Slower Price Growth, Modest Utilization Increases Drove Slowdown In US Health Care Spending Growth, 2014–19 Authors: Nikhil R. Sahni nikhil.sahni@gmail.com, Vishnu Murale, Heather Bello Thornhill, and David M. Cutler

https://www.healthaffairs.org/doi/10.1377/hlthaff.2026.00207 US health care spending growth has long outpaced economic growth. However, during the period 2014–19 (before the COVID-19 pandemic), growth in per capita health care spending relative to per capita gross domestic product growth fell by 21 percent compared with 2007–14. We examined spending growth domestically and internationally to determine the causes of this slowdown. We decomposed spending growth by source of funds, compared four drivers of growth over time within the US and relative to fifteen Organization for Economic Cooperation and Development countries, and conducted a US-specific breakdown of utilization. We found that declining growth in health care prices and utilization were major drivers of the slowdown of health care spending. Slower growth did not appear to have been driven by across-the-board reductions in disease burden and input costs, although certain metrics fell. Utilization reduction was a major driver through technology allowing the use of alternative sites of care; greater use of preventive care that reduces costs; ongoing expansion of Medicare Advantage, managed Medicaid, and high-deductible health plans; and increased utilization management. This slowdown suggests the need to monitor trends more closely for signs of additional major shifts in spending growth.