By NextBestFitPhase 5: Stabilize & govern · Step 5.1
Set a spending growth target
Annual, starting Year 5 · Payment Rates Board; Congress (veto)Discuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Total UHP spending per person grows at most at GDP-per-capita growth + 0.5 points. The Rates Board sets fee updates and hospital budget growth to meet it. | ||
| Japan | Biennial fee revisions set total price changes in line with fiscal targets. | Among the slowest spending growth in the OECD for decades. | Controlling prices centrally controls growth. |
| Germany | Statutory principle of contribution-rate stability ties spending growth to wage-base growth. | Moderate growth with periodic reforms. | Tying growth to revenue growth needs periodic legislated reforms to hold. |
| United Kingdom | Spending set in multi-year budget settlements. | Below-trend growth in the 2010s produced long waits. | A target that's too tight shows up as queues. |
Japan
- What they did
- Biennial fee revisions set total price changes in line with fiscal targets.
- What happened
- Among the slowest spending growth in the OECD for decades.
- Lesson for this plan
- Controlling prices centrally controls growth.
Germany
- What they did
- Statutory principle of contribution-rate stability ties spending growth to wage-base growth.
- What happened
- Moderate growth with periodic reforms.
- Lesson for this plan
- Tying growth to revenue growth needs periodic legislated reforms to hold.
United Kingdom
- What they did
- Spending set in multi-year budget settlements.
- What happened
- Below-trend growth in the 2010s produced long waits.
- Lesson for this plan
- A target that's too tight shows up as queues.
More precedent
- Maryland, Massachusetts, and other states' cost-growth benchmarks; Japan's biennial fee revisions; Germany's 'income-oriented expenditure policy'.