C-1 

APPENDIX C - NATIONAL AND INTERNATIONAL HEALTH CARE 

EXPENDITURES AND HEALTH INSURANCE COVERAGE

CONTENTS

National Health Expenditures 

Expenditures for Hospital Care 

Trends in Hospital Utilization 

 Admissions 

 Average Length of Stay 

 Hospital Occupancy 

 Hospital Employment 

Expenditures for Physicians’ Services 

Supply of Hospital Beds 

Supply of Physicians 

Health Insurance Status in 2002 

 Health Insurance Coverage and Selected Population Characteristics 

 Characteristics of the Uninsured Population Under Age 65 

 Trends in Health Insurance Coverage 

International Health Spending 

References 

 

NATIONAL HEALTH EXPENDITURES 

 In 1965, the year prior to the beginning of the Medicare and Medicaid 

Programs, national health expenditures were $41.0 billion. After adjusting for 

inflation, this spending figure represented $188.7 billion, or $944 per capita in 

constant 2001 dollars. Health care expenditures increased substantially over the 

next 36 years. In 2001, the most recent year for which data are available, the 

Nation's health care bill was $1,424.5 billion, or $5,034 per capita (Tables C-1, 

C-2, and C-3). 

 The average annual rate of increase in real (i.e., adjusted for inflation) per 

capita expenditures was 5.8 percent from 1985 to 1990. The rate decelerated to 

3.5 percent for the period from 1990 to 1995, and decelerated further to 

3.1 percent from 1995 to 2000. It has been argued that this relatively low rate of 

growth in health expenditures during the 1990s was due to the influence of 

managed care. However, in recent years, expenditures have grown at rates 

higher than the average rates experienced during the 1990s. Real per capita 

health expenditures grew 5.1 percent in 2001. Real per capita health spending is 

projected to grow at an average annual rate of 4.7 percent between 2001 and 

2005, then decelerate to an average rate of 3.6 percent between 2005 and 2010 

(Table C-3). 
TABLE C-1--NATIONAL HEALTH EXPENDITURES, AGGREGATE AMOUNTS FOR 

SELECTED CALENDAR YEARS 1965-2010 

Amount in Billions of Dollars Spending category 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 20

Health services and supplies 37.4 67.3 121.0 233.5 409.1 669.6 957.6 1,262.3 1,372.6 1,841.3 2,60

Personal health care 34.7 63.2 113.0 214.6 372.3 609.4 865.7 1,137.6 1,236.4 1,638.4 2,3

Hospital care 13.8 27.6 51.9 101.5 166.6 253.9 343.6 416.5 451.2 576.2 77Physician and clinical services 8.3 14.0 24.8 47.1 89.8 157.5 220.5 288.8 313.6 407.0 57

Dental services 2.8 4.7 8.0 13.3 21.7 31.5 44.5 60.7 65.6 82.8 10Other professional services 0.5 0.7 1.4 3.6 8.5 18.2 28.5 38.8 42.3 55.5 79Home health care 0.1 0.2 0.6 2.4 5.6 12.6 30.5 31.7 33.2 43.7 60Nursing home care 1.5 4.2 8.7 17.7 30.7 52.7 74.6 93.8 98.9 119.8 15Prescription drugs 3.7 5.5 8.1 12.0 21.8 40.3 60.8 121.5 140.6 228.6 37Non-durable medical products 

 (excluding prescription drugs) 2.2 3.3 4.9 9.8 16.0 22.5 25.6 31.2 31.8 37.6 47

Durable medical equipment 1.0 1.6 2.6 3.9 6.5 10.6 14.2 17.8 18.4 23.0 31Other personal health care 0.8 1.3 2.0 3.3 5.3 9.6 22.9 36.7 40.9 64.2 11

Government administration and net 

cost of private health insurance 2.0 2.8 5.1 12.1 25.2 40.0 60.4 80.7 89.7 138.2 19

Government public health activities 0.6 1.4 2.9 6.7 11.6 20.2 31.4 44.1 46.4 64.6 96

Research 1.5 2.0 3.3 5.5 8.3 12.7 17.1 29.1 32.8 42.2 61Construction 2.1 3.8 5.6 6.8 9.4 13.7 15.5 18.6 19.2 23.8 31

Total 41.0 73.1 129.8 245.8 426.8 696.0 990.1 1,310.0 1,424.5 1,907.3 2,70

Percent of Total National Health Expenditures

1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 20

Health services and supplies 91.1 92.2 93.2 95.0 95.8 96.2 96.7 96.4 96.4 96.5 96

Personal health care 0.8 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0.9 0

Hospital care 0.3 0.4 0.4 0.4 0.4 0.4 0.3 0.3 0.3 0.3 0Physician and clinical services 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0Dental services 0.1 0.1 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0Other professional services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0Home health care 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0Nursing home care 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0Prescription drugs 0.1 0.1 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0
Non-durable medical products 

 (excluding prescription drugs) 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0

Durable medical equipment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0Other personal health care 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0

Government administration and net cost  of private health insurance 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0Government public health activities 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0

Research 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0Construction 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0Source: Centers for Medicare and Medicaid Services, Office of the Actuary. Percentages calculated by Congressional Research Service. 
TABLE C-2--NATIONAL HEALTH EXPENDITURES IN CONSTANT 2001 DOLLARS, 

SELECTED CALENDAR YEARS 1965-2010 

[In Billions of dollars] 

Spending category 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 

Health services and supplies 171.9 253.5 330.6 447.9 607.4 846.9 1,068.0 1,292.2 1,372.6 1,708.8 

Personal health care 159.8 237.9 308.8 411.7 552.9 770.8 965.6 1,164.5 1,236.4 1,520.5 

Hospital care 63.6 104.0 141.9 194.8 247.3 321.2 383.2 426.4 451.2 534.7 Physician and clinical services 38.3 52.6 67.8 90.3 133.4 199.3 246.0 295.7 313.6 377.7 Dental services 12.9 17.6 21.7 25.6 32.1 39.8 49.6 62.2 65.6 76.8 Other professional services 2.5 2.8 3.8 6.9 12.6 23.0 31.8 39.7 42.3 51.6 

Home health care 0.4 0.8 1.7 4.6 8.4 15.9 34.1 32.5 33.2 40.6 Nursing home care 6.8 15.9 23.7 33.9 45.6 66.7 83.2 96.0 98.9 111.2 

Prescription drugs 17.1 20.7 22.0 23.1 32.4 51.0 67.8 124.4 140.6 212.2 

 Non-durable medical products 

 (excluding prescription drugs) 10.2 12.5 13.5 18.8 23.7 28.4 28.5 31.9 31.8 34.9 

Durable medical equipment 4.6 6.2 7.2 7.4 9.6 13.4 15.8 18.2 18.4 21.4 

Other personal health care 3.6 4.8 5.4 6.3 7.8 12.2 25.6 37.5 40.9 59.6 

Government administration and net cost of private health insurance 9.2 10.4 13.8 23.3 37.4 50.6 67.4 82.6 89.7 128.3 Government public health activities 2.9 5.1 8.0 12.9 17.2 25.6 35.1 45.1 46.4 60.0 

Research 7.0 7.4 9.1 10.5 12.3 16.0 19.1 29.8 32.8 39.1 

Construction 9.8 14.2 15.2 13.1 14.0 17.4 17.3 19.0 19.2 22.1 

Total 188.7 275.1 354.9 471.4 633.8 880.3 1,104.4 1,341.0 1,424.5 1,770.1 

Note- Constant dollar amounts were calculated using the gross domestic product (GDP) implicit price deflator. Source: Congressional Research Service based on data from the Centers for Medicare and Medicaid Services, Office of the Actuary. 
TABLE C-3--NATIONAL HEALTH EXPENDITURES: PER CAPITA AMOUNTS IN CONSANT 2001 DOLLAR

AND AVERAGE ANNUAL PERCENTAGE INCREASES, SELECETED CALENDAR YEARS 1965-2010 

Dollar amount per capita, in constant 2001 dollars Spending category 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 201

Health services and supplies 860 1,207 1,503 1,947 2,510 3,334 3,985 4,615 4,850 5,846 6,97

Personal health care 799 1,133 1,404 1,790 2,285 3,035 3,603 4,159 4,369 5,202 6,18

Hospital care 318 495 645 847 1,022 1,264 1,430 1,523 1,594 1,829 2,06Physician and clinical services 192 251 308 393 551 784 918 1,056 1,108 1,292 1,52

Dental services 64 84 99 111 133 157 185 222 232 263 288 

Other professional services 12 13 17 30 52 90 119 142 150 176 213 Home health care 2 4 8 20 35 63 127 116 117 139 161 Nursing home care 34 76 108 147 188 262 310 343 350 380 425 

Prescription drugs 85 99 100 100 134 201 253 444 497 726 998 Non-durable medical products 

(excluding prescription drugs) 51 60 61 82 98 112 106 114 112 119 127 

Durable medical equipment 23 30 33 32 40 53 59 65 65 73 83 Other personal health care 18 23 25 27 32 48 95 134 144 204 305 

Government administration and net cost of private health insurance 46 50 63 101 155 199 251 295 317 439 257 Government public health activities 14 24 37 56 71 101 131 161 164 205 259 

Research 35 35 41 46 51 63 71 106 116 134 165 Construction 49 68 69 57 58 68 64 68 68 76 83 

Total 944 1,310 1,613 2,050 2,619 3,466 4,121 4,789 5,034 6,056 7,22

Average Annual Percentage Increase 

1965-

1970 

1970-

1975 

1975-

1980 

1980- 

1985 

1985- 

1990 

1990- 

1995 

1995- 

2000 

2000- 

2001 

2001-

2005 

200

201

Health services and supplies 7.0 4.5 5.3 5.2 5.8 3.6 3.0 5.1 4.8 3.

Personal health care 7.2 4.4 5.0 5.0 5.8 3.5 2.9 5.1 4.5 3.

Hospital care 9.3 5.4 5.6 3.8 4.3 2.5 1.3 4.7 3.5 2.4 

Physician and clinical services 5.5 4.2 5.0 7.0 7.3 3.2 2.8 5.0 3.9 3.4 Dental services 5.4 3.4 2.4 3.6 3.4 3.4 3.7 4.4 3.2 1.

