What Is Bending the Cost Curve? An Exploration of Possible Drivers and Unintended Consequences
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.070 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".