Perspective: Unprecedented Decline in Health Spending is Leading the Economic Downturn  

April 30, 2020

George Miller

Paul Hughes-Cromwick

With yesterday’s Gross Domestic Product Advance Estimate (GDP) release for the first quarter of 2020, we learned that health services contributed 47% of the stunning 4.8% decline in real economic activity. Yet those data pertained to the entire 3-month period, while the true economic devastation did not take hold until several days into March. In contrast, today’s Personal Income and Outlays data concerns only March 2020. It shows that personal income fell 2% for March compared to February, and that personal consumption expenditures fell 7.5% for the month (both in nominal dollars). The report states, “Within services, the leading contributor to the decrease was spending on health care, including physician, dental, and paramedical services.”

In this perspective, we use our Health Sector Economic IndicatorsSM methodology, which emulates national health expenditure data, to analyze total health spending and selected components.

Exhibit 1. Year-over-Year Growth Rates in Health Spending

Preliminary data indicate that total health care spending in March 2020 was 5.5% lower than in March 2019 (Exhibit 1). This is the only occurrence in our historical time series of health spending (which goes back to 1989) that total spending has shown a monthly decline from the previous year. This decline was led by the two largest spending categories: hospital spending, which showed an 8.7% decline, and spending on physician and clinical services, which declined by a huge 19.3%, year over year. Spending declined in all major personal health care categories except nursing home care and prescription drugs (Exhibit 2).

Exhibit 2. Health Spending 12-Month Growth for Selected Categories

In past recessions, health care has helped to provide relief by continuing to generate revenue during and immediately following the economic decline. As we enter what is surely a new recession, this situation is reversed, with health spending being a major contributor to the downturn. Almost overnight, we have gone from concerns generated by government projections that suggest higher prices will accelerate health care spending to concerns over the financial solvency of providers.

As the current crisis fades, some of this decline might be offset by a surge in spending resulting from the pent-up demand for health care that has been deferred. But some of that demand is for routine visits and elective procedures that might simply be forgone rather than delayed.

Some of this might be good news in the long run as we return to a concern for controlling health spending in part by reducing low-value care. But high-value services are also being foregone in the current environment. There is even evidence from declining emergency care volume that patients are forgoing essential services for serious problems such as heart attacks and strokes. A challenge in a post-COVID environment will be to continue to avoid the low-value services while resuming the high-value ones.

Further details about this unprecedented decline in health spending will be included in this month’s Health Sector Economic Indicators, which we plan to release on Thursday, May 14.

Altarum’s health sector tracking work is made possible by a grant from the Robert Wood Johnson Foundation.

Altarum is a nonprofit organization that works with federal and state agencies and foundations to design and implement solutions to improve the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We achieve measurable results by combining our expertise in public health and health care delivery with technology, workforce training and continuing education, applied research, and technical assistance. Our innovative solutions lead to better health for beneficiaries and better value for payers.
Unprecedented Decline in Health Spending is Leading the Economic Downturn  


George Miller

George Miller  - PhD, BSE, MSE

Fellow and Research Team Leader

Areas of Expertise
  • Value of Health
  • Low-Value Care
  • Health Economics

Dr. George Miller is a fellow participating in Altarum's efforts to track national spending, analyze the drivers of spending growth, and quantify a sustainable spending growth rate. Dr. Miller received his BSE, MSE, and PhD degrees in industrial and operations engineering from the University of Michigan, where he subsequently served as an adjunct assistant professor.

Paul Hughes-Cromwick

Paul Hughes-Cromwick  - MA

Co-Director of Sustainable Health Spending Strategies

Areas of Expertise
  • Health Sector Spending
  • Health Policy Analysis

For over 35 years, Paul Hughes-Cromwick has been involved in health care economic and policy analyses including economic forecasting and health sector economic indicators. Paul leads Altarum’s monthly series of timely briefs covering national health spending, employment, prices and health care utilization. Paul has a bachelor’s degree from the University of Notre Dame and a master’s degree from Clark University.