# Presentation: 763854

## An Overview of the U.S. 

**Health Care System**
**Chart Book**
**Centers for Medicare and Medicaid Services**
**And**
**Office of the Assistant Secretary for Planning and Evaluation**
**January 31, 2007**

## Table of Contents - Section 1

**Section 1: ****	****Overview of the U.S. Health Care System****	**				**8**
- Table 1.1	National Health Expenditures and their share of GDP, 1980-2015				9
- Table 1.2	National Health Expenditures per Capita, 1980-2015					10
- Table 1.3	Personal Health Expenditures by Source of Funds, 1960-2004				11
- Table 1.4	Health Insurance Coverage for the Under 65 Population, 1980-2004				12
- Table 1.5	Personal Health Care Expenditures by Service, 1960-2003					13
- Table 1.6	Annual Percent Change in Personal Health Care Expenditures for Medicare, Medicaid, and Total, 1971-2015		14
- Table 1.7	Average Annual Growth in Medicare & Private Health Insurance Benefits Per Enrollee,   Selected Periods		15
- Table 1.8	Concentration of Health Spending, 1987-2002					16
- Table 1.9	Factors Accounting for Growth in Prescription Drug Spending per Capita, 1980-2011			17
- Table 1.10	Prescription Drug Expenditures by Source of Funds, 1965-2004				18
- Table 1.11	Sources of Payment for Nursing Home and Home Health Care, 2004				19
- Table 1.12	Number of People Employed in Health Care, 1990-2005					20
- Table 1.13	Health Care Employment by Occupation, 1983-2005					21
- Table 1.14	Health Care Employment Growth Projections, 2000-2010					22
- Table 1.15	Average Annual Salaries of Selected Groups of Workers, 2005				23
- Table 1.16	HMO Enrollment by Ownership Status, 1981-2004					24
- Table 1.17	Concentration of Managed Care Enrollment, 1988-2003					25
- Table 1.18	Managed Care Enrollment by Type of Plan, 1984-2004					26
- Table 1.19	Health Care as a Percent of Income by Age, 2004					27
- Table  1.20	Annual Growth Rates in the Overall CPI and MCPI, 1993-2005				28

## Table of Contents - Section 2

**Section 2: ****	****International Comparisons****	****	****	****	****	****	****29**
- Table 2.1	Percent of GDP Spent on Health Care by OECD Country, 1960-2004				30
- Table 2.2	Per Capita Spending on Medical Services by OECD Country, 1980-2004				31
- Table 2.3	Average Annual Growth in Per Capita Spending by Decade by OECD Country, 1960-2003			32
- Table 2.4	Per Capita Health Spending by Type of Service by OECD Country, 2003				33
- Table 2.5	Share of Total Health Spending on Outpatient care by OECD Country, 1970-2003			34
- Table 2.6	National Health Spending by Source of Funds by OECD Country, 2003				35
- Table 2.7	Per Capita Spending on Drugs and other Non-durables by OECD Country, 1970-2003			36
- Table 2.8	Drug Spending as a Percentage of Total Health Spending, 1980-2003				37
- Table 2.9	Infant Mortality Rates per 1,000 Live Births by OECD Country, 1970-2004				38
- Table 2.10	Male and Female Life Expectancy at Birth by OECD Country, 1960-2004				39
- Table 2.11	Male and Female Life Expectancy at Age 65 by OECD Country, 1960-2004				40
- Table 2.12	Number of Inpatient Discharges and Total Beds per 1,000 persons, by OECD Country, 2004			41
- Table 2.13	Average Length of Hosptial Stay for Selected OECD Countries, 2004				42
- Table 2.14	Medical Technology and Use of High Technology Medical Procedures by OECD Country, 2004			43
- Table 2.15	Selected Indicators of Mobidity by OECD Country, Selected Years				44
- Table 2.16	Selected Indicators of Mortality by OECD Country, 2004					45

## Table of Contents - Section 3

**Section 3:****	****Providers****	****	****	****	****	****	****	****46**
- Table 3.1	Number of Hospitals by Type, 1980-2004					47
- Table 3.2	Number of Hospital Beds and Occupancy Rates by Hospital Type, 1980-2004				48
- Table 3.3	Number of Hospital Beds per 1,000 Persons by State, 2004					49
- Table 3.4	Number of Nursing Home Beds & Residents, 1985-2003					50
- Table 3.5	Number of Physicians per 100,000 Persons by State, 2004					51
- Table 3.6	Distribution of Active Physicians:1950-1998					52
- Table 3.7	Percentage of Physicians in Differing Practice Arrangements, 1987-2001				53
- Table 3.8	Physician Revenue by Payer, 1986-2004					54
- Table 3.9	Physician Participation in Managed Care, 1988-2001					55
- Table 3.10	Physician Managed Care Payment Arrangements, 2001					56
- Table 3.11	Hospital Participation in HMOs and PPOs, 1987-2004					57
- Table 3.12	Hospital Managed Care Payment Arrangements, 2001					58
- Table 3.13	Hospital Profit Margins for All Payers and Medicare, 1997-2004				59
- Table 3.14	Hospital Payment to Cost Ratios for Medicare, Medicaid, and Private Payers, 1985-2002			60
- Table 3.15	Change in Nursing Home Institutionalization Rate for Elderly, 1985-1999				61
- Table 3.16	Nursing Home Resident Rate by State, 2003					62
- Table 3.17	Number of Hospital Discharges and Average Length of Stay, 1980-2004				63
- Table 3.18	Number of Physician Visits per 1,000 Persons, 1990-2000					64

## Table of Contents – Section 4, Tables 4.1 to 4.20

**Section 4: ****	****Public Programs****	****	****	****	****	****	****	****65**
- Table 4.1	Public Payers’ Share of National Health Spending, 1980-2010				66
- Table 4.2	Personal Health Care Expenditures by Type of Service and Percent Medicare Paid, 2004			67
- Table 4.3	Personal Health Care Expenditures by Type of Service and Percent Medicare Paid, 1980			68
- Table 4.4	Where the Medicare Dollar Went, 1980 and 2005					69
- Table 4.5	Medicare Trustees Report: Part A Income and Expenses, 1970-2015				70
- Table 4.6	Number of Medicare Beneficiaries, 1970-2040					71
- Table 4.7	Medicare Beneficiaries as a Share of the US Population, 1970-2030				72
- Table 4.8	Medicare Spending for Fee-For-Service Beneficiaries by Income, 2003				73
- Table 4.9	Living Arrangements of Medicare Beneficiaries, 2003					74
- Table 4.10	Age and Gender of the Medicare Population, 2003					75
- Table 4.11	Total Health Care Spending for Medicare Beneficiaries, 2003				76
- Table 4.12	Sources of Payment for Medicare Beneficiaries’ Medical Services, 2003				77
- Table 4.13	Sources of Payment for Medicare Beneficiaries by Type of Service, 2003				78
- Table 4.14 	Types of Supplemental Health Insurance held by Fee-for-Service Medicare Beneficiaries, 2003			79
- Table 4.15 	Medicare Beneficiary Out-Of-Pocket Spending, 2003					80
- Table 4.16 	Per Capita Out-Of-Pocket Expenses for Medicare Beneficiaries by Type of Insurance Coverage, 1993 and 2003		81
- Table 4.17	Distribution of Medicare Enrollees by Functional Status, 2003				82
- Table 4.18	Beneficiaries with Poor Health or Functional Limitations by Insurance Status, 2003			83
- Table 4.19	Medicare Managed Care Enrollment, 1990-2005					84
- Table 4.20	Medicare Beneficiaries with Prescription Drug Coverage,1992-2003				85

## Table of Contents – Section 4, Tables 4.21 to 4.40

**Section 4: ****	****Public Programs****	****	****	****	****	****	****	****65**
- Table 4.21	Total Spending for Prescription Drugs for all Medicare Beneficiaries, 1996-2003			86
- Table 4.22	Medicare Beneficiaries with Drug Coverage by Primary Source of Supplemental Coverage, 1995 and 2003		87
- Table 4.23	Personal Health Expenditures by Type of Service and Percent Medicaid Paid, 2004			88
- Table 4.24	Personal Health Expenditures by Type of Service and Percent Medicaid Paid, 1980			89
- Table 4.25	Medicaid Enrollment by Eligibility Group, 2003					90
- Table 4.26	Average Medicaid Payments Per Person Served by Eligibility Group, 1985-2003			91
- Table 4.27	Medicaid Enrollees by Eligibility Group, 1975-2003					92
- Table 4.28	Total Medicaid Expenditures by Type of Service, FY 2005					93
- Table 4.29	Total State Spending and Federal Funds Provided to States, 2004				94
- Table 4.30	Medicaid Spending for Long-Term Care, 1999-2003					95
- Table 4.31	Births Financed by Medicaid as Percent of Total Births by State, 2005				96
- Table 4.32	Medicaid Enrollment by Age, Sex, and Ethnicity, 2003					97
- Table 4.33	Medicaid Managed Care Enrollment, 1996-2004					98
- Table 4.34	Health Insurance Coverage of Children, 1988-2005					99
- Table 4.35	State Children’s Health Insurance Program Spending and Enrollment, 1998-2004			100
- Table 4.36	State Children’s Health Insurance Program Plan By State, 2006				101
- Table 4.37	State Health Spending as a Percent of Gross State Product, 2004				102
- Table 4.38	Share of State Health Spending Financed by Medicare and Medicaid, 2004				103
- Table 4.39	Share of State Health Spending Financed by Medicare, 2004				104
- Table 4.40	Share of State Health Spending Financed by Medicaid, 2004				105