Other professional services 1.7 5.2 11.8 11.6 11.7 5.6 3.6 5.4 4.2 3.9 

Home health care 14.0 14.4 20.7 11.8 12.6 15.2 -1.8 1.0 4.3 3.
TABLE C-3--NATIONAL HEALTH EXPENDITURES: PER CAPITA AMOUNTS IN CONSANT 2001 DOLLAR

AND AVERAGE ANNUAL PERCENTAGE INCREASES, SELECTED CALENDAR YEARS 1965-201

continued 

Average Annual Percentage Increase

Spending category 1965-

1970 

1970-

1975 

1975-

1980 

1980- 

1985 

1985- 

1990 

1990- 

1995 

1995- 

2000 

2000- 

2001 

2001-

2005 

200

201

Nursing home care 17.4 7.3 6.5 5.0 6.9 3.4 2.0 1.9 2.1 2.

Prescription drugs 2.9 0.3 0.1 5.9 8.5 4.7 11.9 11.8 10.0 6.

Non-durable medical products 

(excluding prescription drugs) 3.2 0.6 5.9 3.7 2.7 -1.0 1.4 -1.6 1.5 1.3 

Durable medical equipment 5.1 2.0 -0.3 4.2 5.9 2.3 1.9 0.1 3.0 2.Other personal health care 4.9 1.7 2.0 3.4 8.2 14.7 7.0 7.7 9.0 8.4 

Government administration and net cost 

of private health insurance 1.5 4.8 10.0 8.8 5.2 4.8 3.2 7.5 8.5 3.7 

Government public health activities 11.2 8.5 9.0 4.8 7.3 5.4 4.3 1.7 5.8 4.

Research 0.0 3.3 2.0 2.3 4.4 2.5 8.4 9.0 3.7 4.

Construction 6.7 0.4 -3.8 0.4 3.4 -1.2 1.0 -0.2 2.8 1.

Total NHE 6.8 4.3 4.9 5.0 5.8 3.5 3.1 5.1 4.7 3.

Note - Constant dollar amounts were calculated using the gross domestic product (GDP) implicit price deflator. Source: Congressional Research Service based on data from the Centers for Medicare and Medicaid Services, Office of the Actuary. 
C-7 

 The majority of health spending is for personal health care services that 

treat or prevent illness and disease in individuals. In 2001, 86.8 percent of all 

health spending ($1,236.4 billion) was for personal health care. The remaining 

13.2 percent ($188.1 billion) was spent on health program administration; 

administrative costs and profits earned by private health insurers; public health 

activities; noncommercial health research; and construction of health facilities 

(Table C-1).

 A combination of factors can cause personal health care spending to 

increase: rising prices, population growth, increases in the quantity of medical 

services each person receives, advances in medical knowledge and technology, 

and other factors. Chart C-1 depicts the share of personal health care spending 

growth attributable to increases in medical care prices, increases in population, 

and increases in real per capita health expenditures (what some experts describe 

as the “intensity” of care). For much of the time period shown in Chart C-1, 

prices played a larger role in personal health spending increases than population 

or non-price factors (e.g., improved medical technology or higher utilization). 

During the late 1990s, medical care prices, constrained by managed care, grew 

at lower rates than in any other year shown. Price growth is projected to increase 

during the next decade, though not to the high levels experienced during the 

1970s and 1980s. 

Source: Congressional Research Service analysis of data from the Centers for Medicare and 

Medicaid Services, Office of the Actuary.

 

CHART C-1--FACTORS INFLUENCING GROWTH IN NOMINAL PERSONAL 

HEALTH CARE EXPENDITURES, 1965-2012 

0% 

2% 

4% 

6% 

8% 

10% 

12%

14%

16% 

1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 

Y ear

A ctual Projected

Increase in Medical Care Prices

Increase in Real Personal Health Care Spending (Per Capita) 

Increase in Population

Increase in Nominal Personal Health Expenditures 
C-8 

 Hospital care and physician services are the two largest categories of 

personal health care spending. In 2001, they accounted for 31.7 percent 

($451.2 billion) and 22.0 percent ($313.6 billion), respectively, of total national 

health expenditures (Table C-1). Another major service area, prescription drugs, 

grew from 5.8 percent of all national health expenditures in 1990 to 9.9 percent 

in 2001. In real per capita terms, spending on prescription drugs increased 

11.8 percent over 2000 levels, making this category of personal health care the 

fastest growing. It is projected to remain the fastest growing category of 

personal health care in the near future (Table C-3). 

 Direct payments for personal health care come from five general sources: 

consumer payments out-of-pocket, payments by private insurance companies, 

Federal funds, State and local funds, and “other” private funds. Out-of-pocket 

payments include payments by those without health insurance. Out-of-pocket 

payments also include payments by the insured for deductibles, coinsurance, and 

costs not covered by insurance (excluding premiums). “Other” private funds 

consist mostly of philanthropic contributions to the health care system. 

 Ultimately, all health care spending is paid for by individuals through 

direct payments, cost-sharing, insurance premiums, taxes, and charitable 

contributions. However, most of these payments are redistributed; what a 

person pays does not necessarily reflect how much health care that person 

receives. One who pays relatively high taxes might not have any of their health 

care financed by the government. Similarly, there are some people who pay 

health insurance premiums, yet use less care than the sum of the premiums paid. 

Only when individuals pay directly for the cost of treatment (either because they 

are uninsured or because they have not met their deductible) do personal 

expenditures directly reflect the amount of care received. 

Table C-4 shows the percent of personal health care spending attributable 

to each source. In 1965, 52.3 percent of all personal health care was financed 

out-of-pocket, whereas private insurance paid for 25.1 percent and the Federal 

government paid for 8.1 percent. In 2001, only 16.6 percent of personal health 

care was paid out-of-pocket while private insurance paid for 35.4 percent and 

the Federal government paid for 32.9 percent. Much of the increase in the 

Federal government’s share of health spending occurred during the 1960s, when 

the Medicare and Medicaid programs were introduced. 

EXPENDITURES FOR HOSPITAL CARE 

 Based on data from the Centers for Medicare and Medicaid Services 

(CMS), hospitals accounted for 31.7 percent of total national health expenditures 

in 2001, down from 41.3 percent in 1980. A different data source, the National 

Center for Health Statistics, provides expenses incurred by hospitals based on 

ownership structure (Table C-5). Total expenses for hospitals of all types 

reached $395.4 billion in 2000, up 6.0 percent from the previous year. This 

increase is higher than in recent years; expenses for hospitals of all types 

increased 3.9 percent in 1998 and 4.9 percent in 1999. However, the growth in 

2000 is still lower than the average growth that occurred during the late 1970s
TABLE C-4--PERSONAL HEALTH CARE EXPENDITURES, AGGREGATE AMOUNTS AND PERCENTA

DISTRIBUTION, SELECTED CALENDAR YEARS 1965-2010 

Source of funding 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 

Amount in billions of dollars 

Private 27.7 40.9 68.0 128.0 225.6 371.5 478.4 648.1 699.4 935.7 1

Private health insurance 8.7 14.1 27.5 60.6 111.3 203.6 288.2 397.1 437.2 604.4 

Out-of-pocket 18.2 25.1 37.4 58.2 95.5 137.3 146.2 194.7 205.5 262.4 

Other private 0.8 1.8 3.1 9.2 18.8 30.6 44.1 56.3 56.7 68.9 

Public 7.1 22.3 45.0 86.6 146.7 237.9 387.2 489.5 537.0 702.7 1

Federal 2.8 14.5 30.6 62.8 109.7 174.2 296.5 371.1 406.6 523.6 

State and local 4.3 7.8 14.4 23.8 37.0 63.7 90.8 118.4 130.4 179.1 

Total 34.7 63.2 113.0 214.6 372.3 609.4 865.7 1,137.6 1,236.4 1,638.4 2

 Percentage distribution Private 79.6 64.8 60.2 59.7 60.6 61.0 55.3 57.0 56.6 57.1 

Private health insurance 25.1 22.3 24.4 28.3 29.9 33.4 33.3 34.9 35.4 36.9 Out-of-pocket 52.3 39.7 33.1 27.1 25.6 22.5 16.9 17.1 16.6 16.0 Other private 2.2 2.8 2.7 4.3 5.1 5.0 5.1 4.9 4.6 4.2 

Public 20.4 35.2 39.8 40.3 39.4 39.0 44.7 43.0 43.4 42.9 

Federal 8.1 22.9 27.1 29.3 29.5 28.6 34.2 32.6 32.9 32.0 State and local 12.3 12.3 12.7 11.1 10.0 10.5 10.5 10.4 10.6 10.9 

Source: Centers for Medicare and Medicaid Services, Office of the Actuary. Percentages calculated by Congressional Research Service 
TABLE C-5-- HOSPITAL EXPENSES BY TYPE OF OWNERSHIP, SELECTED CALENDAR YEARS 

1975-2000 

Type of hospital 1975 1980 1985 1990 1995 1997 1998 1999 2000 

Total expenses in billions of dollars 

All hospitals 48.7 91.9 153.3 234.9 320.3 342.3 355.5 372.9 395.4 

Federal 4.5 7.9 12.3 15.2 20.2 22.7 22.6 23.7 23.9 Non-federal 1 44.2 84.0 141.0 219.6 300.0 319.6 332.9 349.2 371.5 

Community 2 39.0 76.9 130.5 203.7 285.6 305.8 318.8 335.2 356.6 

Non-profit 27.9 55.8 96.1 150.7 209.6 225.3 238.0 251.5 267.1 

For profit 2.6 5.8 11.5 18.8 26.7 31.2 31.7 31.2 35.0 State-local government 8.5 15.2 22.9 34.2 49.3 49.3 49.1 52.5 54.5 

Expenses per inpatient day 

Community 2 151 245 460 687 968 1,033 1,067 1,103 1,149 

Non-profit 150 246 463 692 994 1,074 1,111 1,140 1,182 For profit 146 257 500 752 947 962 968 999 1,057 State-local government 157 239 433 634 878 914 949 1,007 1,064 

Expenses per inpatient stay 

Community 2 1,165 1,851 3,245 4,947 6,216 6,262 6,386 6,512 6,649 

Non-profit 1,178 1,902 3,307 5,001 6,279 6,393 6,526 6,608 6,717 

For profit 968 1,676 3,033 4,727 5,425 5,219 5,262 5,350 5,642 State-local government 1,197 1,750 3,106 4,838 6,445 6,475 6,612 6,923 7,106 1The category of non-Federal hospitals is comprised of psychiatric, tuberculosis and other respiratory disease hospitals, and long-term and shortterm general and other special hospitals. 

