I've done some more analysis of the matters raised in US healthcare efficiency did not go off the rails until about 30 years ago and posted a lengthy update with charts there.  It became clear that there was no "going off the rails" of healthcare spending--it increased every year at a near constant rate.  What did go off the rails in 1982 was the rate of increase in life expectancy at birth--the rate of increase slowed abruptly and dramatically. Possibly that's because we suddenly shifted spending away from those kinds of care that most affect life expectancy and started spending instead on care that has less or no effect on that outcome.  Or maybe there is only a tenuous connection between spending and life expectancy, and we need to look to other outcomes to measure healthcare spending efficiency.  Or maybe we need to look at how life expectancies at birth are estimated.