## Table of Contents – Sections 5 and 6

**Section 5: ****	****Private Health Insurance****	****	****	****	****	****	****106**
- Table 5.1	Health Spending From Out-of-Pocket and Private Health Insurance, 1980-2010				107
- Table 5.2 	Changes in Employer Health Insurance Premiums, Overall Inflation, and Workers' Earnings, 1989-2005		108
- Table 5.3	Change in Health Insurance Premiums by Firm Size, 1988-2005				109
- Table 5.4	Employee Contributions to Health Insurance Premiums, 1988-2005				110
- Table 5.5	Average Annual Premium Costs by Plan Type, 2005					111
- Table 5.6	Changes in Employee Benefit Packages, 1980-2004					112
- Table 5.7	Firms Offering Health Insurance Coverage by Firm Size, 1996-2005				113
- Table 5.8	Number of Health Plans Offered by Firm Size, 2005					114
- Table 5.9	Private Health Insurance Enrollment by Plan Type, 1988-2005				115
- Table 5.10	Employees With a Choice of Health Plans, 1988-2005					116
- Table 5.11	Covered Employees in Firms that Offer Health Benefits, 2005				117
- 									**	****	**
**Section 6: ****	****Uninsured****	****	****	****	****	****	****	****118**
- Table 6.1	Out of Pocket Spending by the Under 65 Population by Insurance Status by Income, 2001 and 2003			119
- Table 6.2 	Out of Pocket Spending by the Under 65 Population by Insurance Status by Type of Service, 2001 and 2003		120
- Table 6.3	Percent Uninsured within Age Categories, 1987-2005					121
- Table 6.4	Percent Uninsured within Income Categories, 1987-2005					122
- Table 6.5	Percent Uninsured by Ethnicity, 1987-2005					123
- Table 6.6	The Uninsured by Age, 1987-2005						124
- Table 6.7	The Uninsured by Income, 1987-2005						125
- Table 6.8	The Uninsured by Ethnicity, 1987-2005						126
- Table 6.9	The Uninsured by State, 2005						127
- Table 6.10	Impact on Non-Elderly Adults of Being Uninsured, 2006					128

## Section 1

**Overview of the U.S. Health Care System**

## Table 1.1

**Table 1.1**
**National Health Expenditures and Their **
**Share of Gross Domestic Product (GDP), 1980-2015**

*Source:* CMS, Office of  the Actuary, National Health Statistics Group.

**Actual**

**Projected**

*National health spending is projected to continue to increase as a**share of GDP over the next decade.** *

## Table 1.2

**National Health Expenditures Per Capita, 1980-2015**

**Calendar Year**

*Source:*  CMS, Office of  the Actuary, National Health Statistics Group.

**Actual**

**Projected**

*National health spending per capita is projected to increase rapidly over the next decade.** *

## Table 1.3

**Table 1.3**
**Personal Health Care Expenditures by Source of Funds:**
**Selected Years 1960-2004**

*Source:*  CMS, Office of  the Actuary, National Health Statistics Group.

**Total Private**

**Total Public**

**$23.3**

**$63.1**

**$214.5**

**$609.3**

**$1,553**

*Over the last several decades, both the public and private sector share of health spending has increased, while the share from out-of-pocket spending has declined. *

**55%**

**40%**

**27%**

**23%**

**14%**

**21%**

**16%**

**12%**

**10%**

**12%**

**21%**

**22%**

**28%**

**33%**

**35%**

**2%**

**3%**

**4%**

**5%**

**5%**

**12%**

**17%**

**18%**

**17%**

**8%**

**12%**

**11%**

**16%**

**Dollars in Billions**

**Other Public**
**Medicare**
**Total Medicaid, SCHIP expansion and SCHIP**

**Out-of-Pocket**
**Other Private**
**Private Health Insurance**

**13%**

**7%**

**35%**

**13%**

**17%**

**16%**

**$1,877.6**

## Table 1.4

**Health Insurance Coverage for the Under 65 Population, 1980-2004**

- Notes: ESI - Employer Sponsored Insurance. Any Private includes ESI and individually purchased insurance. Any government includes Medicare for the disabled population.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

*Over the last two decades, private coverage has declined, public coverage (mostly Medicaid) has increased a small amount, and the uninsured have grown.*

**ESI**

**Any Private**

**Medicaid**

**Any Government**

**Uninsured**

## Table 1.5

**Personal Health Care Expenditures by Type of Service, 1960-2003**

**Service**

** **
**    ****Percent**

*Source:*  CMS, Office of  the Actuary, National Health Statistics Group.

**39.3%**

**47.3%**

**41.7%**

**36.5%**

**22.9%**

**21.9%**

**25.9%**

**25.3%**

**0.2%**

**1.1%**

**2.1%**

**2.9%**

**11.4%**

**5.6%**

**6.6%**

**10.8%**

**3.6%**

**8.2%**

**8.6%**

**8.2%**

**22.5%**

**15.8%**

**15.2%**

**16.4%**

*The share of health spending on prescription drugs has grown since 1980. Physician share has stayed about the same while the hospital share grew and then declined.*

**35.8%**

**25.7%**

**7.7%**

**12.4%**

**2.8%**

**15.6%**

## Table 1.6

**Table 1.6**
**Annual Percent Change in  Personal Health Care Expenditures for Medicare, Medicaid and Total: 1971-2015**

**Percent**

**Calendar Year**

*Source:*  CMS, Office of  the Actuary, National Health Statistics Group.

**Medicare Prospective**
**Payment System (1983****)**

**Projected**

**Balanced Budget Act**
**(1997)**

**Balanced**
**Budget**
**Refinement**
** ****Act (1999)**

**Actual**

**Medicare**
**Catastrophic**
**Coverage**
**Act of 1988**

*While the actual percent changes vary, overall spending for Medicare and *
*Medicaid tend to rise and fall together. *

**Medicare Extended to**
**Disabled & ESRD**
**(1973)**

**Medicaid Taxes**
**& Donations**
**(1991)**

- PHCE

- Medicare

- Medicaid

- PHCE
- (projected)

- Medicare
- (projected)

- Medicaid
- (projected)

## Private Health Insurance Benefits Per Enrollee :  Selected Periods

**Average Annual Growth in Medicare and **
**Private Health Insurance Benefits Per Enrollee** **:  Selected Periods**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**Entire Period**

**Selected Calendar Year Periods**

*Except for 1993-1997, Medicare has grown slightly more slowly than private health insurance.*

- Calendar Years

**1970-2004**

**1970-1993**

**1993-1997**

**1997-1999**

**1999-2004**

## Table 1.8

**Concentration of Health Spending, 1987-2002**

*Source: *Yu, William W. & Trena M.Ezzati-Rice, Medical Expenditure Panel Survey Statistical Brief #81, AHRQ, May 2005.

*Health spending remains highly concentrated on a small percentage of people. The top**1% of people account** about a quarter of all health spending,*

**Population Ranked By Expenditures**

**Percentage of Expenditures**

## Table 1.9

**Factors Accounting for Growth in Prescription Drug Spending****per Capita, 1980-2011**

- Note: Utilization also includes the effects of intensity and population growth.  Per capita drug spending in 1990 was $252
- * Without the effect of Part D, overall growth would be 8.1% (price: 3.8%, Utilization 4.3%)
*Source:* CMS, Office of the Actuary, Health Affairs Web Exclusive, Exhibit 6, pp. W70

**10.7%**

** ****12.3%**

**   ****8.2%**

** ****8.0%**

**  ****8.1%**

**   ****7.7%**

**8.3%**

*****

*Drug Prices and Utilization significantly affect prescription drug spending per capita. *

## Table 1.10

**Prescription Drugs Expenditures by Source of Funds,****1965-2004**

- Note: Percentages may not sum to 100 due to rounding.  Drug spending grew from $3.7 billion in 1965 to $188.5 billion in 2004
*Source:* CMS, Office of the Actuary, National Health Statistics Group.

*The share of drug spending covered by public and private sources has grown significantly.*

## Table 1.11

**Sources of Payment for Nursing Home and Home Health Care, 2004**

*Most such care is paid for by Medicare and Medicaid.*

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**Out-of-Pocket****29.6%**

**Private LTC Ins.****8.4%**

**Medicaid****47.3%**

**Medicare****14.8%**

**Medicaid **
**34%**

**Private LTC Ins.****12.9%**

**Out-of-Pocket****12.3%**

**Medicare****40.8%**

**Total nursing home and home health care spending in 2004 is $148 Billion**

**Nursing Home**

**Home Care**

## Table 1.12

**Number of People Employed in Health Care, 1990-2005 **

- Note: Not seasonally adjusted.  Health Care Employment includes those who work in ambulatory health care services, hospitals, and nursing and residential care facilities.
*Source:*  Kaiser Family Foundation, *Trends and Indicators in the Changing Health Care Marketplace, 2006 Chartbook*.

*Number of people employed in health is growing.** *

** ****Health Services **
**Employment as a % **
**of Non-Farm Private **
**Sector Employment**

**7.5%   1990  **
**8.0%   1991  **
**8.2%   1992    **
**8.3%   1993  **
**8.3%   1994  **
**8.4%   1995 **
**8.4%   1996**
**8.4%   1997**
**8.4%   1998 **
**8.3%   1999   **
**8.2%   2000**
**8.5%   2001  **
**8.8%   2002  **
**9.1%   2003**
**9.2%   2004**
**9.2%   2005**

## Table 1.13

**Health Care Employment by Occupation, 1983-2005**

*Source:* Dept. of Labor, Bureau of Labor Statistics. Occupational Employment Statistics.

*Health care employment growth varies by occupation.*

**Percent Change 1990-05**
**72.3%**
**-67.4%**
**139.4%**
**0.8%**
**11.8%**
**-23.5%**
**150.9%**
**151.9%**
**26.1%**
**-23.9%**
**-24.1%**
**46.2%**
**33.6%**
**80.8%**
**-9.5%**
**-24.6%**
**-17.1%**
**-57.1%**
**485.7%**

**. . . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
** ****. .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . . . . . . .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  **
**. . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . **
**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
** ****. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  **
**. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
**. . . . . . . . . . . . . . . . . . . . . . . . . . . . .**
** ****. . . . . . . . . . . . . . . . . . .**

## Table 1.14

**Health Care Employment Growth Projections, 2000-2010**

- *Note: Five of the nation’s top 10 fastest growing occupations are in health care.
*Source:* Dept. of Labor, Bureau of Labor Statistics. _Monthly Labor Review._ November 2001.