2 Community hospitals are non-Federal short-term general and special hospitals whose facilities and services are available to the public. Exclude

hospital units in institutions such as prison and college infirmaries, facilities for the mentally retarded, and alcoholism and chemical dependency 

hospitals. Special hospitals include obstetrics and gynecology; eye, ear, nose and throat; rehabilitation; and orthopedic. Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2002.
TABLE C-6 -- NATIONAL EXPENDITURES ON HOSPITAL CARE BY SOURCE OF FUNDS, 

SELECTED CALENDAR YEARS 1965-2010 

Source of funding 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 

 Amount in billions of dollars Out-of-pocket 2.7 2.5 4.3 5.3 8.8 11.2 10.5 13.1 13.8 17.4 Third-party 11.1 25.1 47.6 96.3 157.8 242.7 333.1 403.4 437.4 558.7 

Private health insurance 5.7 9.0 17.1 36.1 58.6 97.1 111.1 139.3 152.1 202.7 Other private 0.3 0.9 1.4 5.0 8.2 10.4 14.6 22.0 22.1 28.3 Government 5.1 15.2 29.0 55.2 91.0 135.2 207.3 242.1 263.1 327.7 

Federal 2.0 9.9 20.1 41.5 71.2 102.7 167.2 193.0 209.4 262.0 

Medicare 0.0 5.4 11.5 26.4 48.9 67.8 108.0 125.9 135.0 165.6 Medicaid (incl. SCHIP expansion)1 0.0 1.4 2.8 5.7 8.5 16.4 35.9 41.3 45.0 60.1 

 Other federal 2.0 3.1 5.7 9.4 13.8 18.5 23.3 25.8 29.4 36.3 

State and local 3.1 5.3 8.9 13.7 19.8 32.4 40.2 49.1 53.7 65.7 

Medicaid (incl. SCHIP expansion)2 0.0 1.2 2.3 4.8 7.1 11.2 18.6 29.0 32.4 43.5 Other state and local 3.1 4.1 6.6 8.8 12.7 21.2 21.6 20.1 21.3 22.2 

Total 13.8 27.6 51.9 101.5 166.6 253.9 343.6 416.5 451.2 576.2 

Percent of total hospital expenditures

Out-of-pocket 19.8 9.1 8.4 5.2 5.3 4.4 3.0 3.2 3.1 3.0 Third-party 80.2 90.9 91.6 94.8 94.7 95.6 97.0 96.8 96.9 97.0 

Private health insurance 41.2 32.6 33.0 35.6 35.2 38.3 32.3 33.4 33.7 35.2 Other private 1.9 3.3 2.8 4.9 4.9 4.1 4.3 5.3 4.9 4.9 Government 37.1 55.1 55.9 54.3 54.6 53.2 60.3 58.1 58.3 56.9 

Federal 14.6 35.9 38.7 40.9 42.7 40.5 48.7 46.3 46.4 45.5 

Medicare 0.0 19.4 22.2 26.0 29.3 26.7 31.4 30.2 29.9 28.7 Medicaid (incl. SCHIP expansion)1 0.0 5.2 5.5 5.7 5.1 6.4 10.5 9.9 10.0 10.4 

 Other federal 14.6 11.4 11.0 9.2 8.3 7.3 6.8 6.2 6.5 6.3 

State and local 22.4 19.1 17.2 13.5 11.9 12.8 11.7 11.8 11.9 11.4 

Medicaid (incl. SCHIP expansion)2 0.0 4.4 4.5 4.8 4.3 4.4 5.4 7.0 7.2 7.6 

Other state and local 22.4 14.7 12.7 8.7 7.6 8.4 6.3 4.8 4.7 3.9 

1 Federal share only. 2 State and local share only. 

Source: Centers for Medicare and Medicaid Services, Office of the Actuary. Percentages calculated by Congressional Research Service 
C-12 

and the 1980s. From 1975 to 1980, hospital expenses grew at an average annual 

rate of 13.5 percent. From 1980 to 1985, hospital expenses grew at an average 

annual rate of 10.8 percent. From 1985 to 1990, hospital expenses grew at an 

average annual rate of 8.9 percent. 

 Based on data from CMS, expenditures for hospital care are financed 

primarily by third parties, as shown in Table C-6. In 2001, private health 

insurers paid 33.7 percent of total hospital expenditures. Medicare financed 29.9 

percent of hospital spending in 2001, and Medicaid (including both the Federal 

and State shares) financed 17.2 percent of hospital spending. The share financed 

by out-of-pocket payments from individuals was only 3.1 percent in 2001, down 

from 19.8 percent in 1965. 

TRENDS IN HOSPITAL UTILIZATION 

ADMISSIONS 

 Hospital utilization in the United States has undergone major change in 

the past twenty years, greatly influenced by technology, health care policy, and 

population dynamics. During the 1970s, hospital admissions increased 

consistently and had reached highs of over 36 million in the early 1980s. With 

the introduction of Medicare’s prospective payment system (PPS) in 1983, 

which encouraged more cost efficient treatment methods, admissions declined 

dramatically for several years, as shown in Table C-7. After 1987, total 

admissions continued to decrease, though more slowly, and reached a low of 

30.7 million in 1994. Since 1994, hospital admissions again have increased 

each year, due in part to the growing health care needs of adults 65 and older. 

The largest increases, since 1999, also may be attributable to the weakening 

impact of managed care. Close to 34 million people were admitted to hospitals 

in 2001, a level roughly comparable to that of 1985. 

 Another significant trend that has developed since the implementation of 

Medicare’s PPS has been the increasing provision of health care services in 

more cost-effective outpatient settings favored by insurers. This has been made 

possible by scientific and technological advances which allowed surgical 

procedures to be completed safely in a shorter amount of time. Total outpatient 

visits more than doubled from 212 million in 1984 to 538 million in 2001, 

steadily growing by an average of over 5 percent each year (Table C-7). 
C-13 

TABLE C-7—ANNUAL NUMBER AND CHANGE IN HOSPITAL 

ADMISSIONS, TOTAL OUTPATIENT VISITS, AND 

EMERGENCY DEPARTMENT VISITS, 1980-20011

Year Admissions Percent 

Change

Total 

Outpatient 

Visits 

Percent 

Change

Emergency 

Department 

Visits2

Percent 

Change 

1980 36,143,445 — 202,309,969 — 77,245,450 — 

1981 36,438,232 0.8 202,767,648 0.2 77,492,569 0.3 

1982 36,379,446 -0.2 248,123,640 22.4 75,981,004 -2.0 

1983 36,151,780 -0.6 210,044,017 -15.3 72,721,575 -4.3 

1984 35,155,462 -2.8 211,961,312 0.9 72,980,188 0.4 

1985 33,448,631 -5.9 218,716,402 3.2 74,546,904 2.1 

1986 32,378,796 -3.2 231,911,949 6.0 76,601,412 2.8 

1987 31,600,817 -2.4 245,523,911 5.9 78,287,282 2.2 

1988 31,452,835 -0.5 269,129,322 10.2 81,259,787 3.8 

1989 31,116,048 -1.1 285,711,585 6.5 84,305,300 3.7 

1990 31,181,046 0.2 301,329,000 5.5 86,692,503 2.8 

1991 31,064,283 -0.4 322,047,875 6.9 88,533,073 2.1 

1992 31,033,557 -0.1 348,521,652 8.2 90,768,575 2.5 

1993 30,748,051 -0.9 366,884,946 5.7 92,554,898 2.0 

1994 30,718,136 -0.1 382,923,566 4.4 90,497,301 -2.2 

1995 30,945,357 0.7 414,344,837 8.2 94,745,938 4.7 

1996 31,098,959 0.5 439,863,107 6.2 93,111,952 -1.7 

1997 31,576,960 1.5 450,140,010 2.3 92,819,892 -0.3 

1998 31,811,673 0.7 474,193,468 5.3 94,771,405 2.1 

1999 32,359,042 1.7 495,346,286 4.5 99,484,462 5.0 

2000 33,089,467 2.3 521,404,976 5.3 103,144,030 3.7 

2001 33,813,589 2.2 538,480,378 3.3 105,957,778 2.7 

1

 Survey data for U.S. registered community hospitals (non-federal, short-term general 

and other special hospitals). 

2 Emergency department visits are included within the category “Total Outpatient Visits.” 

3

 AHA categorizes a “visit” as an appearance by an outpatient to a unit of the hospital. 

Each test, examination, treatment or procedure rendered to an outpatient counts as one 

“occasion of service.” In 1982, “visits” and “occasions of service” were not reported 

separately and let to a higher than normal count. This was corrected for 1983. 

Source: American Hospital Association. Hospital Statistics. 

 

Hospital emergency department visits also continued to rise steadily from 

1984 to 1993, though at a slower rate of 2 to 3 percent (Table C-7). The 1986 

Emergency Medical Treatment and Labor Act (EMTALA), which required 

emergency departments to perform a screening examination and treat or stabilize 

patients for transfer to another facility, may have influenced growth during this 

time frame. This was followed by several years (1994, 1996, 1997) of decline in 

total visits, perhaps due to restrictions by insurers. The Balanced Budget Act of 

1997, however, required the Medicaid and Medicare programs to reimburse 

hospitals for emergency care that a reasonable person would consider necessary 

and many States passed laws with similar “prudent layperson” standards. Since 

then, hospital emergency department visits have increased by 14 percent from 

93 million in 1997 to 106 million 2001. This number is expected to grow as 

hospital emergency departments are increasingly used as a “safety net” by 

persons without health insurance. 
C-14 

AVERAGE LENGTH OF STAY 

 

 Advances in medical technology and drug therapy contributed to a steady 

decrease in the average length of hospital stay from over 8 days in the late 1960s 

to 7.1 days in 1982. The implementation of the Medicare PPS system in 1983 

caused the average stay to fall further to 6.5 days in 1985. The change was even 

greater for patients over 65, who saw a decline in length of stay from 10.1 in 

1982 to 8.7 in 1985. In the latter part of the 1980s as outpatient visits increased, 

patients admitted to hospitals tended to be those with more severe illnesses 

which required longer hospital stays, and the average length of stay became 

more stable and even increased for those 65 or over. Beginning in the early 

1990s, however, declines occurred which were even steeper than in the first 

years of PPS. The average length of stay in 2001 was at 4.9 for all ages, 

compared to 6.4 in 1990, a decrease of 23 percent. For persons over the age of 

65, the average length of stay declined 33 percent from 8.7 days in 1990 to 

5.8 days in 2001. Declines in the past ten years have been attributed to greater 

insurance coverage of post-acute care alternatives to hospitalization, an increase 

in managed care and other cost-containment programs, as well as continuing 

technological advances. 

