有许多因素促成了这一增幅，但大部分专家都同意，最重要的原因是按服务计费（fee-for-service）制度，该制度鼓励医疗服务提供者尽可能多地提供收费服务，而不是把维持人民健康和有效治疗疾病放在首位。
While many factors contributed to this surge, most experts agree that the single most important cause was a fee-for-service system that rewarded health-care providers for billing as many services as possible, rather than for keeping people healthy and treating their illnesses efficiently.