Barriers to constraining health care cost growth.

Managing health care cost growth is a fundamental challenge facing our health care system. Through analysis of semistructured interviews, we conclude that barriers to health plan-level cost containment activities and strong forces outside the control of individual health plans will prevent many health system reforms (such as more competition among plans or modest increases in patient copayments) from stemming health care cost inflation. Policy debates and budgetary discussions must recognize that health care cost growth in excess of gross domestic product (GDP) growth is likely inevitable in the foreseeable future. The policy focus should be directed toward encouraging value.