TABLE C-8--AVERAGE LENGTH OF STAY AND ANNUAL CHANGE 

BY AGE GROUP, 1980-2001 

All Ages 65 and Older 

Year Average Length 

of Stay in Days Percent Change Average Length 

of Stay in Days Percent Change 

1980 7.3 — 10.7 —

1981 7.2 -1.4 10.5 -1.9 

1982 7.1 -1.4 10.1 -3.8 

1983 6.9 -2.8 9.7 -4.0 

1984 6.6 -4.5 8.9 -8.2 

1985 6.5 -1.5 8.7 -2.2 

1986 6.4 -1.5 8.5 -2.3 

1987 6.4 0.0 8.6 1.2 

1988 6.5 1.6 8.9 3.5 

1989 6.5 0.0 8.9 0.0 

1990 6.4 -1.5 8.7 -2.2 

1991 6.4 0.0 8.6 -1.1 

1992 6.2 -3.1 8.2 -4.7 

1993 6.0 -3.2 7.8 -4.9 

1994 5.7 -5.0 7.4 -5.1 

1995 5.4 -5.2 6.8 -8.1 

1996 5.2 -3.7 6.5 -4.4 

1997 5.1 -1.9 6.3 -3.1 

1998 5.1 0.0 6.2 -1.6 

1999 5.0 -2.0 6.1 -1.6 

2000 4.9 -2.0 6.0 -1.6 

2001 4.9 0.0 5.8 -3.3 

Source: National Center for Health Statistics. National Hospital Discharge Survey of non-federal, 

short-stay hospitals. 
C-15 

HOSPITAL OCCUPANCY 

 Table C-9 shows that community hospital occupancy rates were over 

70 percent in the early 1980s. The number of hospital beds was increasing and 

exceeded 1 million by 1981. Following the introduction of PPS, however, 

occupancy rates decreased dramatically. From 1983 to 1986, the aggregate 

occupancy rate fell from 73.5 percent to 64.3 percent. There was a slight 

increase in occupancy rates in the late 1980s, but even though the number of 

hospital beds had been steadily declining, a reduction in the average length of 

stay lowered the occupancy rate below 63 percent by 1993. Since 1997, there 

have been slight increases each year in hospital occupancy rates and in 2001 the 

nationwide rate was at 64.5 percent. During this same period of time, the 

number of community hospitals steadily declined from 5,830 in 1980 to 4,908 in 

2001. With fewer hospitals and beds, the increasing occupancy rate is causing a 

struggle for some hospitals to cope with growth in patient admissions. 

TABLE C-9--NUMBER AND PERCENT CHANGE IN HOSPITALS, 

TOTAL BEDS, AND OCCUPANCY RATE, 1980 - 20011

Year Community 

Hospitals 

Percent 

Change 

Total 

Beds 

Percent 

Change 

Occupancy 

Rate 

Percent 

Change 

1980 5,830 — 988,387 — 75.6 — 

1981 5,813 -0.3 1,003,435 1.5 76.0 0.5 

1982 5,801 -0.2 1,012,191 0.9 75.3 -0.9 

1983 5,783 -0.3 1,018,482 0.6 73.5 -2.4 

1984 5,759 -0.4 1,017,057 -0.1 69.0 -6.1 

1985 5,732 -0.5 1,000,678 -1.6 64.8 -6.1 

1986 5,678 -0.9 978,375 -2.2 64.3 0.8 

1987 5,611 -1.2 958,312 -2.1 64.9 0.9 

1988 5,533 -1.4 946,697 -1.2 65.5 0.9 

1989 5,455 -1.4 933,318 -1.4 66.2 1.1 

1990 5,384 -1.3 927,360 -0.6 66.8 0.9 

1991 5,342 -0.9 924,049 -0.4 66.1 -1.0 

1992 5,292 -0.9 920,943 -0.3 65.6 -0.8 

1993 5,261 -0.6 918,786 -0.2 62.9 -4.1 

1994 5,229 -0.6 902,061 -1.8 62.8 -0.2 

1995 5,194 -0.7 872,736 -3.3 62.8 0.0 

1996 5,134 -1.2 862,352 -1.1 61.6 -1.9 

1997 5,057 -1.5 853,287 -1.6 61.8 0.3 

1998 5,015 -0.8 839,988 -1.2 62.5 1.1 

1999 4,956 -1.2 829,575 -1.2 63.4 1.4 

2000 4,915 -0.8 823,560 -0.7 63.9 0.8 

2001 4,908 -0.1 825,966 0.3 64.5 0.9 

1 Survey data for U.S. registered community hospitals (non-federal, short-term general an other 

special hospitals, including separate hospital nursing home units. 

Source: American Hospital Association. Hospital Statistics. 
C-16 

HOSPITAL EMPLOYMENT 

 Hospitals experienced a significant downturn in total employment levels at 

the time PPS was introduced, with the number of full-time equivalent hospital 

employees (FTEs) declining each year from 1983 to 1986 (Table C-10). 

Though variable, the number of FTEs increased by 2 to 3 percent through the 

late 1980s and early 1990s. After jumps of 4.2 percent in 1994 and 5.8 percent 

in 1995, the growth rate slowed. After reaching a low of 0.2 percent in 1999, it 

rose to 1.9 percent for both 2000 and 2001. In 2001, almost 4.0 million FTEs 

were employed in community hospitals. This slower rate of growth since 1996 

is attributed to a response to managed care and steps taken by hospitals to assure 

greater efficiencies in the provision of care. There are concerns, however, that 

this decline in growth has occurred as the volume of admissions and outpatient 

visits have risen and the aging of our population puts increasing pressure on the 

health care delivery system. There are also questions about the quality of care 

that can continue to be provided by a registered nurse workforce which showed 

little sign of growth. RNs comprise 24 percent of the workforce in community 

hospitals, or 958,026 RNs in 2001. (Community hospitals employed 92 percent 

of the total 1,045,501 registered nurses in all hospitals throughout the United 

States.) 

TABLE C-10--ANNUAL NUMBER AND PERCENT CHANGE IN 

HOSPITAL EMPLOYMENT, 1980 - 20011

Full-Time Equivalent Personnel Year 

Total Personnel Percent Change Registered Nurses Percent Change 

1980 2,873,064 — 622,052 — 

1981 3,033,272 5.6 629,463 1.2 

1982 3,305,590 8.9 671,902 6.7 

1983 3,095,638 -6.4 698,162 3.9 

1984 3,016,850 -2.5 697,814 0.0 

1985 2,997,095 -0.6 709,510 1.7 

1986 3,024,853 -0.9 736,266 3.8 

1987 3,113,607 2.9 758,973 3.1 

1988 3,205,112 2.9 770,619 1.5 

1989 3,303,286 3.1 791,537 2.7 

1990 3,419,519 3.5 809,927 2.3 

1991 3,535,294 3.4 840,509 3.8 

1992 3,619,849 2.4 858,909 2.2 

1993 3,677,000 1.6 868,452 1.1 

1994 3,692,316 4.2 890,910 2.6 

1995 3,713,887 5.8 893,735 0.3 

1996 3,725,000 0.3 895,107 0.2 

1997 3,789,752 1.7 901,198 0.6 

1998 3,831,068 1.1 929,657 3.2 

1999 3,837,964 0.2 938,051 0.9 

2000 3,911,412 1.9 957,550 2.1 

2001 3,987,274 1.9 958,026 0.1 

1 Survey data for U.S. registered community hospitals (non-federal, short-term general and other 

special hospitals, including separate hospital nursing home units). 

Source: American Hospital Association. Hospital Statistics. 
C-17 

EXPENDITURES FOR PHYSICIANS’ SERVICES

 Health care expenditures for physician services were $313.6 billion in 

2001, an increase of 8.6 percent from 2000. This amounted to 22.0 percent of 

national health expenditures. 

 Third-party payments financed 88.8 percent of physician services in 2001. 

Private health insurance was the single largest payer, accounting for 

48.1 percent of total spending on physician services. The share of physician 

services paid by private insurance increased from 35.3 percent in 1980 to 

47.8 percent in 1993. After 1993, the share of physician services financed by 

private insurance remained relatively stable. From 1993 to 2001, private 

insurance financed between 47.2 percent and 48.6 percent of total physician 

expenditures. The stabilization in the share of physician services funded by 

private insurance is likely the result of the increased use of managed care during 

the 1990s. 

 Public expenditures on physician services have grown relatively slowly. 

In 1980, the public sector financed 30.5 percent of all physician payments; in 

2001, the public sector financed 33.6 percent of all physician payments. Of the 

$105.4 billion spent by the government on physician services in 2001, 

$63.9 billion was for the Medicare program. Out-of-pocket payments by 

individuals for physician services have decreased from 30.2 percent in 1980 to 

11.2 percent ($35.0 billion) in 2001 (Table C-11). 

 As measured by Consumer Price Index (CPI), inflation in physicians' fees 

has outpaced that of the U.S. economy as a whole since 1980. The inflation rate 

of 2.8 percent for 2002, however, is the lowest since 1964 and the same rate of 

growth as 1999 (Table C-12). Also, the “excess” rate of increase in physician 

services prices above overall inflation since 1993 decreased to an average 

1.2 percentage points per year, down from 2.9 percentage points for the years 

from 1981 to 1992. 

 Mean physician net income (after expenses but before taxes) rose from 

$144,700 in 1988 to $205,700 in 2000 (Table C-13). This increase represents an 

average annual growth rate of 3.0 percent. Average annual increases in 

physician net income between 1988 and 2000 varied by specialty, geographic 

area, and employment status. On average, physicians in the specialty of 

radiology experienced the highest average annual increase in net income 

between 1988 and 2000 (4.2 percent). Over that same time period, physicians 

practicing anesthesiology and obstetrics/gynecology experienced the lowest 

average annual increase in net income (1.9 percent). Physicians in the West 

North Central region experienced the highest average annual increase in net 

income between 1988 and 2000 (3.5 percent). (The West North Central region 

includes North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa, and 

Missouri.) Physicians in the South Atlantic region experienced the lowest 

average annual increase in net income between 1988 and 2000 (2.2 percent). 

(The South Atlantic region includes Delaware, the District of Columbia, 

Maryland, Virginia, West Virginia, North Carolina, South Carolina, Georgia, 

and Florida.) 
C-18 

 Table C-14 shows the distribution of physicians' net incomes in 2000 by 

specialty and geographic region. While the average net income of all physicians 

was $205,700, one-half of all physicians earned $175,000 or less. One-fourth of 

all physicians earned $123,000 or less, while one-fourth earned $250,000 or 

more. Median incomes across all physician specialties remained far apart in 

2000. The median income for physician’s specializing in diagnostic radiology 

and cardiovascular diseases was $300,000, while pediatricians reported median 

incomes of $125,000. 

 On average, 40.8 percent of physician practice revenue is from some form 

of managed care contract (Table C-15). Of all specialties, obstetrics/gynecology 

and pediatrics receive the highest percent of revenues from managed care 

(56.4 percent and 54.9 percent, respectively). Psychiatry received the lowest 

percent of revenues from managed care, 28.6 percent. The share of practice 

revenue received from managed care was lowest in East South Central States. 

