What is it about healthcare costs?

A key effort of the Forum on Healthcare Innovation is the Survey of Executive Sentiment in Healthcare. When organizing the conference, we realized that we had a unique opportunity to ask senior executives from across all sectors of the healthcare industry about their views on the cost and quality challenges facing the American healthcare system.

We did not ask these executives to report objective data—there are already many well-regarded sources for that information—but rather to provide their thoughts regarding the industry and opportunities to improve value within it. In particular, we asked the executives for their impressions of the current state and future trajectory of both quality and cost—the two underlying components of value in healthcare.

In terms of healthcare quality, respondents were somewhat evenly split. Twenty percent believe that quality in the United States is currently worse than and falling behind that of other industrialized nations, which is only slightly more than the 14% who believe that healthcare quality in the United States is currently better than and pulling ahead of other industrialized nations.

In contrast, when we asked respondents to think about the trajectory of quality and cost control together, we found that while 22% believe that quality is falling behind and healthcare costs are increasing more than general inflation, only 1% believe that quality is pulling ahead and healthcare costs are increasing less than general inflation.

This is quite surprising. Our cost question did not simply ask whether respondents felt healthcare costs would increase in the next five years—few expect healthcare costs to do anything other than increase in the near term. Rather, we asked whether the rate of healthcare cost growth would exceed growth in the cost of other things, such as general inflation.

While our respondents were somewhat evenly divided in their opinions about quality alone, they were significantly more negative when we asked them to consider the potential for controlling cost growth. This leads us to wonder: realizing that current healthcare costs in the United States are high, what has caused so many within the industry to feel that healthcare costs will continue to grow faster than the costs of other goods? What is it about healthcare that makes it predisposed not just to high costs, but also to high cost growth?