Despite a more than 30% increase in costs over ten years, medical imaging has become a smaller contributor to overall healthcare spending, adding over 25% less than non-imaging services.

According to researchers at the Harvey L. Neiman Health Policy Institute, imaging allocations grew 35.9% between 2010 and 2021, compared to 63.7% for other forms of care. As spending for non-imaging services rose, the amount that imaging contributed to healthcare costs fell from 10.5% to 8.9%.

“General price inflation accounted for nearly two-thirds of the 35.9% increase in spending for imaging," said Eric Christensen, director of economics and health services research at the Neiman Health Policy Institute, in a statement. “The next largest contributor to increased imaging spending was increased utilization, which accounted for another one-fifth of imaging spending growth.”

Price rises were not uniform, with nuclear medicine seeing a 39.90% hike, compared to CT and MR, which rose 12.38% and 2.35%, respectively. Shifts to more expensive, advanced imaging also contributed to more spending, though this growth was slower, making up one-tenth of total increases. Demographic shifts made up another tenth. In contrast, greater imaging use in lower-cost places of service and more in-network scanning offset spending uptakes.

The researchers evaluated data on 34 million patients per year during the allotted time frame, from the Merative MarketScan 2010-2021 Commercial Database, one of the largest proprietary U.S. claims databases used for healthcare research.

They attributed these data findings largely to policy changes enacted after 2010, such as the Affordable Care Act, which increased access to preventive care services, such as cancer screenings, by reducing out-of-pocket costs, leading to rises in patient volumes. Another example is the American College of Radiology’s Choosing Wisely campaign, designed to decrease unnecessary and low-value imaging.

Based on these regulatory changes, the researchers found the total number of patients who underwent imaging decreased from 46.2% in 2010 to 40.3% in 2021. Those who did have imaging, however, underwent more scans.

“What needs further study is whether this is related to more judicious use of imaging, barriers to imaging related to burdensome preauthorization, and/or other factors,” said co-author Dr. Richard Duszak, professor and chair of radiology at the University of Mississippi Medical Center.

While Duszak, Christensen, and their colleagues did not determine the appropriateness of imaging in their study, they do say that ordering providers are the main driver behind the rise in imaging volumes and not radiologists. Therefore, they say that initiatives such as Choosing Wisely should focus on ensuring these physicians understand appropriateness guidelines to better control aggregate imaging growth and spending.

The findings were published in Health Affairs Scholars.

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