(The East South Central region includes Kentucky, Tennessee, Mississippi, and 

Alabama.) The share of practice revenue received from managed care was 

highest in New England States. (New England States include Maine, New 

Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island.) 

SUPPLY OF HOSPITAL BEDS 

 The national supply of community hospital beds per 1,000 population 

steadily increased from the 1940s, reaching 4.5 beds per 1,000 population in 

1980. By 2000, the number of beds dropped to 2.9 per 1,000 population. 

Among the 9 Census regions, the East South Central experienced the largest 

increase, from 1.7 per 1,000 population in 1940 to 5.1 in 1980. By 2000, this 

number had declined to 3.8, but was second in rank to West North Central which 

had 3.9 beds per 1,000. In contrast, the New England and Pacific regions never 

rose above their 1940 levels. The Middle Atlantic, East North Central, and 

Mountain Census regions experienced increases in the 1970s, but are now also 

below their 1940 levels. While all Census regions experienced a decrease in the

number of hospital beds between 1990 and 2000, the New England (-3.0), 

Mountain (-2.9), and Pacific (-2.5) regions experienced the largest drops in 

average annual percent changes. The change in the Middle Atlantic region was 

the smallest at -1.9 percent (Table C-16). 
TABLE C-11 -- EXPENDITURES FOR PHYSICIAN SERVICES BY SOURCE OF FUNDS, 

SELECTED CALENDAR YEARS 1965-2010 

Source of funding 1965 1970 1975 1980 1985 1990 1995 2000 2001 2005 

 Amount in billions of dollars 

Out-of-pocket 4.9 6.5 9.0 14.2 24.5 30.4 26.3 33.4 35.0 43.7 

Third-party 3.5 7.5 15.8 32.8 65.3 127.1 194.3 255.4 278.7 363.3 

Private health insurance 2.8 4.2 7.9 16.6 33.6 67.7 107.1 137.5 150.9 205.1 Other private 0.1 0.2 0.5 1.8 5.8 11.3 17.6 21.5 22.3 26.3 

Government 0.6 3.1 7.4 14.4 26.0 48.2 69.6 96.3 105.4 131.8 

Federal 0.1 2.3 5.6 11.3 21.1 38.7 56.2 79.8 87.0 105.7 

Medicare 0.0 1.6 3.4 8.2 16.8 30.2 41.7 59.6 63.9 72.7 Medicaid (incl. SCHIP expansion)1 0.0 0.3 1.0 1.4 2.0 4.1 8.7 11.4 12.7 19.0 

Other federal 0.1 0.3 1.1 1.8 2.3 4.4 5.9 8.8 10.4 14.0 

State and local 0.4 0.8 1.9 3.0 5.0 9.4 13.3 16.5 18.5 26.1 

Medicaid (incl. SCHIP expansion)2 0.0 0.3 0.8 1.1 1.5 2.9 6.2 7.8 9.0 13.7 

Other state and local 0.4 0.5 1.1 2.0 3.4 6.5 7.2 8.6 9.5 12.4 

Total 8.3 14.0 24.8 47.1 89.8 157.5 220.5 288.8 313.6 407.0 

Percent of total physician expenditures 

Out-of-pocket 58.5 46.1 36.3 30.2 27.2 19.3 11.9 11.6 11.2 10.7 Third-party 41.5 53.9 63.7 69.8 72.8 80.7 88.1 88.4 88.8 89.3 

Private health insurance 33.0 30.1 31.7 35.3 37.4 43.0 48.6 47.6 48.1 50.4 

Other private 1.5 1.6 2.1 3.9 6.4 7.2 8.0 7.5 7.1 6.5 

Government 6.9 22.2 30.0 30.5 29.0 30.6 31.5 33.3 33.6 32.4 

Federal 1.6 16.2 22.4 24.1 23.4 24.6 25.5 27.6 27.7 26.0 

Medicare 0.0 11.8 13.8 17.4 18.7 19.1 18.9 20.6 20.4 17.9 

Medicaid (incl. SCHIP expansion)1 0.0 2.5 3.9 2.9 2.2 2.6 3.9 3.9 4.0 4.7 

Other federal 1.6 1.9 4.6 3.7 2.5 2.8 2.7 3.1 3.3 3.5 

State and local 5.3 6.0 7.6 6.5 5.5 6.0 6.0 5.7 5.9 6.4 

Medicaid (incl. SCHIP expansion)2 0.0 2.1 3.3 2.3 1.7 1.8 2.8 2.7 2.9 3.4 

Other state and local 5.3 3.9 4.3 4.2 3.8 4.1 3.3 3.0 3.0 3.0 

1 Federal share only. 2 State and local share only. 

Source: Centers for Medicare and Medicaid Services, Office of the Actuary. Percentages calculated by Congressional Research Service 
C-20 

TABLE C-12 -- ANNUAL PERCENTAGE CHANGE IN SELECTED 

COMPONENTS OF THE CONSUMER PRICE INDEX FOR 

ALL URBAN CONSUMERS, 1960-2002 

Year All 

Items 

All Items Less 

Medical Care 

Medical Care 

Total 

Physicians' 

Services 

1960 1.7 1.3 3.7 2.8 

1961 1.0 1.0 2.7 2.3 

1962 1.0 1.0 2.6 3.1 

1963 1.3 1.0 2.6 2.2 

1964 1.3 1.3 2.1 2.5 

1965 1.6 1.6 2.4 3.7 

1966 2.9 3.1 4.4 5.6 

1967 3.1 2.1 7.2 7.2 

1968 4.2 4.2 6.0 5.6 

1969 5.5 5.4 6.7 7.0 

1970 5.7 5.9 6.6 7.5 

1971 4.4 4.1 6.2 7.0 

1972 3.2 3.2 3.3 3.0 

1973 6.2 6.4 4.0 3.4 

1974 11.0 11.2 9.3 9.2 

1975 9.1 9.0 12.0 12.1 

1976 5.8 5.3 9.5 11.2 

1977 6.5 6.3 9.6 9.3 

1978 7.6 7.6 8.4 8.4 

1980 13.5 13.6 11.0 10.5 

1981 10.3 10.4 10.7 11.0 

1982 6.2 5.9 11.6 9.4 

1983 3.2 2.9 8.8 7.8 

1984 4.3 4.1 6.2 6.9 

1985 3.6 3.4 6.3 5.9 

1986 1.9 1.5 7.5 7.2 

1987 3.6 3.5 6.6 7.3 

1988 4.1 3.9 6.5 7.2 

1989 4.8 4.6 7.7 7.4 

1990 5.4 5.2 9.0 7.1 

1991 4.2 3.9 8.7 6.0 

1992 3.0 2.8 7.4 6.3 

1993 3.0 2.7 5.9 5.6 

1994 2.6 2.5 4.8 4.4 

1995 2.8 2.7 4.5 4.5 

1996 3.0 2.8 3.5 3.6 

1997 2.3 2.3 2.8 3.0 

1998 1.6 1.5 3.2 3.0 

1999 2.2 2.1 3.5 2.8 

2000 3.4 3.3 4.1 3.7 

2001 2.8 2.7 4.6 3.6 

2002 1.6 1.4 4.7 2.8 

Source: U.S. Department of Labor, Bureau of Labor Statistics 
TABLE C-13 – PHYSICIANS’ AVERAGE NET INCOME1 AFTER EXPENSES BUT BEFORE TAXES, 

SELECTED CALENDAR YEARS 1988-2000 

[Amounts in thousands of dollars]

Category 1988 1990 1992 1994 1996 1998 2000 

Average 

Percent 

1998-

Specialty: 

General/family practice 94.6 102.7 114.4 121.4 139.1 142.5 144.7 0.

Internal medicine 130.9 152.5 162.1 175.1 185.7 182.1 196.1 3.Surgery 207.5 236.4 250.5 255.3 275.2 268.2 274.7 1.2 Pediatrics 94.9 106.5 123.9 126.2 140.6 139.6 137.8 -.0Obstetrics/gynecology 180.7 207.3 220.7 200.7 231.0 214.4 227.0 2.Radiology 188.5 219.4 257.3 237.5 275.1 258.8 310.1 9.Psychiatry 111.4 116.5 132.1 128.7 133.7 139.0 145.7 2.4 Anesthesiology 194.5 207.4 231.1 218.4 228.4 230.2 244.7 3.

Geographic area: 

New England 132.9 142.5 171.2 156.4 169.1 178.9 195.8 4.Middle Atlantic 135.0 156.1 172.4 178.0 200.3 192.0 202.2 2.East North Central 147.0 172.4 187.1 192.0 199.8 191.9 213.1 5.4 West North Central 138.0 151.4 187.5 183.9 212.6 194.2 208.4 3.

South Atlantic 156.0 169.0 186.4 189.3 196.4 193.2 203.6 2.East South Central 164.8 169.0 180.0 199.3 229.6 231.7 227.8 -0.West South Central 160.7 178.8 193.8 195.7 217.5 205.3 226.2 5.Mountain 132.1 170.9 175.7 175.6 199.1 187.7 197.3 2.Pacific 136.0 162.5 178.1 172.0 184.6 188.3 190.1 0.

Employment status: 

Self-employed 159.9 185.6 208.3 210.2 231.6 224.3 229.5 1.2 Employee 107.0 119.8 137.6 148.6 159.2 157.8 170.3 3.9 Independent contractor 137.7 147.6 141.0 168.7 181.7 156.3 171.3 4.7 

All physicians3 144.7 164.3 181.7 182.6 199.0 194.4 205.7 2.9 

1 These figures include contributions made into pension, profit-sharing, and deferred compensation plans. 2 Data not available for 1999. 3 Includes physicians in specialties not reported separately. 

