Health Care Trends

PROLOGUE: As in life and art, perspective is of paramount importancein understanding the effects of public and private policy decisions,for patterns and relationships only emerge over time and whenviewed against the backdrop of events. However, in an age whereinformation changes hands at lightning speed and planning horizonsare becoming shorter, the long view often takes a back seat.But it is just this view that one needs in order to answer questionsthat are crucial to evaluating policy: What is working, whatisn’t? Who is doing better, who is doing worse?

It is in that spirit that we present the following five papers,which examine trends in various aspects of health care spendingand use and attitudes toward the health care system. In thelead paper Marc Berk and Alan Monheit update their previouswork on the distribution of health care spending and evaluatethe results in the context of managed care trends. Jim Lubitz,Linda Greenberg, Yelena Gorina, Lynne Hartman, and David Gibsonthen look at changes in health care use by the elderly sincethe inception of Medicare and find that this program may havehad unforeseen consequences for the health of the group it serves.Polling gurus Bob Blendon and John Benson explore data frommore than 100 opinion surveys spanning several decades and findperplexing dualities in Americans’ views of health careand those who provide it.

Jon Gabel, Paul Ginsburg, Jeremy Pickreign, and James Reschovskyexamine changes in out-of-pocket medical spending for insuredworkers, with some surprising results. Finally, Amy Bernstein,Esther Hing, Catharine Burt, and Margaret Hall wade throughdata from six surveys covering more than three decades, to examinechanges in health care use in an era of major changes in financingand delivery. Several other papers elsewhere in this volume—byAlan Monheit, Jessica Vistnes, and John Eisenberg; Samuel Zuvekas;and Lola Jean Kozak, Margaret Hall, and Maria Owings—exploretrends on more specific questions involving health insuranceand health care use.

Health Affairs gratefully acknowledges the Agency for HealthcareResearch and Quality for providing financial support for thisissue.

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