A study by the Harvey L. Neiman Health Policy Institute examined the impact of medical imaging on U.S. healthcare spending. Published in Health Affairs Scholar, it revealed that while spending on imaging increased by 35.9% from 2010 to 2021, its share of total healthcare spending decreased from 10.5% to 8.9%, as other healthcare expenditures rose. To pinpoint the key cost drivers, researchers analyzed data from the Merative MarketScan 2010-2021 Commercial Database, covering around 34 million patients annually.

“Between 2010 and 2021, healthcare spending increased 60.8%, but this growth differed substantially by type of service,” says Michal Horný, PhD, assistant professor at Emory University School of Medicine in Atlanta. “We found that spending growth was 35.9% for imaging while it was 63.7% for all other healthcare services. Hence, while imaging spending has increased, the growth in non-imaging services has been substantially higher. Therefore, imaging has become a smaller piece of the pie.”

The study pinpointed several factors driving imaging spending growth, including price inflation, increased usage, shifts in imaging types, demographic changes among the insured, variances in imaging facility preferences, and differences in insurer-provider networks.

“General price inflation accounted for nearly two-thirds of the 35.9% increase in spending for imaging”, said Eric Christensen, PhD, director of economics and health services research at the Neiman Health Policy Institute. 

“The next largest contributor to increased imaging spending was increased utilization, which accounted for another one-fifth of imaging spending growth,” adds Christensen. “The remaining growth resulted from shifts to more advanced imaging modalities and demographic shifts, each about one-tenth of the total. Conversely, shifts to lower-cost places of service and more in-network imaging offset some spending increases.”

Since 2010, policy changes affected imaging spending, with the Affordable Care Act lowering costs for preventive screenings and initiatives like Choosing Wisely aiming to reduce unnecessary imaging.

“While our findings cannot speak to the appropriateness of imaging, they do highlight important trends. We found that the percentage of patients undergoing imaging declined from 46.2% in 2010 to 40.3% in 2021, while those who had imaging underwent more imaging exams,” says coauthor Richard Duszak, MD, professor and chair of radiology at the University of Mississippi Medical Center in Jackson. “What needs further study is whether this is related to more judicious use of imaging, barriers to imaging related to burdensome pre-authorization, and/or other factors.”