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It’s no secret that everything is increasingly expensive, including healthcare. In FACT, spending for healthcare goods, services, insurance, and investments increased 2.7 percent between 2020 and 2021. Meanwhile, hospital costs increased by 4.4 percent while the cost of prescription medications increased by 7.8 percent.
For those with chronic health conditions, healthcare costs are becoming insurmountable. In 2023, healthcare coverage for an individual with a chronic health condition cost an average of $6,032 annually. Those with chronic health conditions are often faced with difficult decisions regarding their finances. Do they pay rent, the utility bill, or manage a health condition?
To understand how these costs can be managed, let’s look at the top conditions driving healthcare costs.
Which Conditions Drive Increased Healthcare Costs?
According to the Centers for Disease Control and Prevention (CDC), six out of 10 U.S. adults have a chronic condition, and four out of 10 U.S. adults have two or more chronic conditions– those that last at least one year, require ongoing medical care, and limit activities of daily living.
Approximately 90 percent of healthcare spending in the U.S. is for those with mental health and chronic conditions. Some of the top conditions contributing to excessive healthcare costs in the U.S. include diabetes, heart disease, cancer, obesity, arthritis, and Alzheimer’s disease. Many of these conditions are caused by risky behaviors such as excessive use of alcohol, tobacco use, physical inactivity, and poor nutrition.
Healthcare Spending: Where Is the Money Going and Who Pays the Bill?
In 2021, most healthcare spending (31.1 percent) was for hospital care, whereas 14.9 percent was for physician services, such as office visits and therapeutic and diagnostic services.
Other categories—including clinical services, prescriptions, nursing care, home health care, personal health care, government administrative costs for insuring those in health insurance programs, health insurance, public health activities, and investment spending—make up the rest of the expenditure.
Who's paying these bills?
- 28.5% - private health insurance
- 21.2% - Medicare
- 17.2% - Medicaid
- 10.2% - Out of pocket
Investments, third-party payers and other health insurance programs, federal programs, government and public health efforts cover the rest.
Why Are Healthcare Costs So High?
Several factors contribute to rising Healthcare costs, One of the primary drivers is health insurance, which typically has a deductible in addition to the premium and co-pay.
How much a patient pays for each of these is determined by their plan type. However, people tend to stick with what they know. Quite often, enrolled members keep the same insurance coverage they've had for several years instead of evaluating new options to see if their current plan is still the best choice for their family’s health needs. Unfortunately, many may not realize that sticking with the plan they know could potentially cost them more through a higher deductible and increased out-of-pocket costs.
In addition to increased out-of-pocket costs, specialist appointments and prescription medications also contribute to a significant amount of healthcare spending. For example, medical care equipment may not be covered by insurance; and chronic conditions may lead to other conditions, such as eye problems stemming from diabetes.
How Healthcare Navigation Solutions Can Help
Healthcare quality and cost navigation solutions are essential to help patients and employers save money on healthcare costs. For example, Healthcare Bluebook’s suite of navigation solutions includes Bluebook CareConnect™ and Bluebook Rx™, which can reduce costs for complex procedures and prescriptions.
Bluebook CareConnect assists members through a member concierge who helps them find high-quality care at a Fair Price™. Having a concierge to assist with scheduling appointments, transferring medical records, and following up throughout the care journey ensures members receive the highest value for their health needs.
For people with chronic health conditions, prescription drug costs may be insurmountable. According to a Gallup survey, approximately 7 percent of U.S. adults, or 18 million people, were unable to afford at least one prescription in June 2021. For those with three or more chronic conditions, this number climbs to 11 percent, and 18 percent for those with eight or more prescriptions.
Reducing prescription costs and healthcare costs is critical to relieving the financial burden on these patients and helping them afford the care they need. Implementing a pharmacy savings program is one of the most effective ways to reduce prescription spending. Bluebook Rx reviews claims data to determine where overpriced prescriptions are being used and then sends a personalized savings report with recommendations for lower-cost alternatives. Bluebook makes it easy for members to see where and how they can save money on their medical and Rx needs by providing access to both navigation solutions in one intuitive platform.
Reduce Costs of Health Conditions that Increase Your Medical Spend
Investing in a healthcare navigation solution can help your members and organization save money associated with the top health conditions that drive up spending. Discover how to choose your organization’s healthcare navigation tool with our resource, How to Choose a Healthcare Navigation Solution That's Right for Your Organization.
