In 1960, US health care expenditures totaled slightly more than $100 per person and 5% of the gross domestic product (GDP). Now in 2012, individual health care expenditures are more than $8000 per year and the proportion of the GDP spent on health care is more than 17%. Health care costs are widely believed to contribute to the economic challenges faced by the public and private sectors of the US economy. Calls to bend the health care cost curve have become headline news.
Prior approaches to slowing the growth in US health care costs have had limited success. The use of cost-benefit analyses to make coverage or clinical decisions has proven socially and politically unacceptable in the United States. Managed care temporarily slowed cost increases in health care but the public backlash against restriction of choice undermined its potential long-term effects. Similarly, the unwillingness to include economic outcomes in the current investment in comparative effectiveness research will limit its effects on health care costs.1 New approaches are needed.
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