The distribution of healthcare expenditures is highly concentrated, yet most Americans use few healthcare resources and have low out-of-pocket spending, according to a new Health Affairs analysis. What's more, this low spending has remained almost unchanged for the better part of four decades.
In examining the data and dividing the population into two halves -- the top half, or biggest spenders, and the bottom half -- researchers found that the ongoing level of expenditures incurred by the bottom half of the population stayed within a remarkably narrow range from 1977 to 2014, never dipping to less than 2.7 percent of total health expenditures or climbing higher than 3.5 percent.
That low rate of expenditures for the bottom half may even predate the implementation of the Medicare and Medicaid programs, the analysis found. In 1963, the bottom half collectively accounted for 5 percent of expenditures.
The data reinforces the complexity of the questions surrounding resource distribution, the authors said. It also could affect the long-term viability of the Affordable Care Act, or any alternatives that may be offered by the Trump administration. If insurance coverage of the low spenders declines, insurers' ability to offer affordable coverage to high spenders with greater need will also decline.
Broken down demographically, about 31 percent of the low spenders were younger than age 18 as of 2014, compared to about 16 percent of high spenders. Five percent of low spenders were 65 or older, compared to about 25 percent of high spenders.
Low spenders believe they're healthy, generally. In 2014 only 5 percent of them reported being in "fair" or "poor" health, compared to about 17 percent of high spenders.
While nearly one in three low spenders did not have a usual source of care, fewer than 7 percent reported lacking immediate access to care, meaning they either couldn't get the care they needed or had to delay getting it. In contrast, high spenders were more than twice as likely to report difficulty with immediate access to care. And more than 21 percent of the very highest spenders, those in the top 1 percent, reported having a problem with immediate access.
The authors caution that, despite the numbers, policymakers should still be concerned about healthcare access and the equitable distribution of resources for low spenders. The 6.5 percent of the low-expenditure population expressing concerns about access translated into about 10.4 million people.
The development of any new initiatives, they said, will require an understanding of healthy people with low expenditures and low demand for healthcare.