Source: American Medical Association. Physician Socioeconomic Statistics, 2003 Ed. Percentage change calculated by Congressional Research Ser
C-22 

TABLE C-14--DISTRIBUTION OF PHYSICIAN NET INCOME AFTER 

EXPENSES BUT BEFORE TAXES, 

 BY SPECIALTY AND CENSUS DIVISION 

[In Thousands of Dollars]

Category Mean 25th percentile Median 75th percentile 

Specialty: 

General/family practice 144.7 100.0 132.0 170.0 

Internal medicine 196.1 120.0 160.0 240.0 

General 164.1 110.0 144.0 195.0 

Cardiovascular diseases 315.5 210.0 300.0 385.0 

Gastroenterology 299.2 160.0 250.0 351.0 

Other 204.9 150.0 200.0 250.0 

Surgery 274.7 165.0 240.0 325.0 

General 263.7 165.0 240.0 300.0 

Otolaryngology 214.5 150.0 202.0 280.0 

Orthopedic 335.8 200.0 284.0 400.0 

Ophthalmology 229.2 150.0 200.0 297.0 

Urological 264.5 169.0 225.0 350.0 

Other 325.0 175.0 275.0 450.0 

Pediatrics 137.8 98.0 125.0 165.0 

Obstetrics/gynecology 227.0 150.0 200.0 275.0 

Radiology 310.1 210.0 289.0 385.0 

Diagnostic 327.7 225.0 300.0 400.0 

Other 292.6 190.0 270.0 360.0 

Psychiatry 145.7 100.0 135.0 175.0 

Anesthesiology 244.7 180.0 250.0 300.0 

Pathology 246.5 150.0 230.0 300.0 

Other 191.5 140.0 180.0 220.0 

Emergency medicine 197.1 150.0 180.0 225.0 

Neurology 183.1 125.0 160.0 212.0 

Dermatology 219.5 150.0 180.0 240.0 

Other 170.7 124.0 160.0 205.0 

Geographic area: 

New England 195.8 120.0 180.0 240.0 

Middle Atlantic 202.2 120.0 175.0 250.0 

East North Central 213.1 132.0 180.0 250.0 

West North Central 208.4 136.0 175.0 250.0 

South Atlantic 203.6 120.0 168.0 250.0 

East South Central 227.8 130.0 190.0 287.0 

West South Central 226.2 140.0 190.0 250.0 

Mountain 197.3 120.0 160.0 250.0 

Pacific 190.1 120.0 160.0 240.0 

All physicians1

 205.7 123.0 175.0 250.0 1

 Includes physicians in specialties not listed separately. 

Source: American Medical Association. Physician Socioeconomic Statistics, 2003 Ed. 
C-23 

TABLE C-15--AVERAGE PERCENT OF PRACTICE REVENUE FROM 

MANAGED CARE, 2001 

Category Percent 

Specialty: 

General/family practice 42.5 

Internal medicine 38.0 

Surgery 38.3 

Pediatrics 54.9 

Obstetrics/gynecology 56.4 

Radiology 42.0 

Psychiatry 28.6 

Anesthesiology 48.1 

Pathology 34.8 

Other 31.8 

Geographic area: 

New England 46.0 

Middle Atlantic 45.6 

East North Central 36.9 

West North Central 38.5 

South Atlantic 38.8 

East South Central 30.3 

West South Central 44.9 

Mountain 41.6 

Pacific 40.9 

All physicians1

 40.8 

1

 Includes physicians in specialties not listed separately. 

Source: American Medical Association. Physician Socioeconomic Statistics, 2003 Ed. 
TABLE C-16--COMMUNITY HOSPITAL BEDS PER 1,000 POPULATION AND AVERAGE ANNUAL PERCENT 

CHANGE BY REGION AND STATE, SELECTED YEARS 1940-2000 

Beds per 1,000 civilian population Average annual percent change Region and State 1940 19501 19602 1970 1980 19903 20003 1940-19601, 2 1960-19702 1970-1980 1980-19903 1990-20003

New England 4.4 4.2 3.9 4.1 4.1 3.4 2.5 -0.6 0.5 0.0 -1.9 -3.0 

Maine 3.0 3.2 3.4 4.7 4.7 3.7 2.9 0.6 3.3 0.0 -2.4 -2.4 New Hampshire 4.2 4.2 4.4 4.0 3.9 3.1 2.3 0.2 -0.9 -0.3 -2.3 -2.9 Vermont 3.3 4.0 4.5 4.5 4.4 3.0 2.7 1.6 0.0 -0.2 -3.8 -1.0 Massachusetts 5.1 4.8 4.2 4.4 4.4 3.6 2.6 -1.0 0.5 0.0 -2.0 -3.2 Rhode Island 3.9 3.8 3.7 4.0 3.8 3.2 2.3 -0.3 0.8 -0.5 -1.7 -3.2 Connecticut 3.7 3.6 3.4 3.4 3.5 2.9 2.3 -0.4 0.0 0.3 -1.9 -2.3 

Middle Atlantic 3.9 3.8 4.0 4.4 4.6 4.1 3.4 0.1 1.0 0.4 -1.1 -1.9 

New York 4.3 4.1 4.3 4.6 4.5 4.1 3.5 0.0 0.7 -0.2 -0.9 -1.6 

New Jersey 3.5 3.2 3.1 3.6 4.2 3.7 3.0 -0.6 1.5 1.6 -1.3 -2.1 Pennsylvania 3.5 3.8 4.1 4.7 4.8 4.4 3.4 0.8 1.4 0.2 -0.9 -2.5 

East North Central 3.2 3.2 3.6 4.4 4.7 3.9 2.9 0.6 2.0 0.7 -1.8 -2.9 

Ohio 2.7 2.9 3.4 4.2 4.7 4.0 3.0 1.2 2.1 1.1 -1.6 -2.8 Indiana 2.3 2.6 3.1 4.0 4.5 3.9 3.2 1.5 2.6 1.2 -1.4 -2.0 Illinois 3.4 3.6 4.0 4.7 6.1 4.0 3.0 0.8 1.6 0.8 -2.4 -2.8 Michigan 4.0 3.3 3.3 4.3 4.4 3.7 2.6 -1.0 2.7 0.2 -1.7 -3.5 Wisconsin 3.4 3.7 4.3 5.2 4.9 3.8 2.9 1.2 1.9 -0.8 -2.5 -2.7 

West North Central 3.1 3.7 4.3 6.7 6.8 4.9 3.9 1.6 2.9 0.2 -1.7 -2.3 

Minnesota 3.9 4.4 4.8 6.1 5.7 4.4 3.4 1.0 2.4 -0.7 -2.6 -2.5 Iowa 2.7 3.2 3.9 5.6 5.7 5.2 4.0 1.9 3.7 0.2 -1.1 -2.4 Missouri 2.9 3.3 3.9 5.1 5.7 4.8 3.6 1.5 2.7 1.1 -1.7 -2.8 

North Dakota 3.5 4.3 5.2 6.8 7.4 7.0 6.0 2.0 2.7 0.8 -0.6 -1.5 South Dakota 2.8 4.4 4.5 5.6 5.5 6.1 5.7 2.4 2.2 -0.2 1.0 -0.7 Nebraska 3.4 4.2 4.4 6.2 6.0 5.5 4.8 1.3 3.5 -0.3 -0.9 -1.4 Kansas 2.8 3.4 4.2 5.4 5.8 4.8 4.0 2.0 2.5 0.7 -1.9 -1.8 

South Atlantic 2.5 2.8 3.3 4.0 4.5 3.7 2.9 1.4 1.9 1.2 -1.9 -2.4 

Delaware 4.4 3.9 3.7 3.7 3.6 3.0 2.3 -0.9 0.0 -0.3 -1.8 -2.6 Maryland 3.9 3.6 3.3 3.1 3.6 2.8 2.1 -0.8 -0.6 1.5 -2.5 -2.8 District of Columbia 5.5 5.5 5.9 7.4 7.3 7.6 5.8 0.4 2.3 -0.1 0.4 -2.7 
Virginia 2.2 2.5 3.0 3.7 4.1 3.3 2.4 1.6 2.1 1.0 -2.1 -3.1 

West Virginia 2.7 3.1 4.1 5.4 5.5 4.7 4.4 2.1 2.8 0.2 -1.6 -0.7 North Carolina 2.2 2.6 3.4 3.8 4.2 3.3 2.9 2.2 1.1 1.0 -2.4 -1.3 South Carolina 1.8 2.4 2.9 3.7 3.9 3.3 2.9 2.4 2.5 0.5 -1.7 -1.3 Georgia 1.7 2.0 2.8 3.8 4.6 4.0 2.9 2.5 3.1 1.9 -1.4 -3.2 Florida 2.8 2.9 3.1 4.4 5.1 3.9 3.2 0.5 3.6 1.5 -2.4 -2.0 

East South Central 1.7 2.1 3.0 4.4 5.1 4.7 3.8 2.9 3.9 1.5 -0.8 -2.1 

Kentucky 1.8 2.2 3.0 4.0 4.5 4.3 3.7 2.6 2.9 1.2 -0.5 -1.5 

Tennessee 1.9 2.3 3.4 4.7 5.5 4.8 3.6 3.0 3.3 1.6 -1.4 -2.8 Alabama 1.5 2.0 2.8 4.3 5.1 4.6 3.7 3.2 4.4 1.7 -1.0 -2.2 Mississippi 1.4 1.7 2.9 4.4 5.3 5.0 4.8 3.7 4.3 1.9 -0.6 -0.4 

West South Central 2.1 2.7 3.3 4.3 4.7 3.8 3.0 2.3 2.7 0.9 -2.1 -2.3 

Arkansas 1.4 1.6 2.9 4.2 5.0 4.6 3.7 3.7 3.8 1.8 -0.8 -2.2 Louisiana 3.1 3.8 3.9 4.2 4.8 4.6 3.9 1.2 0.7 1.3 -0.4 -1.6 Oklahoma 1.9 2.5 3.2 4.5 4.6 4.0 3.2 2.6 3.5 0.2 -1.4 -2.2 Texas 2.0 2.7 3.3 4.3 4.7 3.5 2.7 2.5 2.7 0.9 -2.9 -2.6 

Mountain 3.6 3.8 3.5 4.3 3.8 3.1 2.3 -0.1 2.1 -1.2 -2.0 -2.9 

Montana 4.9 5.3 5.1 5.8 5.9 5.8 4.7 0.2 1.3 0.2 -0.2 -2.1 Idaho 2.6 3.4 3.2 4.0 3.7 3.2 2.7 1.0 2.3 -0.8 -1.4 -1.7 Wyoming 3.5 3.9 4.6 5.5 3.6 4.8 3.9 1.4 1.8 -4.1 2.9 -2.1 

Colorado 3.9 4.2 3.8 4.6 4.2 3.2 2.2 -0.1 1.9 -0.9 -2.7 -3.7 New Mexico 2.7 2.2 2.9 3.5 3.1 2.8 1.9 0.4 1.9 -1.2 -1.0 -3.8 Arizona 3.4 4.0 3.0 4.1 3.6 2.7 2.1 -0.6 3.2 -1.3 -2.8 -2.5 Utah 3.2 2.9 2.8 3.6 3.1 2.6 1.9 -0.7 2.5 -1.5 -1.7 -3.1 Nevada 5.0 4.4 3.9 4.2 4.2 2.8 1.9 -1.2 0.7 0.0 -4.0 -3.8 

Pacific 4.1 3.2 3.1 3.7 3.5 2.7 2.1 -1.4 1.8 -0.6 -2.6 -2.5 

Washington 3.4 3.6 3.3 3.5 3.1 2.5 1.9 -0.1 0.6 -1.2 -2.1 -2.7 Oregon 3.5 3.1 3.5 4.0 4.5 2.8 1.9 0.0 1.3 -1.3 -2.2 -3.8 California 4.4 3.3 3.0 3.8 3.6 2.7 2.1 -1.9 2.4 -0.5 -2.8 -2.5 Alaska ------ ------ 2.4 2.3 2.7 2.3 2.3 ------ -0.4 1.6 -1.6 0.0 Hawaii ------ ------ 3.7 3.4 3.1 2.7 2.5 ------ -0.8 -0.9 -1.4 -0.8 

United States 3.2 3.3 3.6 4.3 4.5 3.7 2.9 0.6 1.8 0.5 -1.9 -2.4 

1 1940 and 1950 data are estimated based on published figures. 2 1960 includes hospital units of institutions. 
TABLE C-16--COMMUNITY HOSPITAL BEDS PER 1,000 POPULATION AND AVERAGE ANNUAL PERCENT 

CHANGE BY REGION AND STATE, SELECTED YEARS 1940-2000-continued

3 1990 Data.Source: Health, United States, 2002. 
C-27 

SUPPLY OF PHYSICIANS 

 Physician shortages in the 1950s and 1960s led to Federal and State 

initiatives to increase the supply of physicians. The resulting growth in the 

number of physicians per capita led to forecasts that an oversupply was 

imminent and that the nation had too few generalists and too many specialists. 

