Where Does the Blame for High Health Care Costs Go? An Empirical Analysis of Newspaper and Journal Articles Criticizing Health Care Costs

Background: Public perception of whom to blame for health care costs varies. Whether there is a mismatch between the causes of rising health care costs and the blame attributed to potential culprits has emerged as a topic of debate. We sought to compare the allocation of blame for rising health care costs in lay media articles and academic literature with actual health care spending in the United States. Methods: We performed a cross-sectional systematic analysis of published lay media and academic articles. On April 10, 2018, 200 PubMed (academic) and 200 Google News (lay media) articles were collected through searches using the terms “healthcare costs” and “health care costs.” Articles were included if they criticized high cost of health care in the US. We calculated descriptive statistics for area(s) of health care blamed for high costs, publication type, and primary author affiliation. Results: PubMed articles named 47 potential drivers of high cost and Google News articles named 225. Among PubMed articles, environment, lifestyle, and medical problems (n = 15/47; 32%) were the most commonly cited source of high cost of health care, followed by ‘no group singled out’ (n = 14/47; 30%), and drugs or devices (n = 8/47; 17%). Among Google News articles, insurers (n = 63/225; 28%) were most commonly cited as possible sources of high cost of health care, followed by ‘no group singled out’ (n = 46/225; 21%) and hospitals (n = 37/225; 17%). Conclusions: Allocation of blame for high health care costs is not always in proportion with true health care spending, and certain health care drivers are under- and overrepresented by academic and lay media publications.