Radiology contributes less than expected to national health expenditure
Conclusions “conflicting statements” on the role of imaging in the increase of NHE
After adjusting dollar values for inflation and calculating price elasticity of supply and compound annual growth rates (CAGR), corresponding author Keval Parikh MD, MHA and colleagues found:
- Throughout the 10-year period analyzed, imaging services represented a minor fraction of Medicare Part B (7%) and NHE (0.28%). The authors note that these numbers are consistent with previous analysis.
- While the NHE, Global Medicare and Global Part B had positive growth rates in total spending, Imaging did not.
- Imaging had the most negative CAGR of all other categories, including drugs, procedures, O&M, and durable medical equipment.
These findings and others the team found “contradict claims that medical services and imaging are a significant contributory factor to spending growth and the disproportionate amount the United States spends on health care per compared to other countries,” comment Parikh and his co-authors in their discussion. .
They cite a 2018 Harvard study showing that, from 2013 to 2016, the United States had a comparable number of hospital beds (2.8 per 1,000) but higher use of MRI (118 per 1 000) and computed tomography (245 per 1000) compared to other countries. .
The authors also note that CMS’s latest update to advance Medicare Part B budget neutrality “proposed an increase in reimbursement in one of the categories (e.g., E&M), which was offset by a decrease in other categories, including imagery”.
Regarding utilization per se, Parikh and colleagues suggest that growth discrepancies may be due to the negative and relative inelasticity of imaging services.
“The negative elasticity of supply indicates that there is an inverse relationship between volume and price,” they write, adding that it “could indicate that suppliers increased volume to recoup lost revenue, a phenomenon called behavioral compensation or volume response”.