普华永道：2027医疗成本趋势报告：五大上涨驱动因素与控费约束分析（2026）（英文版）（60页）.pdf

1、Five forces.Few brakes.What 2027 means for healthcare costsMedical cost trend:Behind the numbers 202701 Heart of the matter 0302 Inflator1:AI-enabledrevenueoptimizationincreases documentationandcodingintensity0903 Inflator2:Providerreimbursementpressureremainselevated1404 Inflator3:Pharmacypressurer

2、emainsbroad,durable,andhighcost2005 Inflator4:Behavioralhealthcontinuestooutpacebroadermedicaltrend2606 Inflator5:Provider-favorableIDRoutcomesaresustaining out-of-networkpressure3007 Deflator:Plansshouldprioritizecost-of-careleversbasedon realizablevalueandspeedtoimpact3508 IndividualACAmarketsubsi

3、dyexpirationreshaped the2026marketbaseline4509 Trendstowatch4910 Finalthoughts54Aboutthisresearch55Acknowledgments56Endnotes57Table of contentsMedical cost trend:Behind the numbers 20273PwC2025202420232022202120202019201820172016201520142013201220112010200920082027 20269.9%9.2%9.0%9.0%8.5%7.5%6.5%6.

4、8%6.2%5.5%5.7%5.7%6.0%7.0%8.0%8.5%8.5%9.0%5.5%9.0%6.5%7.5%8.5%7.5%8.5%GroupIndividualHeart of the matterFivepowerfulinflatorsrisetothetopindrivingmedicalcosttrendheadinginto2027,withfewmeaningfuldeflatorsinsight.AI-enabledbillingtoolsarehelpingproviderscapturemorerevenueperencounter.Reimbursementrat

5、esareincreasinglydrivenbyinflationandpressurefromcontinuedconsolidationofprovidersandphysicians.PharmacycostsareincreasingashighercostspecialtyandGLP-1therapiesgainbroaderutilization.Behavioralhealthutilizationcontinuestoincrease.TheunintendedconsequencesofthearbitrationprocessoftheNoSurprisesAct(NS

6、A)areincreasingout-of-networkreimbursementcosts.01Figure 1.PwC medical cost trends,20082027PwCprojectsmedicalcosttrendtobe9.0%forGroupand8.5%forIndividualin2027,inlinewithrestated2026trendsSource:PwCanalysisThistrenddoesnottakeintoaccounttheimpactoftheexpirationofenhancedsubsidiesintheIndividualACAm