Reversing a long-term trend, the wealthiest 20 percent of the American population —generally the healthiest income group — now account for more healthcare spending per capita than middle and low income groups, according to a Harvard study published in the July issue of Health Affairs.
"An increasing share of medical resources is being devoted to people with the least medical need," the study authors wrote. Their findings indicate there could be a widening disparity in healthcare access.
In examining the overall deceleration of medical spending growth between 2004 and 2013 — which has been attributed to the Great Recession, rising copayments and deductibles, improved quality and a decrease in cost for medical innovations — the researchers chose to zero in on how different income levels have slowed spending. To do this, they analyzed data from 22 nationally representative surveys of health expenditures and corresponding demographic information. They looked into mean per capita health spending for each income quintile and other income-related trends.
The researchers found health expenditures for the poorest Americans grew more rapidly than for any other income group between 1963 and 1987. As of 1977 the poorest income group's healthcare expenditures per capita were 23 percent greater than all other Americans, according to the report. However, these expenditures fell 3.7 percent annually between 2004 and 2012, while expenditures for the wealthiest Americans rose almost 20 percent in the eight-year period. Middle class Americans' per capita healthcare expenditures grew moderately — a total of 12.5 percent over the study period.
Shifts in health status cannot explain this trend, but age plays a role, according to the study. When comparing by age, the researchers found older Americans in every income group had flat expenditure growth, and the poorest elderly Americans still had the highest expenditures. Among younger Americans, healthcare spending grew rapidly among top earners, a moderate amount among the middle class and the least among the poorest group.
The findings show healthcare spending has slowed because poor and middle-income Americans have cut back on healthcare consumption. This pattern echoes that of consumption trends of other goods, the authors wrote, and could indicate need is no longer the primary motivating factor for people to seek healthcare services. "We fear that it might presage deepening disparities in health outcomes," the authors wrote.
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