelfth consecutive year. The growth in clinical services spending was driven primarily by continued strong growth in spending for freestanding ambulatory surgical and emergency centers. Following 5.1 percent growth in 2014 and 5.8 percent growth in 2015, health spending in 2016 slowed to 4.3 percent.

The report concludes that the 2016 expenditure slowdown was broadly based as growth for all major payers (private health insurance, Medicare, and Medicaid) and goods and service categories (hospitals, physician and clinical services, and retail prescription drugs) slowed in 2016, according to CMS actuaries.

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Healthcare spending growth in 2016 actually fell below what CMS actuaries projected previous year. Medicaid spending also decelerated in growth compared to previous years, increasing 3.9% to $565.5 billion.

Every US resident spent, on average, $10,348 a year ago on health care. Slower growth was due to a leveling in the number of people gaining health coverage past year, according to the researchers. On a per enrollee basis, private health insurance spending increased 5.1% in 2016, about the same as 2015. Overall, Medicare expenditures hit $672.1 billion in 2016.

The fraction of uninsured Americans fell 2.8%, from 29.5 million in 2015 to 28.6 million in 2016, a stark slowdown from 2014 and 2015 where the number fell by more than 17% both years.

Experts disagree about the extent to which cost-containment elements of the Affordable Care Act also contributed to the less-rapid spending growth and about whether larger structural changes are occurring in the health care system that led to less growth. Last year, on a per enrollee basis, Medicaid spending increased 0.9%, down from 4.5% in 2015, which reflects increased efforts by states to control costs, a decline in supplemental payments to hospitals, and a decrease in per enrollee costs for newly eligible adults. Overall use and intensity of services was 2.3%, lower than the increase of 3.4% in 2015, due to the effects of the ACA.

Spending on retail prescription drugs grew by only 1.3 percent, to $328.6 billion, in 2016.

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