*Over the next decade, health care employment is expected to grow at a rapid rate.*

**General Health Care Occupations**

**Fastest Growing* Specific Health Care Occupations**

## Table 1.15

**Average Annual Salaries for Selected Groups of Workers, 2005**

*Source:  *National Compensation Survey: Occupational Wages in the US, June 2005* . *US Department of Labor, July 2006.

*Health professionals earn higher than average incomes.*

**Health Professionals**

**Professional,**
**Technical,**
**Specialty**
**Workers**

**All**
**Workers**

## Table 1.16

**HMO Enrollment by Ownership Status, 1981-2004**

- Note: HMO enrollment includes enrollees in both traditional HMOs and point-of-service (POS) plans through: group/commercial plans, Medicare, Medicaid, the Federal Employees Health Benefits Program, direct pay plans, supplemental Medicare plans, and unidentified HMO products.
*Source:*  Kaiser Family Foundation. Trends & Indicators in the Changing Health Care Marketplace,  2006 Chartbook.

*The proportion of HMO enrollees in not-for-profit plans stabilized in 1997.*

**Total HMO enrollment in 2004 = 66.1 Million**

## Table 1.17

**Concentration of Managed Care Enrollment, 1988-2003**

- *Note: The decrease in concentration does not represent a decline, but rather a change in the methodology.
- Note: The largest national managed care firms include Kaiser Foundation Health Plans, UnitedHealth Group, WellPoint Health Networks, Aetna, and Health HMO enrollment includes enrollees in both traditional HMOs and point of service plans.
*Source:*  Kaiser Family Foundation. Trends & Indicators in the Changing Health Care Marketplace, 2005 – Chartbook.

*Half of managed care enrollees are enrolled in the nation’s 10 largest**managed care firms.*

- *

## Table 1.18

**Managed Care Enrollment by Type of Plan, 1984-2004**

*Note: *Plans analyzed are comprehensive HMO plans.  Traditional HMOs and point of service plans are included, managed care carveouts for selected services such as behavioral health are not  included.  Enrollment includes group and commercial plans, Medicare, Medicaid, Federal Employee group health program, and others.
*Source:* Kaiser Family Foundation, Trends & Indicators in the Changing Health Care Marketplace, 2006 Chartbook.

*Mixed model HMO plans grew rapidly before 2000 and declined less rapidly after 2000.*

** ****31.4     **

**    ****38.8**

**63.3**

**78.9**

**       ****15.1**

**NA**
**19.5%**
**23.3%**
**43.6%**
**13.6%**

**NA**
**43.0%**
**18.0%**
**25.4%**
**13.6%**

**17.3%**
**41.7%**
**10.0%**
**24.8%**
**6.2%**

**36.4%**
**43.4%**
**5.3%**
**13.7%**
**1.2%**

**40.0%**
**41.9%**
**8.9%**
**8.8%**
**0.4%**

**Mixed**
**IPA**
**Network**
**Group**
**Staff**

**38.4%**
**40.2%**
**11.2%**
**9.9%**
**0.2%**

**66.1**

**43.7%**
**32.6%**
**12.5%**
**11%**
**0.3%**

**74.2**

## Table 1.19

*Those over 65 and those with incomes under $20,000 spend a higher percentage of their income on health than other groups.*

*Source*: Dept. of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.

**Table 1.19**
**Health Care as a Percent of Income by Age, 2004**

**By Income Level**

**By Age Group**

**Age Group**

**Income Level**

## Table 1.20

**Annual Growth Rates in the Overall Consumer Price Index (CPI) and **
**Medical-Specific Consumer Price Index (MCPI), 1993-2005**

*Source:* Dept. of Labor, the Bureau of Labor Statistics.

*Medical prices have risen faster than overall consumer prices.*

**MCPI**

**CPI**

## Section 2

**International Comparisons**

## Table 2.1

**Percent of GDP Spent on Health Care by OECD Country, 1960-2004**

- *For 1960, no data was available.
- **2003 data was used because 2004 were not available.
- Note: The data is arrayed by spending growth from 1990 to 2004. The medians include all OECD countries.
*Source:* OECD Health Data 2006.

*The U.S. has had a higher share of GDP spent on health than the OECD median for**the past four decades. *

**Median:    3.9%    5.1%     6.8%     7.5%   9.6 %**

## Table  2.2

**Table  2.2**
**Per Capita Spending on Medical Services by OECD Country, 1980-2004**

- * 2003 Data Used for Germany and Japan
*Source*: OECD Health Data, 2006

*US spending is growing rapidly compared with other OECD countries.*

**Average Annual Growth in Per Capita Spending by Decade**
**by OECD Country, 1960-2003**

- ^ Average annual change calculated from 2000-2002
- Note: Each bar represents the average annual nominal growth over the decade. The data is arrayed by spending growth from 1990 to 1999. The medians include all OECD countries.
*Source:* OECD Health Data 2005.

*Health spending growth over the last decade is lower in OECD countries than in prior decades.*

**	**

## Table 2.4

**Per Capita Health Spending by Type of Service by OECD Country, 2003**

*Source:* OECD Health Data 2006.

*Per capita outpatient spending in the US is almost double inpatient spending. In other OECD countries per capita inpatient spending is greater than outpatient spending.*

- *

## Table  2.5

**Table  2.5**
**Share of Total Health Spending on Out-Patient Care by OECD Country, 1970-2003**

- Source: OECD Health Data 2006

*In 2003, the U.S. spent the highest percent of total healthcare spending on out-patient care; In 1970 Japan spent an even higher percent of total health care spending on outpatient care*

## Table 2.6

**National Health Spending by Source of Funds by OECD Country, 2003**

*Source:* OECD Health Data 2006

*Source of funding varies significantly by country. For instance, out-of-pocket spending ranges from 8% to 18% of health spending, with the U.S. at about the median.  *

## Table 2.7

**Per Capita Spending on Pharmaceuticals and Other Non-Durables****by OECD Country, 1970-2003**

- Expenditures in U.S. dollars using purchasing power parity rates.
- Note: Data is arrayed by spending levels for 2003. Japan not available for 1970.
*Source:* OECD Health Data 2006.

*Variation across countries is increasing.  Recent growth in North America is most rapid.*

*****

## Table 2.8Drug Spending as a Percentage of Total Health Spendingby OECD Country, 1980-2003 

***2003 data for Japan is not available; 2002 was used**
**Source: OECD Health data, 2006. **

*Although, recent drug spending in the United States on this measure has grown, it is still low compared to other OECD countries *

## Table 2.9

**Infant Mortality Rates per 1,000 Live Births by OECD Country, 1970-2004**

- Note: The median includes all OECD countries. The decrease from 1960-2004 is in percentage points.
- 2003 data used for Canada and the United States as the latest available.
*Source:* OECD Health Data 2006.

*OECD country infant mortality rates have declined since 1970.*

**United States**

**United States**

**Median**

**Median**

**Canada**

**Canada**

**France**

**France**

**Japan**

**Japan**

## Japan has the highest life expectancy at birth for both males and females.

**Male and Female Life Expectancy at Birth by OECD Country,****1960-2004**

- *2003 data was used because 2004 was not available.
- Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.
*Source:* OECD Health Data 2006

**Male**

**Female**

**Median =   67.2      70.0      76.4       **

**Median =   72.5      76.6     81.4**

*****

*Japan has the highest life expectancy at birth for both males and females*.

## Japan has the highest male and female life expectancy 

**Male and Female Life Expectancy at Age 65 by OECD Country,**
**1960-2004**

- Note: Data are arrayed by male life expectancy; countries are kept together * 2003 data  **Data are 2001 for females and 2002 for males.
*Source:* OECD Health Data 2006.

**Male**

**Female**

*Japan has the highest male and female life expectancy*

## Table 2.12

**Number of In-Patient Discharges and Total Beds per 1,000 Persons **
**by OECD Country, 2004**

*Discharge rates generally track bed supply.*

*Source:* OECD Health Data 2006  * 2004 data not available, used 2003.

**Discharges/1000**

**Number of beds/1000**

## Table  2.13

- *2003 Data.; **2002 data ***no data available   Countries are listed alphabetically.  Data Expressed in Days
*Source*: OECD Health Data 2006.