In 1994, the Council on Graduate Medical Education (COGME) reported that by 

the year 2000, “an expected staffing ratio of one physician for every 

370 Americans, was more than adequate and the nation would do well to 

greatly scale back its residency programs and shift training away from 

specialists and toward primary care.” (Weiner, 2002) 

 Tables C-17 and C-19 indicate that while the total number of physicians 

grew by 40 percent from 1970 (334,028) to 1980 (467,679), over the next ten 

years the number grew at a slower rate (31.7 percent) to 615,241 in 1990. From 

1990 to 2000, the total number of physicians grew 32.3 percent to 813,770. In 

2000, the total physician-population ratio was 294 per 100,000 persons or one 

physician for every 340 Americans. 

 The predicted physician surplus did not materialize, due in part to the lack 

of sustained impact of managed care. According to the American Medical 

Association, the percent of physicians in primary care and primary care 

specialties (general and family practice, internal medicine, obstetrics and 

gynecology, and pediatrics) has remained relatively stable at approximately 

34-40 percent since 1970. (See Tables C-17 and C-19 for number of physicians 

by specialty.) Some hospitals, however, are now reporting it difficult to recruit 

specialists such as radiologists, orthopedic surgeons, anesthesiologists, and 

cardiologists (Thrall, 2003). 

 There are also concerns about the geographic distribution of physicians 

and a continuing problem with access to care in more rural areas. Table C-18 

shows variations in the supply of non-Federal physicians relative to population 

by State. In 2000, the District of Columbia had the highest ratio (718 physicians 

per 100,000 population) while Idaho had the lowest ratio (178 physicians per 

100,000 population). 

 The adequacy of physician supply is once again the subject of debate. 

Richard Cooper and colleagues at the Medical College of Wisconsin forecast 

that the demand for physician services will continue to increase as the U.S. 

economy grows. They warn that as the U.S. population expands and ages, if the 

per capita number of physicians remains flat, today’s small national shortage of 

physicians will become a deficit of 200,000 by 2020 (Cooper, 2002). The 

Council on Graduate Medical Education is reported to be reconsidering its 

earlier position in the light of a study by Ed Salzberg of the University of 
TABLE C-17--PHYSICIAN SUPPLY BY MAJOR CATEGORIES, SELECTED YEARS 1970-2000 

1970 1980 1990 2000 Category Number Percent Number Percent Number Percent Number Perce

Federal 29,501 9 17,787 4 20,475 3 19,381 3 Non-Federal 301,323 90 443,502 96 592,166 97 792,149 97 Patient care 278,535 83 376,512 80 503,870 82 647,430 80 

Nonpatient care 32,310 10 38,404 9 43,440 8 44,938 6 Primary 134,354 40 170,705 37 213,514 35 274,653 34 

Primary care specialties 3,161 1 16,642 4 30,911 5 52,294 6 Male 308,627 92 413,395 88 511,227 83 618,223 76 Female 25,401 8 54,284 12 104,194 17 195,537 24 

U.S. graduates 270,637 81 362,307 77 475,394 77 603,869 74 

International medical graduates 57,217 17 97,726 21 131,764 21 196,961 24 Canadian graduates 6,174 2 7,646 2 8,263 1 10,717 1 

Total physicians1 334,028 100 467,679 100 615,421 100 813,770 100 

Total physician-population ratio  (per 100,000 persons) 161 -- 202 -- 244 -- 294 -- 1 Address unknown excluded from all Federal/non-Federal categories, not-classified, inactive, and address unknown are excluded from patient 

care/nonpatient care categories. 

Note-Total may not equal sum of rounded components. Source: American Medical Association (2002). 
C-29 

Albany Center for Health Workforce Studies that forecasts a shortage of about 

150,000 physicians by 2020 (Romano, 2003). 

 The long training “pipeline” makes it difficult to predict physician supply. 

According to the Association of American Medical Colleges (AAMC), since 

reaching an all-time high of 47,000 for the 1996 entering class, the number of 

medical school applicants declined to 33,501 for 2002. They projected an 

increase of 4 to 6 percent for 2003, based on the number of individuals who took 

the Medical College Admission Test in 2002 and initial applications. While the 

number of residents in training declined from 98,143 in 1997 to 96,410 in 2001, 

there was an increase to 98,258 for 2002. The number of medical school 

graduates remained more stable, though declining slightly from 16,143 in 1998 

to 15,640 in 2002 (Table C-20). 

 The supply of international medical graduates (IMGs) also could have a 

significant impact on the U.S. physician workforce. IMGs comprised 17 percent 

of total physicians in 1970. By 2000, this had risen to 24 percent of the total 

physician population (Table C-17). The number of residency positions occupied 

by IMGs fluctuated over the period 1971-95. Due to stricter immigration laws 

and more rigorous competency requirements, IMGs dropped from 41 percent of 

all residents in 1971 to about 17 percent in 1985. Since then the number of 

IMGs in training in the United States more than doubled, from 12,509 in 1985 to 

25,783 in 2002 (26 percent of all residents in training). In 1998, the Education 

Commission for Foreign Medical Graduates (ECFMG) began requiring that 

IMGs pass a basic clinical skills examination. According to the ECFMG, “the 

number of IMGs seeking and receiving certification has decreased, but the 

quality of the applicants appears to have improved and the number of IMGs 

certified annually continues to adequately fill GME positions not taken by U.S. 

medical graduates.” (Whelan, 2002) While the portion of IMGs in the U.S. 

physician workforce continues to represent approximately one-quarter of the 

physicians practicing in the U.S., since 1999, there has been a decrease in the 

number of foreign nationals and a trend toward a higher percent of U.S. citizens 

in the pool applying for certification. 

 There is considerable uncertainty as to whether there is enough evidence 

to suggest a coming physician shortage. Those who are skeptical that there is a 

doctor shortage suggest it is limited to problems with recruitment of specialists 

such as radiologists, orthopedic surgeons, anesthesiologists, and cardiologists, or 

to hospitals in certain areas because of specific market conditions. They also 

point to the difficulties in predicting how the economy will shape health care, 

e.g, if consumer-directed plans become more common, demand for services 

could fall. New kinds of health care delivery systems also could emerge with 

changes in licensing allowing clinicians to do some of the work now restricted 

to doctors (Thrall, 2003). 
C-30 

TABLE C-18--NON-FEDERAL PHYSICIAN/POPULATION RATIOS1

AND RANK BY STATE, SELECTED YEARS 1970-2000 

State 1970 1975 1985 1990 1995 2000 2000 

rank 

Alabama 90 103 152 170 202 218 41 

Alaska 74 95 137 155 164 194 48 

Arizona 144 185 220 233 239 230 36 

Arkansas 92 103 150 165 192 208 44 

California 194 219 266 272 275 281 13 

Colorado 178 186 216 232 257 263 21 

Connecticut 192 224 302 332 372 385 5 

Delaware 134 155 203 217 246 261 24 

District of Columbia 390 467 607 658 714 718 1 

Florida 155 185 236 251 269 280 14 

Georgia 108 126 172 187 214 225 38 

Hawaii 160 185 239 266 283 300 10 

Idaho 94 104 133 142 162 178 51 

Illinois 138 164 217 229 265 285 11 

Indiana 102 116 156 171 200 219 40 

Iowa 103 113 149 167 189 199 45 

Kansas 118 137 179 195 223 234 35 

Kentucky 102 122 162 181 211 230 37 

Louisiana 120 131 187 200 241 268 19 

Maine 111 133 193 208 235 277 15 

Maryland 183 217 334 360 384 406 4 

Massachusetts 207 237 331 364 420 448 2 

Michigan 125 145 190 201 232 250 27 

Minnesota 151 172 223 240 267 284 12 

Mississippi 84 94 126 144 155 181 50 

Missouri 129 148 195 209 236 246 28 

Montana 104 116 155 181 214 236 33 

Nebraska 116 134 170 185 220 245 29 

Nevada 114 129 173 175 178 196 47 

New Hampshire 140 162 207 227 248 275 16 

New Jersey 146 174 243 267 302 323 8 

New Mexico 113 130 184 206 229 238 31 

New York 236 258 318 339 391 409 3 

North Carolina 111 132 185 209 239 255 26 

North Dakota 96 106 168 184 224 242 30 

Ohio 133 147 199 213 242 262 23 

Oklahoma 103 113 149 160 177 184 49 

Oregon 144 171 215 233 250 265 20 

Pennsylvania 152 169 234 256 301 318 9 

Rhode Island 160 194 248 277 328 357 7 

South Carolina 93 114 161 177 212 234 34 

South Dakota 81 90 143 154 187 214 43 

Tennessee 119 139 189 210 247 263 22 

Texas 117 135 174 188 206 217 42 

Utah 138 155 185 200 216 221 39 

Vermont 187 207 268 288 316 375 6 

Virginia 125 149 214 233 253 272 18 

Washington 149 168 223 241 259 274 17 

West Virginia 104 124 171 183 216 238 32 

Wisconsin 120 137 188 207 239 257 25 

Wyoming 101 108 140 156 176 197 46 

United States1

 148 169 220 237 264 288 ----- 1 The ratios are for non-Federal physicians per 100,000 civilian population. Excludes 

counts of physicians in U.S. possessions and with unknown addresses. 

