1. Peterson-Kaiser Health System Tracker What is behind the recent slowdown in health spending?

2. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group U.S. health care spending per capita has risen at historically low rates in recent years Average annual growth rate of health spending per capita for 1970’s – 1990’s; Annual change in actual health spending 2000 – 2013 and projected (2014 – 2023)

3. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health expenditure and financing: Health expenditure indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on June 25, 2014). Notes: Data unavailable for: Australia and the Netherlands in 2012; France from 1981 through 1984 and 1986 through 1989; and Germany in 1991. OECD reports a break in series for: Belgium in 2003; Canada in 1975 ; France in 2003; and the Netherlands in 2005. Canada and Switzerland data are reported as estimated values for 2012. Health spending growth has slowed in the U.S. and in comparable countries Average annual growth rate in total health expenditures per capita, U.S. dollars, PPP adjusted

4. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation Analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group Low growth rates have persisted for five years, sparking researchers to look for the causes Annual change in U.S. per capita health spending 2000 – 2013

5. Exhibit 4 Peterson-Kaiser Health System Tracker Changes in insurance –Higher deductibles and cost sharing –Shifts from employer-sponsored coverage to lower-paying public coverage and in uninsurance Changes in Medicare and Medicaid payment policies and limits on provider reimbursements Slower diffusion of new medical technology, as examples: –Few new high-cost prescription drugs, combined with existing brands moving to generic status –Slowing use of advanced imaging and expensive heart procedures Increased efficiency of health care providers What types of structural changes in the health care system may be contributing to the slowdown?

6. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of mandatory Medicare outlays and Medicare enrollment data from CBO Medicare baseline projections, 2010- 2014: https://kaiserfamilyfoundation.files.wordpress.com/2014/07/medicare-spending-figure-1.png Notes: Grey lines represent 2011 – 2013 baseline projections.https://kaiserfamilyfoundation.files.wordpress.com/2014/07/medicare-spending-figure-1.png Medicare spending slowed for different reasons than private spending CBO projections of Mandatory outlays per Medicare beneficiary, predicted based on baseline year

7. Peterson-Kaiser Health System Tracker Source: Kaiser Family Foundation analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group An annual percentage point difference in growth rates makes a very large difference in spending over time Projected annual change in U.S. per capita health spending 2014 – 2023, alternative scenarios