**Table  2.13**
**Average Length of Hospital Stay For Selected OECD Countries, 2004**

_**Average Length of Stay- In-Patient Acute**_

_**Average Length of Stay- Appendicitis***_

*The length of stay for specific procedures varies differently from total length of stay*

## Table 2.14

**Medical Technology and Use of High-Technology Medical Procedures by OECD Country, 2004**

- *2003 data,**2002 data, ***2001 data, ****2000 data, *****earlier data.  Medians reflect all OECD countries
*Source: OCED Health Data 2006*

|  | 
MRIs per 
Million People | 
CT Scanners per Million People | Coronary Bypass
Procedures per
100,000 People | Coronary Angioplasty
Procedures per 100,000 People | Patients Undergoing
Dialysis per
100,000 People | Bone Marrow
Transplants per 100,000 People |
| --- | --- | --- | --- | --- | --- | --- |
| Australia | 3.7 | 20.8***** | 77.9* | 153.0* | 39.5 | 5.6* |
| Austria | 14.9 | 28.5 | 54.6* | 174.8**** | 43.7 | 4.6 |
| Canada | 4.9 | 10.3 | 97.6* | 167.4*** | 56.4 | 3.9*** |
| Denmark | 10.2 | 14.5 | 60.0* | 156.9* | 45.1 | 0.7***** |
| France | 3.2 | 7.5 | 40.8*** | 155.9**** | 26.2***** | 6.9 |
| Germany | 6.6 | 15.4 | 86.5 | 301.6 | 73.9 | 4.8 |
| Greece | 2.3** | 17.1** | 59.6***** | 122.9** | 75.4 | 1.9 |
| Hungary | 2.6 | 6.8 | 135.5 | 235.8 | 49.6 | 2.8 |
| Italy | 10.2 | 20.6 | 46.5* | 92.4* | 34.4***** | 7.1* |
| Japan | 35.3** | 92.6** | _ | _ | 194.3 | 0.9 |
| Mexico | 1.7 | 3.1 | 2.3 | 1.5 | 37.2 | 0.1 |
| Netherlands | 3.9***** | 9***** | 58.2 | 92.6* | 28.2***** | 3.6 |
| Poland | 1* | 6.3* | 8***** | 19***** | ...... | 2.1* |
| Spain | 7.7 | 13.3 | 29.9* | 58.5* | 49.3 | 4.6 |
| Sweden | 7.9***** | 14.2***** | 75.1* | 144.0* | 25.5***** | 2.0*** |
| Switzerland | 14.3 | 17.9 | 32.6 | 85.6 | 26.5***** | 1.7 |
| United Kingdom | 5.0 | 7.0 | 55.5 | 113.4 | 41.6 | 4.2 |
| United States                                     | ..... | ..... | 160.7* | 426.4* | 159.5* | 5.1* |
| Median | 6.0* | 14.0* | 60.0* | 158.5* | 45.1* | 2.9* |

*Different countries spend health dollars in different ways: Japan has the highest rate of diagnostic high-tech procedures, the U.S. has the highest rate of heart procedures.*

## Table 2.15

**Selected Indicators of Morbidity by OECD Country, Selected Years**

- *2003, **2002, ***2001, ****2000, *1999 or earlier
- Median includes all OECD countries.
*Source:* OECD Health Data 2006.

|  | 2002
Incidence of Cancer
(All Types of Malignant Neoplasms)per 100,000 | 
2004
Incidence of AIDSin Population,per 1,000,000 | 

2004
Total Surgeries on an In-patient Basis, per 1,000 | 
2004
Percentage of Population That is Obese (BMI >30) | 
2004
Percentage of Population That are Daily Smokers | 
2004Percentage of Total Live Births That are Low-birthweight Births |
| --- | --- | --- | --- | --- | --- | --- |
| Australia | 312.0 | 12.0 | 50.2* | 21.7***** | 17.7 | 6.3* |
| Austria | 275.5 | 8.2 | 133.6* | 9.1***** | 36.3***** | 6.8 |
| Canada | 299.9 | 9.4 | 44.8* | 122.4 | 15.0 | 5.8* |
| Denmark | 281.4 | 9.9 | 97.4 | 9.5**** | 26.0 | 5.3 |
| France | 289.5 | 23.4* | _ | 9.5 | 23.0 | 6.8 |
| Germany | 283.3 | 6.0* | 79.4 | 12.9* | 24.3* | 6.9 |
| Greece | 203.0 | 6.8 | _ | 21.9* | 38.6 | 8.6 |
| Hungary | 318.8 | 2.3 | 228.6 | 18.8* | 30.1* | 8.3 |
| Italy | 276.5 | 29.2 | 52.7* | 8.0* | 24.2* | 6.7* |
| Japan | 214.5 | 3.0 | _ | 3.2* | 29.4 | 9.4 |
| Mexico | 147.3 | 45.3* | 31.3 | 24.2**** | 26.4** | 9.1 |
| Netherlands | 283.0 | 12.1 | 39.8 | 10.9 | 30.0 | 5.4** |
| Poland | 256.1 | 4.9 | _ | _ | 27.6**** | 5.1 |
| Spain | 243.4 | 43.0 | 51.9* | 13.1* | 28.1* | 7.1 |
| Sweden | 264.7 | 7.5 | 54.6** | 9.8 | 16.2 | 4.2 |
| Switzerland | 284.6 | 4.8 | 103.9 | 7.7** | 26.8** | 6.5 |
| United Kingdom | 273.6 | 14.1 | 63.3 | 23.0* | 25.0                                                                                                                                                                                                                                                             | 7.6* |
| United States | 357.7 | 149.0 | 89.9 | 30.6** | 17.0 | 8.1 |
| Median | 266.2 | 9.9 | 52.7* | 12.9* | 26.5 | 5.1 |

*Risky behaviors vary significantly by country: the U.S. has higher rates of obesity and HIV;**Western Europe has higher rates of smoking and in some countries, surgery.*

## Table 2.16

**Selected Indicators of Mortality by OECD Country, 2004**

- Median includes all OECD countries. *2003 data;**2002data;***2001data,****earlier data
*Source:* OECD Health Data 2006.

|  | 

Cancer Mortality Rates, per 100,000 | 
Suicide Rates for Total Population,per 100,000 | 

Homicide Rates for Total Population, per 100,000 | 

Homicide Rates for
Males,per 100,000 | 
HIV Mortality Rates for Total Population Due to HIV Infection,per 100,000 |
| --- | --- | --- | --- | --- | --- |
| Australia | 161.0 | 11.1** | 1.4** | 1.9*** | 0.5** |
| Austria | 161.4 | 14.5 | 0.7 | 0.7 | 0.5 |
| Canada | 173.2** | 10.6** | 1.5** | 2.0** | 1.0** |
| Denmark | 212.5**** | 11.3*** | .8*** | 1.1*** | 0.5*** |
| France | 172.7** | 15.1*** | 0.8** | .9** | 1.4** |
| Germany | 161.2 | 10.3 | 0.6 | 0.7 | 0.5 |
| Greece | 152.4* | 2.9* | 1.0* | 1.5* | 0.2* |
| Hungary | 244.8* | 22.6* | 1.8* | 2.2* | 0.1* |
| Italy | 167.3** | 5.6** | 0.9** | 1.3** | 0.0** |
| Japan | 146.5** | 20.3* | 0.15* | 0.6* | 0.4* |
| Mexico | 114.2**** | _ | 20.1**** | 37.8**** | _ |
| Netherlands | 182.2 | 7.9 | 1.1 | 1.6 | 0.4 |
| Poland | 202* | 13.6* | 1.4 | 2.0* | 0.3* |
| Spain | 158.* | 6.7* | 0.9* | 1.4* | 3.2* |
| Sweden | 148.8** | 11.4** | 1.1** | 1.1** | 0.3** |
| Switzerland | 144.1** | 15.3** | 0.9** | 0.8** | 1.1** |
| United Kingdom | 181.8** | 6.3** | 1.2** | 1.2** | 0.3** |
| United States | 166.3** | 10.2** | 6.2** | 9.7** | 4.2** |
| Median | 166.0** | 11.5** | 1.2** | 1.5** | 0.35** |

*Causes of mortality differ: the U.S. and Mexico have high homicide rates, Japan and Europe have high suicide rates. *

## Section 3

**Providers**

## Table 3.1

**Table 3.1**
**Number of Hospitals by Type, 1980-2004**

- *Includes specialty hospitals such as TB, Ob-Gyn; eye, ear, nose and throat; orthopedic and chronic disease.
*Source:* American Hospital Association, personal communication, 2006.

**General**

**All Hospitals**

**Psychiatric**

**Fed General**

**Total Other***

**Fed Psych**

**Rehabilitation**

**Pediatric**

**Specialty Hospitals**

*The number of hospitals has declined with the exception of rehabilitation hospitals*.

## Table 3.2

**Number of Hospital Beds and Occupancy Rates**
**by Hospital Type, 1980-2004**

*The decline in the percentage of general hospital beds is greater than the percentage decline in occupancy rates in general hospitals. *

**Occupancy Rate**

- *Includes specialty hospitals such as TB, Ob-Gyn; eye, ear, nose and throat; orthopedic and chronic disease.
*Source:* American Hospital Association, personal communication, 2006.

**General**

**All Hospitals**

**Psychiatric**

**General**

**Total Other***

**Rehabilitation**

**Pediatric**

**Beds**

## Table 3.3

**Table 3.3**
**Number of Hospital Beds per 1,000 Persons by State, 2004**

- Note: Per 1,000 population.
*Source:* 2004 AHA Annual Survey. Kaiser Family Foundation State Health Facts Online.

**Medium (2.6-3.9)**

**High (4.0 - 6.5)**

**Low (1.8-2.5)**

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

**National average is 3 **

*The number of hospital beds varies by state, with the lowest concentration in the Western U.S.*

## Table 3.4

**Number of Nursing Home Beds and Total Residents, 1985-2003**

*Source: Health, United States, 2005, *National Center for Health Statistics.

*From 1985 to 1999 beds grew slightly more rapidly than residents, after 1999, resident counts fell more rapidly than the bed count.*

## Table 3.5

**Number of Physicians per 100,000 Persons by State, 2004**

- Note: Includes non-federal physicians only.
*Source:* Physician Characteristics and Distribution in the U.S. 2004. American Medical Association. Kaiser Family Foundation State Health Facts Online.

**Medium (241 - 290)**

**High (291 - 752)**

**Low (175-240)**

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

**National average is 281 **

*Availability of Physicians varies substantially by state, with the highest concentration in the Northeast.*

## Table 3.6

- Note:  Includes all active physicians.
*Source:* AMA data from the Bureau of Health Professions and Health, United States, 1993.

