The Council of Economic Advisers, whose members write the president’s report, surmise that structural changes – including stronger incentives for efficiency by hospitals and providers, more cost-sharing in insurance policies, and the substitution of generic drugs for branded drugs – explain most of the deceleration in per capita spending growth. They also suggest that payment reforms contributed to the slowdown in Medicare’s spending growth after 2001, and that early responses to new Medicare regulations in the Affordable Care Act may have caused a further decline after 2010.
这并出人意料，因为医疗保险覆盖者——退休人员中的大部分比工作年龄人口更能抵御宏观经波动。经济顾问委员会——总统经济报告由其成员撰写——推测，结构性变化，包括医院和供应方效率激励的增强、保险合同分担部分的增加以及用非专利药物代替专利药物，解释了大部分人均支出增长的放缓。他们还认为，支付改革是2001年后医疗保险支出增长减速的原因，而针对平价医疗法中的医疗保险监管的最初反应可能导致了2010年后的进一步减速。