The health care costs of the United States are disproportionately high for several reasons. Use of costly new technologies and medicines Such use may be the single biggest factor increasing health care costs. The use may be useful or superfluous, the cost is increased in every case. An example of a suitable, expensive treatment is the use of fibrinolysis or angioplasty for the treatment of MI. Before the 1980s, began with these treatments as was the treatment of an MI much less expensive (but also less effective). On the other hand, offer many new and expensive treatments, including some in popular use, only marginal benefits are ineffective or inappropriate. An example is the use of the lumbar spine fusion in chronic back pain. Many experts believe that this treatment is ineffective and / or has been greatly overused. The use of many such expensive treatments tends to vary greatly depending on the geographical areas and depending on the practices within a geographical area (so-called. “Practical variation”). For certain diseases (eg. As coronary heart disease), the treatment results are better than in areas where the adjusted health spending are high compared to areas where they are lower in any way. Subsidizing businesses and government subsidies eliminate some economic disincentives to health care and have been postulated to increased health care (and therefore costs) contribute. Higher costs for medical products and services The drug costs have increased. One reason is the increasing cost of developing a new drug, which are often located close to $ 1 billion. The cost of developing drugs reduce the economic incentive to develop drugs with less profit potential, even those that could greatly help a particular group of patients (eg. As drugs to treat rare diseases) or medications for public health in general (eg. as vaccines, antibiotics). Marketing of new drugs and devices The intensive marketing to physicians and consumers (with direct consumer advertising) has been recognized as the cause of the excessive use of costly new technologies and medicines. Some of these new measures may be no more effective than older, less costly. Overuse of specialist treatment specialists are increasingly offering more services; the reasons may be a decreasing number of family doctors and the increased desire of patients to seek medical attention. Specialist care is often more expensive than the basic service; Specialists have higher fees and can more tests than GPs perform (often rare diseases). In addition, the evaluation and treatment of a patient who had by a single doctor can be done, can lead to the consultation of several medical specialists. High administrative costs, the share of funding for health care, which is spent on administration is estimated to be 20 to> 30%. Most administrative costs caused by private insurance companies, and most of these costs are caused by marketing and patient recruitment, operations that do not improve health care. “The Affordable Care Act” reduced the amount to expend the private insurance administrative costs. The presence of numerous private insurance companies in the same geographical area typically increases the processing cost of healthcare providers (eg. As payment claims, coding) complicated and time consuming. Medical expenses physicians in the US are paid higher than other occupational groups in the US and more than doctors in many other countries. This difference also therefore occurs because doctors in other countries typically spend far less money on their medical education and legal protection insurance (for actions for Kunsfehlern) than their counterparts in the US and also have less costs for rooms and equipment. Because medical expenses are only responsible for about 20% of total health care costs, would even a significant reduction in medical expenses, only a relatively small effect on the total cost. Cost of malpractice The issue of “malpractice” adds to the cost of medicine both directly and indirectly (through the cause of defensive medicine). Direct costs consist in the contributions for legal expenses insurance against lawsuits for malpractice, which are paid by the doctors, other providers, health care facilities and medical drug and device manufacturers. These contributions, which cover the settlement of claims and legal expenses insurance, must be paid from the income of health care eventually. may be so onerous as the insurance premiums and the threat of lawsuits for individual doctors (especially in special areas), was the overall annual insurance sum that was paid by doctors and companies in 2008, at $ 12 billion, which is only 0 , 6% of the total annual expenditure on health. The actual legal consequences of malpractice that have been paid out to victims in 2014, will be $ 3.9 billion. These are <0.2% of total health costs. Thus, a significant reduction of the amounts for damages in malpractice would not be a significant reduction of total health expenditure, but it would mean a lot for many individual doctors and their way of working. Defensive medicine with defensive medicine are meant diagnostic tests or treatments that are made to protect doctors against possible lawsuits for malpractice, even though such tests and treatments are not clinically justified. For example, a doctor may instruct a patient to the hospital, which would probably also well served with an outpatient treatment to prevent a possible lawsuit. The actual costs that are attributable to this type of defensive medicine are very difficult to estimate. Few rigorous studies have assessed these costs so far, but estimates from these studies vary widely, ranging from negligible to substantial (some experts believe that these costs are greater than the direct costs of actual malpractice). A part of the uncertainty lies in that defensive medicine is subjectively defined, d in the fact. H. it is the decision of the physician to take the test, and how likely or unlikely is not the disease, is tested for. The motivation of the doctor is difficult to determine and various doctors can, of course, in their assessment of the need for testing are very different in a particular case (except in relatively few situations, the clear, sensitive and specific guidelines for the exam). In some studies on defensive medicine doctors were asked if and when they practice defensive medicine. However, such a self-assessment can be quite unreliable, and such surveys often have low return rate. Thus, the amount of defensive medicine is still unknown. And even if defensive tests could be identified, the calculation of the potential cost savings is not easy. Reducing the number of defensive tests leads to a change in the marginal cost (the cost of the provision or withholding additional service units), which differ from the actual costs or refunds. In addition, studies of the states that have enacted reforms to limit the compensation of patients for iatrogenic injuries made as to conflicting results as to whether such reforms lead to lower health spending. Aging of the population, although it is often cited as a factor in the aging of the population is probably not responsible for the recent increased costs because the generation that is now old, has not yet risen disproportionately. In addition, good health care has led to more severe disease may be delayed in this generation. However, the aging of the "baby boomers" will have on the cost more because the proportion of the population is> 65 to increase from about 13% to nearly 20% after the year 2030th Key points The use of new expensive procedures and drugs may be the single biggest factor among many that can increase the cost of healthcare. The use of such technologies sometimes varies considerably between geographical areas, and increased use does not always lead to better clinical outcomes. The share of funding for the US health care that is spent on administration is 20 to> 30%. The reduction of medical expenses does not necessarily lead to a significant reduction in healthcare costs. Direct costs of medical errors have a small effect on the overall health care costs, but the cost of defensive medicine, which is to protect against malpractice suits are difficult to measure and largely unknown. The aging of the US population has probably not strongly contributed to the disproportionate increase in US health care costs, but just as much as the baby boomer generation.