*Since 1950, urban areas have seen much more rapid growth in physicians than rural areas.*

*****

**Table 3.6**
**Distribution of Active Physicians, 1950-1998**

## Table 3.7

**Percentage of Physicians in Differing Practice Arrangements, 1987-2001**

*Source:* AMA Socioeconomic Monitoring System and 2001 Patient Care Physician Surveys, American Medical Association

*Declines in solo practice physicians are offset by increases in salaried physicians and group practices.*

## Table 3.8

**Physician Revenue by Payer, 1986-2004**

*The share of physician and clinical services revenue paid by patients out-of-pocket has declined substantially since 1986. Private health insurance continues as the largest source of physician and clinical services revenue.*

**Total Private**

**Total Public**

**$99.5 billion**

**Other Public**
**Medicare**
**Total Medicaid, SCHIP expansion and SCHIP**

**Out-of-Pocket**
**Other Private**
**Private Health Insurance**

**$157.5 billion**

**$220.5 billion**

**$286.4 billion**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**$399.9 billion**

## Table 3.9

**Physician Participation in Managed Care, 1988-2001**

- Note: Managed care contracts include HMOs, IPA, and PPOs. Data from the American Medical Association.
*Source:* Trends and Indicators in the Changing Health Care Marketplace, 2005, Kaiser Family Foundation.

*Most physician practices have managed care contracts and receive a significant share of revenue from them.*

- %

- %

## Table 3.10

**Physician Managed Care Payment Arrangements, 2001**

- Note:  Physicians may receive payment in multiple ways, so the payment methods do not add to 100%.
*Source:* Trends and Indicators in the Changing Health Care Marketplace, 2005, Kaiser Family Foundation.

*Fee-for-Service is the predominant payment arrangement for physicians.*

## Table 3.11

**Hospital Participation in HMOs and PPOs, 1987-2004**

*Source:* American Hospital Association, personal communication.

*A steady rise in the number of hospitals participating in both Health Maintenance and Preferred Provider Organizations has leveled off in recent years.*

## Table 3.12

**Hospital Managed Care Payment Arrangements, 2001**

*Source:* Trends and Indicators in the Changing Health Care Marketplace, 2005, Kaiser Family Foundation.

*Most hospitals receive per diem and fee-for-service payments, a much smaller number*
*also receive capitated payments.*

## Table 3.13

**Hospital Profit Margins for All Payers and Medicare, 1997-2004**

*Source:* CMS, Office of the Actuary. Medicare cost report data.

*For both rural and urban hospitals, overall and Medicare inpatient hospital *
*profit margins have declined.  Total margins remain positive.*

**Total Margins**

**Medicare Inpatient Margins**

## Table 3.14

**Hospital Payment to Cost Ratios for Medicare, Medicaid, and****Private Payers, 1985-2002**

*Source:* American Hospital Association Annual Survey. Chapter 4. Trends in Hospital Financing

*Private Payers continue to pay a larger share of hospital costs  than Medicare and Medicaid  but less so than in the late eighties and early nineties..*

**Private **
**Payers**
**119%**

**Medicare**
**97.9%**

**Medicaid**
**96.1%**

## Table 3.15

**Change in Nursing Home Institutionalization Rate for the Elderly, 1985-1999**

*Source:* *Health, United States, 2005*, National Center for Health Statistics.

*While the absolute number of elderly in nursing homes continues to rise, the number of residents per 1,000 elderly has declined.*

**Total Number of Elderly in Nursing Homes**

**Rate of Elderly in Nursing Homes per 1,000 Elderly**

## The Western U.S. houses the smallest share of nursing home residents.

**Nursing Home Resident Rate by State, 2003**

- Note: Number of nursing homes residents (all ages) per 1,000 resident population 85 years of age and over.
*Source:* Health, United States, 2005. Table 116.

**Medium (300 - 400)**

**High (400+)**

**Low (131 - 299)**

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

**National average is 308 **

*The Western U.S. houses the smallest share of nursing home residents*.

## Table 3.17

**Number of Hospital Discharges and Average Length of Stay,****1980-2004**

- Note: Non-Federal short-stay hospitals.
*Source:* Center for Disease Control and Prevention, National Center for Health Statistics.

*Hospital discharges and length of stay have generally declined over the last two decades.*

## Table 3.18

**Number of Physician Visits per 1,000 Persons, 1990-2000**

*Source:* Center for Disease Control and Prevention, National Center for Health Statistics.

*While there was a drop in the overall number of physician visits during the early nineties, by 1996-97, visits steadily increased.*

## Section 4

**Public Programs**

## Table 4.1

**Public Payers’ Share of National Health Spending, 1980-2010**

*The share of national spending by public payers has increased slightly over the last two decades, driven by faster growth in Medicare and Medicaid spending.*

- Note: Total public includes Medicare, Medicaid, other federal (not shown) and state and local spending.
- *2010 is a projection.
*Source:* CMS, Office of the Actuary, National Health Statistics Group.

## Table 4.2

*Total personal health care spending in 2004 was $1.56 trillion; *
*Medicare accounted for over 19%.*

**$570.8 Billion**
**Medicare pays 28.6%**

**$399.9 Billion**
**Medicare pays 20.5%**

**$188.5  Billion**
**Medicare pays 1.8%**

**$115.2 Billion**
**Medicare pays 13.9%**

**$52.7 Billion**
**Medicare pays 19.2%**

**$81.5 Billion**
**Medicare pays 0.1%**

**$53.3 Billion**
**Medicare pays 0%**

**$32.3 Billion**
**Medicare pays 5.9%**

**$43.2 Billion**
**Medicare pays 37.9%**

**$23 Billion**
**Medicare pays 28.3%**

- 1 Medicare payments are mostly from managed care plans, since fee-for-service Medicare did not generally cover outpatient prescription drugs in 2004.
*Source*: CMS, Office of the Actuary, National Health Statistics Group.

**1**

**Table 4.2**
**Personal Health Care Expenditures by Type of Service**
**and Percent Medicare Paid, 2004**

## Table 4.3

**Personal Health Care Expenditures by Type of Service****and Percent Medicare Paid, 1980**

*Total personal health spending in 1980 was $214.6 billion;**Medicare accounted for 17%*

**$13 Billion**
**Medicare pays 0%**

**$101 Billion**
**Medicare pays 26%**

**$47 Billion**
**Medicare pays 17%**

**$12 Billion**
**Medicare pays 0%**

**$17 Billion**
**Medicare pays 2%**

**$3 Billion**
**Medicare pays 8%**

**$3 Billion**
**Medicare pays 0%**

**$2 Billion**
**Medicare pays 27%**

**$9 Billion**
**Medicare pays 0%**

**$3 Billion**
**Medicare pays 8%**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

## Table 4.4Where the Medicare Dollar Went: 1980 and 2005

- 1 Other services include other professional services and ambulance services.
- Note: Data do not sum due to rounding. Spending includes benefit dollars only.
*Source:* CMS, Office of the Actuary, Trustees Report 2006

**Outpatient Hospital**
**and Other**
**Outpatient Facility****1**

**SNF**

**Physician**

**Inpatient Hospital**

**HHA**

**Total = $336 Billion**

*Medicare spending has moved from inpatient hospital services to all other settings. Managed care has grown while the physician share declined. *

**Total = $37 Billion**

**2005**

**1980**

**Inpatient **
**Hospital**

**SNF**

**Home Health Care**

**Physician**

**Managed Care**

**Other**

**Administrative **
**Expenses**

## Table 4.5

**Medicare Trustee’s Report: Part A Income and Expenses, 1970-2015**

*.*
*Source:* CMS, Office of the Actuary.Trustees Report, 2006.

**Actual**

**Projected**

*Projected Expenditures First Exceed Projected Income in 2011 *

## Table 4.6

**Number of Medicare Beneficiaries, 1970-2040**

- .
*Source*:  Medicare Trustees Report 2006

*Enrollment in the Medicare Program is projected to nearly double in the next 30 years.*

**Enrollment (millions)**

**Actual**

**Projected**

## Table 4.7

**Medicare Beneficiaries as a Share of the U.S. Population, 1970-2030**
*The U.S. population will age rapidly through 2030, when 22 percent of the population**will be eligible for Medicare.*

*Source:* Social Security Administration, Office of the Actuary.

**12.1%**

**9.5%**

**13.1%**

**13.9%**

**15.0%**

**18.5%**

**22.0%**

**10.8**

**9.5**

**11.9**

**12.0**

**12.6**

**15.8**

**19.5**

**1.3**

**1.2**

**1.9**

**2.4**

**2.7**

**2.4**

**Total Number of **
**Medicare Beneficiaries:**
**(millions)**

**20.4            28.4             34.3           39.6             46.5             61.6            78.6**

## Table 4.8Medicare Spending for Fee-for-Service Beneficiaries by Income, 2003

**$5,000 or Less**
**4%**

**$5,001 - $10,000**
**25%**

**$10,001 - $15,000**
**17%**

**$15,001 - $25,000**
**24%**

**$25,001 - $40,000**
**16%**

**$40,001 or More**
**14%**

*About seventy percent of Medicare expenditures are on behalf of individuals with**annual incomes of $25,000 or less.*

- Note:  Data may not sum due to rounding.
*Source:* CMS, Office of Research, Development, and Information: Data From the Medicare Current Beneficiary Survey (MCBS) 2003 Access to Care File.

**Table 4.8****Medicare Spending for Fee-for-Service Beneficiaries by Income, 2003**

## $

*Source*:  CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS) 2003 Access to Care File.

*Among the nearly 30 percent of beneficiaries living alone, *
*a large proportion are women and have low incomes.*

**Live with Spouse**
**49%**

**Live in LTC Facility**
**5%**

**Live with Children/Others**
**17%**

**Live Alone**
**29%**

**52% have an income**
**<$15,000**

**70% are women**

**16% are over the age of 85**

**$**

**85+**

**Table 4.9**
**Living Arrangements of Medicare Beneficiaries, 2003**

## Table 4.10Age and Gender of the Medicare Population, 2003

**46%**

**41%**

**29%**

*The proportion of women increases among those 85 and older.*

**Table 4.10****Age and Gender of the Medicare Population, 2003**

- 53%

- 47%

- 54%

- 46%

- 58%

- 42%

- 31%

- 69%

- Note: Fifty-three percent (23.7 million) of all Medicare beneficiaries are female; 44% (18.6 million) are males.  Data reflect Medicare beneficiaries ever enrolled in the program during the year.
*Source*:  CMS, Office of Research, Development, and Information: data from the Medicare Current Beneficiary Survey (MCBS) 2003 Access to Care File.

- 18.2 million

- 6.1 million

- 13.1 million

- 4.9 million

**Enrollees (millions)**

## Table 4.11Total Health Care Expenditures for Medicare Beneficiaries, 2003

**Rx Drugs**
**13.6%**
**($66.7 B)**

- Note:  Premium payments are excluded.  LTC is long-term care.  SNF is skilled nursing facility.
*Source:* CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS) 2003 Cost and Use File.

**Table 4.11****Total Health Care Expenditures for Medicare Beneficiaries, 2003**

*Total Health Care Expenditures = $491 Billion*

**LTC**
**15.6%**
**($76.6 B)**

**Home Health**
**2.7%**
**($13.4 B)**

**Dental**
**2.4%**
**($12.0 B)**

**Medical Provider**
**25.3%**
**($124.3 B)**

**Hospital**
**35.4%**
**($173.7 B)**

**SNF**
**3.6%**
**($17.8 B)**

**Hospice**
**1.2%**
**($6.0 B)**

## Table 4.12Sources of Payment for Medicare Beneficiaries’ Medical Services, 2003

- *Beneficiary out-of-pocket spending does not include their payments for Medicare Part B premiums, private insurance premiums, or HMO premiums.
- Note: Data are for all beneficiaries, both fee-for-service and Medicare+Choice enrollees.
*Source:* CMS, Office of Research, Development, and Information: Data From the Medicare Current Beneficiary Survey (MCBS) 2003 Cost and Use File.

*Medicare pays a little more than half of the total cost of beneficiaries’ medical care.*

**Overall Medical Expenses per Medicare Beneficiary = $12,512**

**Private Insurance**
**13%**
**($1,600)**

**Medicaid**
**11%**
**($1,321)**

**Medicare**
**52%**
**($6,553)**

**Other Sources**
**6%**
**($688)**

**Direct **
**Out-of-Pocket***
**18%**
**($2,350)**

**Table 4.12****Sources of Payment for Medicare Beneficiaries’ Medical Services, 2003**

## Table 4.13Sources of Payment for Medicare Beneficiaries by Type of Service, 2003

- 1 OOP is out-of-pocket.
- 2 Other Medical includes things such as hospice and durable medical equipment.
- Note*:  *Medicare did not generally cover outpatient prescription drugs in 2003.
*Source:* CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS), 2003 Cost and Use File.

**100**
**80**
**60**
**40**
**20**
**0**

**Percent of Expenditure by Payer**

*Medicare pays a large proportion of the total expenses of services it covers.*

**1**

- 2

## Table 4.14

**Table 4.14**
**Types of Supplemental Health Insurance held by Fee-for-Service Medicare Beneficiaries, 2003**

**13.5%**

- Note: Medicaid (shown above) includes both Qualified Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMBs).
*Source:* CMS, Office of Research, Development, and Information: Data From the Medicare Current Beneficiary Survey (MCBS) 2003 Access to Care File.

*Most beneficiaries using fee-for-service Medicare have private, supplemental health plans.*

**No Supplemental Insurance**
**16%**

**Medicaid**
**18%**

**Individual**
** ****Medigap**
**26%**

**Other**
**2%**

**Employer-Sponsored**
**33%**

**Medigap &**
**Employer-Sponsored Insurance**
**5%**

**Notes:**
The share of prescription drugs purchased with direct-from-consumer out-of-pocket payments has fallen steadily.  The out-of-pocket share has fallen due primarily to growth in private health insurance payments.
Managed care enrollment has grown significantly. 
--Lower co-payments for physician visits than are required under traditional indemnity plans.  --Easier access to physicians for Rx and for diagnosis of conditions requiring Rx.   
--Require smaller or no  out-of-pocket payments, further inducing demand.  
--Some analysts believe that prescription drugs are a  more cost-effective way for managed care plans to treat plan members for certain conditions that would otherwise require more involved treatment ( e.g. hospitalization.).
Managed care insurers  reacted to these rapid increases in prescription drug expenditures.  
-- drug “formularies” that partially or fully restrict patient access to an approved list of drugs.  Formularies enable insurers to limit use to the most effective and lowest price drugs, while concentrating volume sufficiently in a limited number of approved drugs to extract price concessions (“rebates” and discounts) from manufacturers.
-- not provide coverage for certain “life-enhancing” drugs, such as those used to treat obesity, impotence and hair loss.  

## Table 4.15Medicare Beneficiary Out-of-Pocket Spending, 2003

**Table 4.15****Medicare Beneficiary Out-of-Pocket Spending, 2003**

- *These are for home health services not covered by Medicare.
- Note: 1)* *Data are for all beneficiaries, both fee-for-service and Medicare+Choice enrollees.*  *2) Total per capita direct out-of-pocket spending is $3,765
*Source*: CMS Office of Research, Development and Information, Medicare Current Beneficiary Survey (MCBS) 2003 Cost and Use file

**Total Out-of-Pocket Expenses****	****           ****Direct Out-of-Pocket**
**	****$159 billion****	****   ****	****    $99 billion**

*The majority of beneficiary out-of-pocket spending is for Medicare *
*cost-sharing and payment for non-covered services*.

**Medicare**
**Cost-**
**Sharing**
**35%**

**Outside**
**Medicare  **
**Benefit**
**Package**
**63%**

## Table 4.16Per Capita Out-of-Pocket Expenses for Medicare Beneficiaries by Type of Insurance Coverage, 1993 and 2003

- Note:  Premium payments are included.
*Source:* CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS), 1993 and 2003 Cost and Use Files.

*Beneficiaries without supplemental insurance and those with Medigap coverage have higher out-of-pocket spending than other groups.*

- Percent Change,
- 1993 to 2003

- 63.3%

- 79.7%

- 46.8%

- 74.5%

- 44.4%

- 107.7%

## Table 4.17Distribution of Medicare Enrollees by Functional Status, 2003

- Note:  ADLs are activities of daily living (e.g., eating, bathing); IADLs are instrumental activities of daily living (e.g., shopping, use of phone, cleaning).
*Source*:  CMS, Office of Research, Development, and Information: Data from Medicare Current Beneficiary Survey (MCBS) 2003 Cost and Use File.

*More than one-third of the Medicare population needs assistance with at least**one “activity of daily living.”*

**Table 4.17****Distribution of Medicare Enrollees by Functional Status, 2003**

- 15%

- 14 %

## Table 4.18

**Beneficiaries with Poor Health and Functional Limitations by Insurance Status, 2003**

*Medicare beneficiaries in poor health or with functional limitations are more likely to receive Medicaid or to have no supplemental insurance**.*

*Source*:  CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS) 2003 Access to Care File.

## Table 4.19Medicare Managed Care Enrollment, 1990-2005

*Source:* CMS, Office of the Actuary.

*Managed care enrollment grew through 2000, then declined, and is now on the upswing.*

## Table 4.20Percent of Medicare Beneficiaries with Prescription Drug Coverage, 1992-2003

**Table 4.20****Percent of Medicare Beneficiaries with Prescription Drug Coverage, 1992-2003**

- Note:  This includes beneficiaries who had some type of drug coverage at any point during the year.  Does not include beneficiaries in facility care.
*Source*:  CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS) 1992-2003 Cost and Use Files.

## Table 4.21Total Spending for Prescription Drugs for All Medicare Beneficiaries, 1996-2003

**1996**

**1997**

**1999**

**1998**

*Total spending for drugs was higher for beneficiaries with drug coverage than without; however, non-covered beneficiaries pay substantially more out-of-pocket costs.*

- Note: Does not include beneficiaries in facility care.  Does not adjust for underreporting of prescription drugs.
*Source*:  CMS, Office of Research, Development, and Information: Data from the Medicare Current Beneficiary Survey (MCBS) 1996-2003 Cost and Use Files.

**2000**

**2001**

**2002**

**2003**

## Table 4.22

**Medicare Beneficiaries With Drug Coverage by Primary Source of Supplemental Coverage, 1995 and 2003**

- Note: Data are based on the non-institutionalized beneficiaries.
- Percentages shown in bars are Medicare beneficiaries with drug coverage as a percent of total Medicare beneficiaries. Beneficiaries do not necessarily get drug coverage from their primary sources of supplemental insurance.
*Source:* CMS/Office of Research, Development and Information. Data are from the Medicare Current Beneficiary Survey.

**65% of Medicare Beneficiaries Have Drug Coverage**

**78% of Medicare Beneficiaries Have Drug Coverage**

**Medicare + Choice****Plans**

**Medicaid**

**Employer-****Sponsored**

**Individually Purchased**

**Other**

*Employer-sponsored retiree coverage is the largest source of coverage for drug spending.*

## Table 4.23

**Personal Health Expenditures by Type of Service and****Percent Medicaid Paid, 2004**

*Total personal health spending in 2004 was $1,560,241,000,000;**Medicaid accounted for 17%*

**$81.5 Billion**
**Medicaid pays 5%**

**$570.7 Billion**
**Medicaid pays 17%**

**$399.9 Billion**
**Medicaid pays 7%**

**$188.5 Billion**
**Medicaid pays 19%**

**$115.2 Billion**
**Medicaid pays 44%**

**$52.7 Billion**
**Medicaid pays 6%**

**$43.1 Billion**
**Medicaid pays 32%**

**$53.2 Billion**
**Medicaid pays 69%**

**$32.3 Billion**
**Medicaid pays 0%**

**$22.9 Billion**
**Medicaid pays 15%**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

## Table 4.24

**Personal Health Expenditures by Type of Service and****Percent Medicaid Paid, 1980**

*Total personal health spending in 1980 was $214.6 billion;**Medicaid accounted for 12%.*

**$13 Billion**
**Medicaid pays 4%**

**$101 Billion**
**Medicaid pays 10%**

**$47 Billion**
**Medicaid pays 5%**

**$12 Billion**
**Medicaid pays 12%**

**$17 Billion**
**Medicaid pays 50%**

**$3 Billion**
**Medicaid pays 5%**

**$3 Billion**
**Medicaid pays 13%**

**$2 Billion**
**Medicaid pays 12%**

**$9 Billion**
**Medicaid pays 0%**

**$3 Billion**
**Medicaid pays 0%**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

## Table 4.25

**Medicaid Enrollment by Eligibility Group, 2003**
*Payments for the elderly, blind and disabled account for 69 percent of total payments.*

- Note: Expenditure distribution based on Congressional Budget Office data that includes only federal spending on services and excludes DSH payments, supplemental provider payments, vaccines for children, administration, and the temporary Federal Medicaid Assistance Percentage Increase..
*Source:* Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace Chartbook 2004.

**Blind & Disabled 43%**

**Children**
**19%**

**Adults 12%**

**Elderly 26%**

**Children**
**48%**

**Adults 27%**

**Elderly 9%**

**Blind & Disabled 16%**

**Total Enrollees = 52.4 million**

**Total Expenditures = $235 billion**

## Table 4.26

**Table 4.26**
**Average Medicaid Payments per Person Served by Eligibility Group, 1985-2003**

*Source:* CMS, CMSO, HCFA-2802 reports; Medicaid Statistical Information System.

*Per capita payments for the elderly, blind and individuals with disabilities continue to be significantly higher than payments for other groups.*

**$2,292**

**$13,303**

**$13,677**

**2003**

**1998**

**1995**

**1990**

**1988**

**1985**

**$1,606**

## Table 4.27 

**Medicaid Enrollees and Beneficiaries by Eligibility Group, 1975-2003**

- Medicaid “enrollees” are those who are enrolled in Medicaid at any time during the fiscal period. “Beneficiaries” are those for whom services have been reimbursed during the fiscal period.
- *Note:  (1) In 1998, a large increase occurred in the number of persons served which is mainly the result of a new reporting methodology of classifying payments to managed care organizations; FY 1998 was the first year capitation payments were counted as a service for purposes of the HCFA 2082 reporting, and thus all managed care enrollees were counted as individuals receiving services; this new methodology probably has the greatest effect on the reported number of children; (2) the term “adults” as used above refers to non-elderly, non-disabled adults; (3) disabled children are included in the blind & disabled category shown above. **The Other category was dropped in 1999.
*Source:* CMS, CMSO, Medicaid Statistical Information System.

*Children historically represent the largest group of Medicaid enrollees.** *

**Adults**
**14.3 million enrollees**
**11.7 m beneficiaries**
**Children Under 21**
**27.3 million enrollees    **
**24.8 million beneficiaries**
**Blind & Disabled**
**8.4 million enrollees**
**7.7 million beneficiaries**
**Age 65 & Older**
**5.2 million enrollees**
**4 million beneficiaries**

**Other****

**2003 Total =55.2 million Enrollees**

## Table 4.28

**Table 4.28**
**Total Medicaid Expenditures by Type of Service, FY 2005**

*Source*:  CMS, Office of the Actuary.

_**Expenditure **_(In Billions)

**Hospital  $76**

**Collections  -$5**

**Medicare Premiums  $8**

**Dental  $3.4**

**Prescription Drugs  $30.7**

**Other  $15**

**Long Term Care  $95.3**

**Outpatient  $23.9**

- Inpatient (General)  $42

- Inpatient (Mental)  $4.7

- Outpatient Hospital  $12.3

- DSH Hospital Payments  $17.1

- Nursing Homes $46.4

- Intermediate Care Facility-MR  $12.5

- Community Based Long Term Care  $36.4

**Capitation Payments $50.6**

**Targeted Case Management  $3**

- EPSDT $1.1

- Lab & Radiology  $1.3

- Clinic Services  $9.1

- Physician Services  $12.4

**25%**

**1%**

**10%**

**32%**

**5%**

**8%**

**3%**

*Total Medicaid Expenditures in FY 2005 were $300.7 billion*

**1%**

**16%**

## Table 4.29

**Total State Spending and Federal Funds Provided to States, 2004**

*Source:* National Association of State Budget Officers, *2004 State Expenditure Report.*

*Over twenty-two percent of state total spending and over forty-four percent of federal**funds provided to states were spent on Medicaid.*

**Total State Spending**

**Federal Funds Provided to States**

**Higher Education**
**10.9%**

**Elementary & Secondary Education**
**21.4%**

**Transportation**
**8.0%**

**All Other**
**31.7%**

**Medicaid**
**22.3%**

**Corrections**
**3.5%**

**Public Assistance**
**2.1%**

**Higher Education**
**5.6%**

**Elementary & Secondary Education**
**11.4%**

**Transportation**
**8.0%**

**All Other**
**26.3%**

**Medicaid**
**44.5%**

**Corrections**
**0.6%**

**Public Assistance**
**3.6%**

## Table 4.30

**Medicaid Spending for Long-Term Care, 1999-2003**

- Notes: The share of Medicaid spending on long term care devoted to home and community based settings increased from 25% of the total in FY1999, 26% in FY2000, 29% in FY2001, 32% in FY2002,  to 34% of the total in FY2003. Institutional spending includes SNF’s, ICF’s, ICF-MR, and Psychiatric Hospitals.
*Sources:* CMS, Center for Medicaid and State Operations, MSIS data.

*Home and community-based services are a growing share of Medicaid’s*
*long term care spending. *

**$55b**

**$59b**

**$66b**

**$73b**

**$77b**

## Table 4.31

**32.0% to 39.9%**

**48% to 55.9%**

**40.0% to 47.9%**

**Less than 32%**

**Table 4.31**
**Births Financed by Medicaid as a Percent of Total Births by State, 2005**

*Source: Kaiser Family Foundation, State Health Facts, *_[http://www.statehealthfacts.org](http://www.statehealthfacts.org/)__ _

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**AK**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

*Medicaid pays for about 41% of the nation’s births.*

**Above 56.0%**

**HI**

## Table 4.32

**Medicaid Enrollment by Age, Sex, and Ethnicity, 2003**

*Source: *MSIS State Summary for 2003.

**Native Hawaiian/ Pacific Islander**
**1%**

**Hispanic**
**21%**

**Multiple Races/ Other 7%**

**21-44**

**Male**

**Female**

**Asian**
**3%**

**American Indian/ Native Alaskan**
**1%**

**African **
**American**
**23%**

**White**
**44%**

**19-20**

**85+**

**75-84**

**65-74**

**45-64**

*There were 55.2 million Medicaid enrollees in 2003.*

**Age**

**Ethnicity**

**Sex**

**0-18**

## Table 4.33

**Medicaid Managed Care Enrollment, 1996-2004**

- Note: The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits. This table also provides unduplicated national figures for the Total Medicaid population and Other population. The statistics also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
*Source:* CMS, Center for Medicaid and State Operations: National Summary of Medicaid Managed Care Programs and Enrollment June 30, 2001. CMS,  Medicaid Managed Care Enrollment Data, 2002-2004.

*Medicaid managed care enrollment grew rapidly over the last decade**.*

**Managed Care           40%****	****     48%            54%            56%****	****          56%****	****  57%           57%            60%            61%**

- % Enrolled in

## Table 4.34

**Health Insurance Coverage of Children, 1988-2005**

- *Other includes private non-group and other public insurance.  A  change in the census questionnaire allowed this category to be separately identified starting in 2000.  see also Table 6.6
- Notes: About 23% of children below poverty (or 4.1 million kids) had no health insurance in 2004.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

*The percentage of children without health insurance has declined since SCHIP was*
* **Implemented in 1998.*

## Table 4.35

**State Children’s Health Insurance Program  **
**Spending and Enrollment, 1998-2004**

- *Note: Ever enrolled in SCHIP during the year, not a point in time estimate.
*Source:* Center for Medicaid and State Operations

**Spending**

**Enrollment***

*The SCHIP program covers a growing number of uninsured low-income children.*

## Table 4.36State Children’s Health Insurance Program Plan Type by State, 2006

_**Key**_
- ***  Approved Unborn State Plan Amendments:  9**  (AR, CA, IL, MA, MI, MN, RI, TX, WA)** **
- ^**  Approved SCHIP 1115 Demonstrations:  6**  (AK, MN, NM, NJ, RI, WI)
- +**  Approved HIFA Demonstrations: 13 **(AZ, AR, CA, CO, ID, IL, MI, NJ, NV, NM, OR, UT, VA)
- #**  State **no longer has a Medicaid expansion program as of September 30, 2002, due to the aging out of the children phased into the Medicaid program under OBRA’90.**  **
_**Summary Information (in order of submission/approval):**_
**Number of Approved Separate State Child Health Plans: 18 **(CO, PA, OR, NV, UT, MT, GA, AZ, KS, VT, WA, WY, WV, AL, MS, TX, CT, NY)
**Number of Approved Medicaid Expansions:  17**  (SC, OH, MO, OK, WI, PR, DC, NE, NM, VI, LA, AK, HI, GU, AS, CNMI, TN)
**Number of Approved Combination Plans:  21 **(FL, MA, NJ, ME, NH, KY, MI, IA, NC, ND, IN, IL, MD, SD, VA, CA, RI, MN, DE, AR, ID)
**Total Number of Amendments Approved:  272**
**Number of Amendments Under Review: 13 **(TN,VA-6th amend, IL-6th amend, IL-7th amend, CA-11th amend, WI-4th amend.)WV-6th-amend; FL-17th amend; PA-7th amend.; DE-3rd amend, WA-8th amend.
- Source:  CMS Center for Medicaid andState Operations.

