Assessing the value of modern US healthcare gains

Over two decades, medical care improvements increased health spans in the U.S. by 1.3 years and medical spending by $234,000 per person over their lifetime – or about $182,000 per additional healthy year of life gained – when measured from birth. These are among the key findings in a new in-depth national study published today in Value in Health.

Researchers examined how improvements in medical care changed health-adjusted life expectancy (HALE) and lifetime health care spending by evaluating changes in 132 causes of disease across all ages between 1996 and 2016. The analysis is the most comprehensive assessment of what Americans received in return for rising medical costs.

These findings highlight that the problem is not simply how much the nation spends on health care, but where those dollars go and what they achieve."

Marcia Weaver, PhD, Study Senior Author and Research Professor, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington 

Bolstering health care resources for roughly 60% of the conditions, including ischemic heart disease, stroke, and HIV/AIDS, produced substantial health gains at relatively modest costs. For example, better medications, devices, and emergency care for ischemic heart disease added a quarter of a healthy year averaged over all Americans at a cost of about $63,000 per healthy year gained. Additionally, HIV/AIDS treatments produced one of the largest increases in survival and quality of life at very low spending of $9,300 per healthy year gained, making them a cost-effective investment in U.S. health care.

The most favorable results occurred when HALE increased and lifetime spending decreased, which was true for 19 causes (14%), including breast cancer. These cost-saving advances in screening and treatment increased people's health span while reducing lifetime costs, reflecting shifts toward less invasive and more effective care.

In contrast, HALE and lifetime spending decreased for seven causes (5%) such as alcohol use disorders. HALE decreased for 26 causes (20%) as lifetime spending increased, which was the case for chronic kidney disease and drug use disorders. In fact, drug use disorders substantially worsened the overall value of U.S. health care during the study period.

"Disease-level spending estimates provide a foundation for identifying patterns in health care spending and understanding how those patterns relate to health outcomes," said co-author Abe Dunn, PhD, Assistant Chief Economist at the United States Bureau of Economic Analysis.

For many diseases, spending increased early in life, while health improved years or decades later. When researchers recalculated the value of health care starting at age 65, the cost per healthy year gained dropped to about $92,000, about half the estimate of $182,000 when calculated from birth. Measuring spending over a lifetime highlights how early investments in prevention and treatment can pay off later, especially for chronic diseases like diabetes and heart disease.

The results suggest that efforts to control health care costs should focus less on across-the-board spending cuts and more on improving access to care for conditions and interventions that deliver meaningful health improvements. Research and innovation are needed for conditions that drive high costs without improving health.

"Better alignment of spending with health outcomes could significantly improve the overall value of U.S. health care, ultimately saving lives, improving quality of life, and making more effective use of limited resources," added Prof. Weaver.