What Is Bending the Cost Curve? An Exploration of Possible Drivers and Unintended Consequences

Health expenditures in most OECD countries have increased at a slower rate since 2008/2009. Potential drivers of this bending of the cost curve include: (1) changes in pharmaceuticals and technology innovations; (2) healthcare reforms, and specifically those focusing on care for complex and high-user patients and (3) government expenditure controls resulting from general economic conditions. We use publicly available National Health Expenditure data from the Canadian Institute for Health Information to assess the merits of each of these drivers, with a focus on British Columbia. We find some evidence for the effects of changes in pharmaceuticals and technology, but the dominant effect is government spending controls, which are greatest for non-Medicare-covered services. These changes suggest potential unintended consequences on access and equity that should be understood before declaring victory for healthcare expenditure control.