Factors Affecting Health Care Affordability

The AHA has classified factors influencing health care affordability and value into three broad categories based on input from hospital and health system leaders:

  • Societal: Only 20 percent of what influences the health of a group of patients is related to access and quality of health care. The other 80 percent — commonly known as the social determinants of health — is related to societal factors, such as housing, transportation, employment, education, and other nonmedical determinants of population health.[1] According to a 2015 issue brief from The Commonwealth Fund, international comparisons show that the U.S. underinvests in these areas relative to other countries.[2] Investing in services that address these nonmedical determinants can have a dramatic impact on preventing serious illness among vulnerable populations and, therefore, drive health cost containment. Likewise, demographic shifts have important implications for the U.S. health care system; for example, the aging of the baby boomer generation has focused attention on advanced care needs. The same can be said of consumer preferences and behaviors, such as changing attitudes toward exercise and diet.
  • Systematic: Issues specific to the U.S. health care system also affect affordability. Systemic factors include questions of access (e.g., coverage rates); plan design (e.g., cost sharing and deductibles); equity (e.g., disparities in coverage and quality among underserved populations); and safety (e.g., variation across the delivery system). In addition, U.S. health care is undergoing a shift from fee-for-service to value-based payment models. This shift is an engine for sectorwide changes, such as an increased emphasis on population health, preventive care, and evidence-based practice.
  • Operational: Finally, a unique set of challenges surrounds the inputs of health care delivery. These include existing and projected workforce shortages; rising prescription drug prices; rapid technology adoption; and the burden of regulatory compliance, among others.


1. Institute for Clinical Systems Improvement. Going Beyond Clinical Walls: Solving Complex Problems. Accessed at:

2. The Commonwealth Fund. U.S. Health Care from a Global Perspective. Accessed at: