Use of CE Data in the National HeExpenditure Accounts

• Cathy A. Cowan• Economist• National Health Statistics Group/Office o

Actuary

• Centers for Medicare & Medicaid Service• Presentation to the Consumer Expenditu

Survey Data Users’ Needs Forum

• June 21-22, 2010
National Health Expenditures Acc

• What is it – what does it measure?• Who uses the NHEA• CE data in the NHEA

▫ Out

-of-pocket spending pocket spending

▫ Individually purchased health insurance▫

S

pecial Studies

• Future needs
National Health Expenditure Accounts—What is it?

• National Health Expenditure Account

▫ Historical spending 1960 Historical spending, 1960

-2008

▫ Health Spending By Sponsor, 1987 -2008▫ Projections

 Short term (10 years) Long term (75 years)

▫ State Health Expenditure Accounts

 S di b t t f id Spending by

st

at

e

of provider

 Per capita spending by state of residency 

▫ Expenditures By Age Group▫ Stec or A li na ys

i

s
Customers--Who Are They?

• Congress• Federal agencies• State governments• Researchers/educators• Mki d ar

keting departments

• Wall Street

• P bli ti P

ublications

• Students
Recent NHEA Products

• September 2007- Health Spending Estimates by 

Residence 1991 Residence, 1991

-2004

http://www.cms.hhs.gov/NationalHealthExpendData/05_NationalHeal

teHealthAccounts.asp#TopOfPage

• November 2007 – Health Spending Estimates by 

1987 1996 1999 2002 d 2004 1987, 1996, 1999, 2002, and 2004http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.1.w1v1?mHITS=10&hits=10&RESULTFORMAT=&fulltext=hartman&andorexactfuarchid=1&FIRSTINDEX=0&resourcetype=HWCIT

• January 2010 – National lh d Heal

th Expen

ditures, 19

http://content.healthaffairs.org/cgi/reprint/29/1/147

• February 2010 – National Health Expenditures P j ti Projections, 2009-2019

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.10
Use of CE in the National Health Expenditure Accounts

• Out-of-pocket spending• Individually purchased health insurance • Special studies
Out-of-pocket Spending for HealtCare

Out-of-pocket spending for health care consists spending by consumers for all health care goodservices. Included in this estimate is the amounout-of-pocket for services not covered by insurathe amount of coinsurance and deductibles requprivate health insurance (including provider pacovered by Health Savings Accounts) and by puprograms such as Medicare and Medicaid (and by some other third party).
Out of Pocket Spending On HealthConsumer Expenditure Survey Da

•

Annual data

• Integrated survey

• B f h d f h h ld B

y age

of head 

of household

s

• By income quintiles
Growth in Out of Pocket Spending1989-2007

Consumer Expenditure SurveyNational Health Expenditure Accounts

15.0%

20.0%

5.0%

10.0%

-5.0%

0.0%

-10.0%

1989 1991 1993 1995 1997 1999 2001 2003 
Individually Purchased Health Insurance

Individually purchased premiums are any that is not purchased or paid “to or throuemployer. These may include group planth h t d i ti i di id l l through trad

e associ

ations, i

ndi

vidual 

p

la

from an insurance broker, or Medicare supplemental plans supplemental plans.
Individually Purchased Health Insurance, p Consumer Ex

penditure 

•

Annual data

• By age of head of household•

S

pecial runs 
CE Data Variables Used for IndividPurchased Health Insurance ▫ First level items:

 Individually obtained-The health insurance policy is obtained by the CU.

 Employer obtained-The health insurance policy is obtained through an em

 O h b i d Ot

her group

obtained- Th h l h i li i b i d f 

Th

e health insurance policy i

s

obtained from some o

▫ Second level items:

 ..._emp pays-The total cost of the policy is paid for by the employer or a lab

 CU 

pyp a

ys 

partial-The cost of the 

p y p yp y olicy is 

partiall

y

paid for by the CU.

 CU pays all-The CU pays for the total cost of the policy. ..._other pays-The total cost of the policy is paid for by someone other than 

employer.

▫ Third level items ( y onl

y for the CU 

pyp a

ys 

partial and CU 

p ya

ys all categ ) ories :

 ..._CU part (all)_ded-At least some of the CU’s contribution to the policy is 

the CU’s paycheck.

 ..._CU part (all)_no ded-None of the CU’s contribution to the policy is ded

CU’s paycheck.

 ... CU _

p () artall) ? _ -It is not known if any p of the CU’s contribution to the 

po

from the paycheck.
Health Insurance Premiums, 1987

-2008

Employer Premiums Employee PremiumsIndividuall

y Purchased Premiums

$

$600

Billions

$

300

$400

$500

$

$100

$200

3

0

1987 1989 1991 1993 1995 1997 1999 2001 2003 

SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
Special Studies

• Out of pocket spending on health as share of 

▫ Medicare Current Beneficiary Survey▫ CE

• Variables

▫ T t l OOP ( l di i t h lth i Total OOP (excluding private health insurance

premiums)

▫ Income (before taxes)

▫ Number of consumer units▫ Average number of persons in consumer unit ▫ Total private health insurance premiums▫ Medicare premiums
Out-of-Pocket Spending Distribution a

Out-of-Pocket Spending Distribution aShare of Income, Medicare BeneficiarSurvey and Consumer Expenditure SuSurvey and Consumer Expenditure Su2005

Percent of Total OOP Spending on Health Care

MCBS 

Total OOP Sp g endin 100 % Direct OOP spending 51.9% Total health care premiums 48.1% 

Private premiums 27 2%. 

Medicare premiums 20.9% 

Total OOP as a share of income 11.1% 
Areas of Improvements

• Timeliness• Sample size• Underreporting• Reconciliation with other surveys• Impact of the Affordable Care Act on:

▫ Out of pocket health spending▫ Health insurance

 Premium Coverage