## Table 4.37

**High (16.9% - 20.5%)**

**Low (9.5% - 13.1%)**

**Table 4.37**
**State Health Spending as a Percent of Gross State Product  2004**

- Note: Data are for personal health care by state of provider.
*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

*Proportion of state output devoted to personal healthcare varies by state.*

**National average is 13.4% **

**Medium (13.2% -16.8%)**

## Table 4.38

**Medium 32%-39%**

**High 40%-51.1%**

**Low 26% - 32%**

**Table 4.38**
**Share of State Health Spending Financed by Both Medicare and **
**Medicaid, 2004**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

*Medicare and Medicaid finance varying proportions of State health spending. *

**National average is 36.6% **

## Table 4.39

**Medium 15.6%-21.8%**

**High 21.9%-28.1%**

**Low 7.4%-15.5%**

**Table 4.39**
**Share of State Health Spending Financed by Medicare, 2004**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

*Medicare finances a varying share of State health spending.** *

**National average is 19.2% **

## Table 4.40

**Medium 16.7%-24.0%**

**High 24.1%–31.6%**

**Low 9.1%-16.6%**

**Table 4.40**
**Share of State Health Spending Financed by Medicaid, 2004**

*Source:* CMS, Office of the Actuary, National Health Statistics Group.

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**KY**

**FL**

**VA**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

*Medicaid finances a varying share of State health spending**.*

**National average is 17.4% **

## Section 5

**Private Health Insurance**

## Table 5.1

**National Health Spending From Out-of-Pocket and Private Health Insurance, 1980-2010**
*Over the last 25 years, the share of national health spending from out-of-pocket sources *
*has declined, while that from private health insurance has increased.*

- *Projected
*Note*: The remainder of national health spending is from public sources.  This chart is a subset off Table 1.3
*Source:* CMS, Office of the Actuary, National Health Statistics Group.

## Table 5.2

**Changes in Employer Health Insurance Premiums, Overall Inflation, and Workers’ Earnings, 1989-2005**

*The rate of increase in employer health insurance premiums is slowing.*

*Source:*  Health Insurance Premiums from personal communication of data from KFF/HRET Employer Health Benefits Surveys
-  from 1999, 2000, 2001, 2005: KPMG Survey of Employer-Sponsored Health Benefits: 1993, 1996; HIAA Employer-Sponsored
-  Health Insurance Survey; 1989. Workers’ Earnings from Bureau of Labor Statistics Current Employment Statistics Survey
- (April-April), 1988-2001. Overall Inflation from Bureau of Labor Statistics, CPI estimates (April-April), 1988-2001,
- at www.bls.gov. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.

## Table 5.3

**Annual Change in Health Insurance Premiums by Firm Size, 2005**

- 29%

*Source*:  Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2005.

*Small firms face higher premium growth than larger firms.*

## Table 5.4

- Sponsored Health Benefits: 1988, 1993, 1996.

**Table 5.4**
**Employee Contributions to Health Insurance Premiums, 1988-2005**

*Employees are paying a higher dollar value, but smaller share of their**health insurance premiums.*

**Percentage of Premium Paid by Employees, 1988-2005**

**Average Monthly Employee Contribution, 1988-2005**

## Table 5.5

*Average premiums vary by plan type. *

**Table 5.5**
**Average Annual Premium Costs by Plan Type, 2005**

**All Plans**

**Conventional FFS**

**HMO**

**PPO**

**POS**

## Table 5.6

**Changes in Employee Benefit Packages, 1980-2004**

- Note: Coverage for selected services offered by medium and large establishments, displayed by % of employees that have each benefit available to them.
- **Not available.  2004 data available only for physical exams and well baby exams.
*Sources:* Dept. of Labor, Bureau of Labor Statistics. Report by Sophie Korczyk, “Trends in Employer-Provided Health Care Coverage: 1980-1997, Final Report March, 2000.  2004 data from Employer Health Benefits 2004 Annual Survey, Kaiser Family Foundation.

******

******

******

******

******

******

******

*Employees were offered more generous benefit packages in recent years. *

## Table 5.7

**Firms Offering Health Insurance Coverage by Firm Size, 1996-2005**

*Source:* *Employer Health Benefits, 2005 Annual Survey*, The Kaiser Family Foundation, and Health Research and Educational Trust.

*Larger firms are more likely to offer health insurance than smaller firms.*

## Table 5.8

**Table 5.8**
**Number of Health Plans Offered by Firm Size, 2005**
*Large firms are more likely to offer employees a choice of plans.*

*Source:* *Employer Health Benefits, 2005 Annual Survey*, The Kaiser Family Foundation, and Health Research and Educational Trust.

## Table 5.9

**Private Health Insurance Enrollment by Plan Type, 1988-2005**

*Source:* *Employer Health Benefits, 2001-2005 Annual Survey*, The Kaiser Family Foundation and Health Research and Educational Trust. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.

*Since 1988, Conventional Fee-for-Service plans have almost disappeared, while PPOs have grown significantly.*

## Table 5.10

**Employees With a Choice of Health Plans, 1988-2005**

- ^ Information was not obtained for POS plans in 1988.
*Source*:  KFF/HRET Survey of Employer-Sponsored Health Benefits, 2000-2005; KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1993, 1996.

*In recent years, fewer employees have a choice of conventional FFS plans. *
*A growing share have a choice of PPOs and POS plans.*

**^**

## Table 5.11

*Source*:  Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2005.

*Not all eligible employees enroll in an employer’s health plan. *

**Table 5.11**
**Covered Employees in Firms That Offer Health Benefits, 2005**

**Percentage of Workers Eligible**
** ****for Employer Health Benefits**

**Small Firms**
**(3-199 Workers)**

**Large Firms**
**(200+ Workers**

**Percentage of Workers Covered **
**by Their Employers’ Health Benefits**

## Section 6

**The Uninsured**

## Table 6.1

**Out-of-Pocket Spending by the Under 65 Population by **
**Insurance Status by Income, 2001 and 2003**

*The percent of health spending from out-of-pocket sources by the uninsured is significantly higher than for those with insurance.*

- Note: Insured includes all types of insurance coverage.
*Source:* Actuarial Research Corporation tabulations of Medical Expenditure Panel Survey.

**Uninsured**

**Insured**

## Table 6.2

**Out-of-Pocket Spending by the Under 65 Population by **
**Insurance Status by Type of Service, 2001 and 2003**

- Note: Insured includes all types of insurance coverage.  Uninsured individuals may have some of their care financed in part by
- charity or providers as uncompensated care.
*Source:* Actuarial Research Corporation tabulations of Medical Expenditure Panel Survey.

**Uninsured**

**Insured**

**Total****	****2001  43% of health spending out-of-pocket**
**	****2003  52%**

**Total****	****2001  19% of health spending out-of-pocket**
**	****2003  18%**

*In 2003, the insured paid about 18% of their health expenses out-of-pocket, compared to about 52% for the uninsured.*

## Table 6.3

**The Percent Uninsured Within Age Categories, 1987-2005**

- Note: Under 65 population.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

*Adults age 18-54 have twice the percentage uninsured as children in 2005 .*

## Table 6.4

**Percent Uninsured Within Income Category, 1987-2005**

*Lower-income groups are more likely to be uninsured than higher-income groups.*

- Note: Under 65 population.  Colored lines represent income as a percentage of the poverty line.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

## Table 6.5

**Percent Uninsured by Ethnicity, 1987-2005**

*About half of the uninsured are white, and the other half are racial or ethnic minorities.*

- Note: Under 65 population.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

**Non-Hispanic Black**

**Non-Hispanic **
**American Indian**

**Total**

**Non-Hispanic**
** ****Asian**

**Other**

**Hispanic**

**Non-Hispanic Black**

**Non-Hispanic **
**American Indian**

**Total**

**Non-Hispanic Asian**

**Other**

**Hispanic**

## Table 6.6

**The Uninsured by Age, 1987-2005**

*A growing majority of the uninsured are adults 18-54.*

- Note: Under 65 population.  See also table 4.34
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

## Table 6.7

**The Uninsured by Income, 1987-2005**

- Note: Under 65 population.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

*The share of the uninsured with incomes above 200% of poverty is growing.*

## Table 6.8

**The Uninsured by Ethnicity, 1987-2005**

*About half of the uninsured are white, nearly one-third are Hispanic.*

- Note: Under 65 population.
*Source:* Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

## Table 6.9

**The Uninsured by State, 2005**

*The South and West have higher rates of uninsured than the Mid-west and East.*

**Medium (14% - 17.9%)**

**High (18%+)**

**Low (7% - 13.9%)**

**WA**

**OR**

**ID**

**MT**

**ND**

**WY**

**NV**

**CA**

**UT**

**AZ**

**NM**

**KS**

**NE**

**MN**

**MO**

**WI**

**TX**

**IA**

**IL**

**IN**

**AR**

**LA**

**AL**

**SC**

**TN**

**NC**

**FL**

**OH**

**MI**

**WV**

**PA**

**NY**

**AK**

**MD**

**ME**

**VT**

**NH**

**MA**

**RI**

**CT**

**DE**

**DC**

**HI**

**CO**

**GA**

**MS**

**OK**

**NJ**

**SD**

**National average is 16% **

**VA**

**KY**

- *Other includes private non-group and other public insurance (mostly Medicare and military-related). Medicaid includes CHIP.
*Source:* Census Bureau, March Current Population Survey.

## Table 6.10

**Impact on Non-Elderly Adults of Being Uninsured, 2006**

*The uninsured face financial and other barriers to health care.*

- Note: Among adults under age 65.
*Source: Kaiser Foundation, The Uninsured: A Primer, Jan. 2006.*