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Medicare is the largest purchaser of health care services in the country, and over the past decade, there's been a gradual change in how those taxpayer dollars are spent, according to data from the independent Medicare Payment Advisory Commission.

Since 2006, Medicare is shifting money from physician practices and inpatient hospitals (where a person needs an overnight stay), and toward private health insurers and other companies that run the Medicare Advantage and Part D prescription drug programs. Spending also has increased in outpatient settings.

Expand chart

Why it matters: The Affordable Care Act contributed to some of this shift by cutting Medicare payments to hospitals. But what's happening in Medicare is representative of the health care system at large: the shift to defined benefits and narrow networks of hospitals and doctors, and avoiding hospitalizations whenever possible.

Where more Medicare funds are flowing:

  • Medicare Advantage: Roughly 20 million seniors and disabled people are now enrolled in the politically popular program, which represents 27% of all Medicare dollars. Seniors give those plans high marks, and it's a profitable business for insurers. But there are concerns that Medicare Advantage isn't saving money and that insurers are gaming the program.
  • Part D: The growth of drug prices has blown away the growth of pretty much every other economic good, and Medicare is barred from negotiating discounts with manufacturers. That inevitably has resulted in more money going into the Part D program (14% of all Medicare spending), and the benefits managers that run it.
  • Outpatient hospital departments and clinics: Technology has made it possible for Medicare enrollees to get some procedures and go home the same day, and it's cheaper than treating someone in the hospital. But hospitals also have been buying physician offices and controversially converting them into hospital outpatient departments, resulting in higher fees for the same services.

Go deeper

Updated 3 hours ago - Sports

Olympics dashboard

Katie Ledecky in Tokyo. Photo: Ding Xu/Xinhua via Getty Images

🚨: Simone Biles won't compete in individual vault or uneven bars

🏊‍♀️: Katie Ledecky wins gold in women's 800m freestyle

🏊: Caeleb Dressel breaks world record in men's 100m butterfly, 3rd gold

🇬🇧: Britain wins gold in first-ever Olympic mixed 4x100m medley relay

🎾: Novak Djokovic defeated in Olympic semi-finals

💻: Japan tests teleporting games and "remote cheering"

Go deeper: Full Axios coverage

Updated 4 hours ago - Sports

Simone Biles won't compete in individual vault or uneven bars Olympic finals

Photo: Loic Venance/AFP via Getty Images

Simone Biles will not compete in the individual vault or uneven bars finals at the Tokyo Olympics, USA Gymnastics announced Friday.

Why it matters: USA Gymnastics said Biles, who previously withdrew from the individual all-around and team finals to prioritize her mental health, will continue to be evaluated to determine if she'll compete in the balance beam or floor exercise events.

4 hours ago - Sports

American Katie Ledecky wins Olympic gold in women's 800m freestyle

USA's Katie Ledecky reacts after taking gold in the final of the women's 800m freestyle race. Photo: Odd Anderson/AFP via Getty Images

American superstar swimmer Katie Ledecky grabbed her second gold medal of this year's Olympic Games, winning the women's 800-meter freestyle race Saturday in Tokyo.

Driving the news: Ledecky, who holds the world record in the 800m freestyle, is considered one of the best women swimmers of all time. Saturday's final marks her third straight Olympic gold in the event.