Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

"Stabilizing health spending and targeting it in ways that ensure access to care and improve health outcomes would free up billions of dollars annually for critically needed economic and social investments."

Executive Summary

Health spending as a share of U.S. gross domestic product (GDP) has climbed steadily over the past half-century. Today, it constitutes 18 percent of GDP, up from 14 percent in 2000 and 5 percent in 1960, and we are well on our way to 21 percent by 2023, based on current projections. This increased dedication of economic resources to the health sector, however, is not yielding commensurate value in terms of improving population health or patients’ experiences with care.

In this report, The Commonwealth Fund Commission on a High Performance Health System endorses the goal of holding future growth in total health spending to a rate no greater than that of long-term growth in GDP, while simultaneously moving toward a high performance health care system. This is an ambitious goal, to be sure, particularly given our aging population and the commitment to access for all. But with such a high proportion of our economic resources already devoted to health care, and with abundant evidence that we can do better, such a target should be achievable. It is also a key to enabling broader economic growth and a more affordable health care system for businesses, families, and federal, state, and local governments.

To show how future health spending growth could be held to a national target and stabilized while moving toward a high performance health care system, this report lays out a synergistic strategy relying on three broad thrusts that slow growth in national spending by a cumulative $2 trillion through 2023:

  • Provider payment reforms to promote value and accelerate health care delivery system innovation.
  • Policies to expand options and encourage high-value choices by consumers armed with better information about the quality and cost of care.
  • Systemwide action to improve how health care markets function, including reducing administrative costs and setting national and regional targets for spending growth


PDF icon Full report (PDF)1.72 MB
PDF icon Executive Summary (PDF)457.53 KB
PDF icon Chartpack (PDF)186.46 KB
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