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Of the $3.36 trillion dollars spent on healthcare, more than 32% was spent on care in hospitals, according to an article in Axios (https://www.axios.com/national-health-spending-slowed-down-…): “Roughly 27% was spent on physicians and other providers, and 10% was spent on prescription drugs. (This shows that even though drug prices continue to ignite anger nationwide, a lot more money is spent on hospitals and doctors.)” And as mentioned in Health Affairs (http://content.healthaffairs.org/content/36/3/553), healthcare spending rose 4.8% from 2015 through 2016, slower than previous years, but more than twice the 2.1% general U.S. inflation rate. The U.S. healthcare expenditure is expected to consume 20% of the economy by 2025.

However, Axios also reports, this time in a summary of research from Altarum”s Center for Sustainable Health Spending (https://altarum.org/…/…/CSHS-Spending-Brief_October_2017.pdf), that spending patterns are changing. High deductible insurance plans with larger copayments have made a mockery of the idea that having insurance is the same as having coverage. Unaffordable extra costs throw cash-strapped patients back into yesterday’s paradigm: go to the emergency room, be treated and figure out payment later, if ever. That may lead to bad debt for the hospital or perhaps the patient will be enrolled in a Medicaid program. Countrywide, this has driven the trend toward outpatient care and more clinic and physician office exposure.

President Trump’s announced regulatory changes–to end cost-sharing subsidies to insurers under Obamacare–will do little to reduce uncertainty about coverage. Thus one would expect continued downward pressure on hospital admissions. We could be in for several years of Congressional dawdling and electoral strife before resolving even the model of coverage. And finally, physician shortages bring ever-longer waiting times.

What this means locally:

Patient visits will increase for the hospital network with the most primary care capacity–in this region, Parkview has perhaps double the capacity of Lutheran.

Parkview Randalia is Fort Wayne’s busiest ER, something of an unexpected outcome of Parkview’s investment in growth that will drive more Parkview hospital volume. Already at Parkview Randalia, once considered for closure, bed capacity has grown from 50 to nearly 150. Perhaps the old Fairfield site of Lutheran Hospital, now empty, is a consideration for an inner-city site.
New methods of healthcare access will be spurred by the overload on outpatient facilities. Concierge care contracts are well established in large urban areas, but they will likely gain traction in Fort Wayne through such new offerings that guarantee rapid access to physician visits, such as Direct Care on Getz Road.

As to the 10% of spending on prescription drugs, the current emphasis on using generic drugs or alternatives to expensive drugs will cause increased burdens on physicians to “pre-certify” the prescriptions they have written, requiring a phone call to insurers. The process of filling a new prescription will grow from minutes to days for many patients.

The attached graph from Axios and Altarum (https://www.axios.com/health-care-spending-2495578207.html) shows the relative trends in spending.