Source: American Medical Association, 2002.
TABLE C-19 -- PHYSICIANS TOTAL AND BY SPECIALTY, PERCENT DISTRIBUTION, 

AND PERCENT GROWTH, FOR 1970, 1980, 1990, AND 2000 

1970 1980 1990 2000 Percent Change 

Specialty Total Percent Distribution Total Percent Distribution Total Percent Distribution Total Percent Distribution 1970- 1980 1980- 1990 1990- 2000 197

200

Aerospace medicine 1,188 0.4 587 0.1 687 0.1 473 0.1 -50.6 17.0 -31.1 -60Allergy/immunology 1,719 0.5 1,518 0.3 3,388 0.6 3,998 0.5 -11.7 123.2 18.0 132Anesthesiology 10,860 3.3 15,958 3.4 25,981 4.2 35,715 4.4 46.9 62.8 37.4 228

Cardiovascular diseases 6,476 1.9 9,823 2.1 15,862 2.6 21,025 2.6 51.7 61.5 32.5 224Child psychiatry 2,090 0.6 3,217 0.7 4,343 0.7 6,158 0.7 56.5 32.8 41.8 194

Colon/rectal surgery 667 0.2 719 0.2 882 0.1 1,127 0.1 7.8 22.7 27.7 68Dermatology 4,003 1.2 5,660 1.2 7,557 1.2 9,675 1.2 41.4 33.5 28.0 141

Diagnostic radiology 1,968 0.6 7,048 1.5 15,412 2.5 21,104 2.6 258.1 118.7 36.9 972

Emergency medicine1 0 1 5,699 1.2 14,243 2.3 23,064 2.8 1 149.9 61.9 1

Family practice2 0 2 27,530 5.9 47,639 7.7 71,635 8.8 2 73.0 50.4 2Forensic pathology 200 0.1 240 0.1 414 0.1 577 0.1 20.0 72.5 39.4 188Gastroenterology 2,010 0.6 4,046 0.9 7,493 1.2 10,627 1.3 101.3 85.2 41.8 428

General practice 57,948 17.3 32,519 7.0 22,841 3.7 15,213 1.9 -43.9 -29.8 -33.3 -73

General preventative medicine 804 0.2 810 0.2 1,036 0.2 1,718 0.2 0.7 27.9 65.8 113General surgery 29,761 8.9 34,034 7.3 38,376 6.2 36,650 4.5 14.4 12.8 4.7 23Internal medicine 41,872 12.5 71,531 15.3 98,349 16.0 134,539 16.5 70.8 37.5 36.8 221

Medical genetics3 0 3 0 3 0 3 361 0.1 3 3 3 3

Neurology 3,074 0.9 5,685 1.2 9,237 1.5 12,333 1.5 84.9 62.5 33.5 301

Neurological surgery 2,578 0.8 3,341 0.7 4,358 0.7 4,997 0.6 29.6 30.4 14.6 93

Nuclear medicine1 0 1 0 1 1,340 0.2 1,448 0.2 1 1 8.0 1

Obstetrics/gynecology 18,876 5.7 26,305 5.6 33,697 5.5 40,241 5.0 39.4 28.1 19.4 113

Occupational medicine 2,713 0.8 2,358 0.5 2,744 0.4 2,990 0.4 -13.1 16.4 9.0 10Ophthalmology 9,927 3.0 12,974 2.8 16,073 2.6 18,126 2.2 30.7 20.8 12.8 82Orthopedic surgery 9,620 2.9 13,996 3.0 19,138 3.1 22,287 2.7 45.5 36.7 16.4 131Otolaryngology 5,409 1.6 6,553 1.4 8,138 1.3 9,417 1.2 21.1 24.2 15.7 74Pathology-anatomic/clin 10,283 3.1 13,402 2.9 16,710 2.6 18,220 2.2 30.3 20.7 12.7 77

Pediatrics 18,332 5.5 28,803 6.2 40,893 6.6 62,386 7.7 57.1 42.0 52.5 240

Pediatric cardiology 487 0.1 659 0.1 1,006 0.2 1,536 0.2 35.3 52.7 52.7 215
TABLE C-19 -- PHYSICIANS TOTAL AND BY SPECIALTY, PERCENT DISTRIBUTION, 

AND PERCENT GROWTH, FOR 1970, 1980, 1990, AND 2000-continued

1970 1980 1990 2000 Percent Change 

Specialty Total Percent Distribution Total Percent Distribution Total Percent Distribution Total Percent Distribution 1970- 1980 1980- 1990 1990- 2000 197

200

Physical medicine/rehabilitation 1,479 0.4 2,146 0.5 4,105 0.7 6,512 0.8 45.1 91.3 58.5 340Plastic surgery 1,600 0.5 2,980 0.6 4,590 0.7 6,200 0.8 86.3 54.0 35.1 287Psychiatry 21,146 6.3 27,481 5.9 35,163 5.7 39,457 4.8 30.0 28.0 12.2 86Public health 3,029 0.9 2,316 0.5 2,015 0.3 1,830 0.2 -23.5 -13.0 -9.2 -39Pulmonary diseases 2,315 0.7 3,715 0.8 6,080 1.0 8,706 1.1 60.5 63.7 43.2 276Radiology 10,524 3.2 11,653 2.5 8,492 1.4 8,661 1.1 10.7 -27.1 1.9 -17Radiation oncology 868 0.3 1,581 0.3 2,821 0.5 3,904 0.5 82.1 78.4 38.4 349

Thoracic surgery 1,809 0.5 2,133 0.5 2,063 0.3 4,953 0.6 17.9 -3.3 140.0 173

Urological surgery 5,795 1.7 7,743 1.7 9,372 1.5 10,302 1.3 33.6 21.0 9.9 77

Other specialty 6,929 2.1 5,810 1.2 7,254 1.2 5,794 0.7 -16.1 24.9 -20.1 -16Unspecified 12,486 3.7 12,289 2.6 8,058 1.3 8,327 1.0 -1.6 -34.4 3.3 -33Inactive 19,621 5.9 25,744 5.5 52,653 8.6 75,168 9.2 31.2 104.5 42.8 283

Not classified 4 4 20,629 4.4 12,678 2.1 45,136 5.5 4 -38.5 256.0 4

Address unknown 3,204 1.0 6,390 1.4 2,780 0.5 1,098 0.1 99.4 -56.5 -60.5 -65

Total physicians 334,028 100.0 467,679 100.0 615,421 100.0 813,770 100.0 40.0 31.6 32.2 143

1 Data were not available for emergency medicine prior to 1980 and nuclear medicine prior to 1985. 2 Data on family practice were not available prior to 1975. 3 Data on medical genetics were not available prior to 1994. 4 Not classified was established in 1970 but complete data were not available until 1972. 

Note- Data for 1990 are as of January 1. Data for all other years are as of December 31. The total for 1970 includes 358 not classified physicians. 

Source: American Medical Association (2002). 
C-33 

TABLE C-20 -- MEDICAL SCHOOL GRADUATES, FIRST-YEAR 

RESIDENTS, AND TOTAL RESIDENTS, SELECTED YEARS 1965-2002 

Year Medical school 

graduates 

First-year 

residents 

Total 

residents 

1965 7,409 9,670 31,898 

1970 8,367 11,552 39,463 

1975 12,714 13,200 54,500 

1980 15,135 18,702 61,465 

1985 16,319 19,168 75,514 

1990 15,336 18,322 82,902 

1991 15,481 19,497 86,217 

1992 15,386 19,794 88,620 

1993 15,512 21,616 96,469 

1994 15,579 19,293 97,832 

1995 15,911 21,372 98,035 

1996 15,902 21,394 98,076 

1997 15,953 21,808 98,143 

1998 16,143 21,732 97,383 

1999 15,824 22,320 97,989 

2000 15,901 NA 96,806 

2001 15,810 21,254 96,410 

2002 15,640 21,864 98,258 

NA- Not available 

Source: American Medical Association (various years). 

TABLE C-21 -- INTERNATIONAL MEDICAL GRADUATE RESIDENTS1

BY CITIZENSHIP, SELECTED YEARS 1971-2002 

Year Total Percent of all 

residents 

U.S. 

residents 

 Foreign 

 nationals 

1971 17,515 41 1,063 16,452 

1976 16,634 29 1,783 14,851 

1981 11,596 17 2,908 8,688 

1985 12,509 17 6,868 5,609 

1991 17,017 20 5,107 11,910 

1992 19,084 22 5,015 14,0692

1993 22,706 24 5,056 17,650 

1994 23,499 24 4,285 19,214 

1995 24,982 25 4,030 20,952 

1996 24,703 25 3,817 20,886 

1997 25,531 26 3,979 21,552 

1998 25,415 26 4,350 21,065 

1999 25,880 26 4,447 21,433 

2000 24,707 26 4,984 19,723 

2001 25,403 26 5,404 19,999 

2002 25,783 26 5,835 19,948 

1

 International medical graduates are defined by location of education. 

2 Includes 6,192 permanent resident aliens. 

Source: American Medical Association (various years). 
C-34 

HEALTH INSURANCE STATUS IN 2002 

 Most people have some form of health insurance. In 2002, an estimated 

84.8 percent of the total noninstitutionalized population had public or private 

coverage during at least part of the year. However, an estimated 43.6 million 

Americans, or 15.2 percent of the population, were without coverage in 2002. 

Almost all the uninsured were under age 65; consequently, 17.2 percent of the 

nonelderly population was uninsured. This section examines characteristics of 

both the insured and the uninsured populations in 2002 (Peterson, 2003), and 

reviews trends in health insurance coverage over the 1987–2002 period. 

 Estimates of health insurance coverage in 2002 are based on analysis of 

the March 2003 Current Population Survey (CPS), a household survey by the 

Department of Commerce’s Census Bureau. Each year’s March CPS asks 

whether individuals had coverage from selected sources of health insurance 

at any time during the preceding calendar year. Thus, the March 2003 CPS 

reflects respondents’ recollection of coverage during all of 2002.1 

HEALTH INSURANCE COVERAGE AND SELECTED POPULATION 

CHARACTERISTICS 

Age 

 Table C-22 provides a breakdown of health insurance coverage by type of 

insurance and age. In 2002, compared to other age groups, those under age 

5 had the highest rates of coverage in Medicaid, the State Children’s Health 

Insurance Program (SCHIP), or some other program for low-income individuals 

(30 percent). Young adults ages 19 to 24 were the most likely to have gone 

without health insurance for the entire year. While most in this age group 

(55 percent) were covered under an employment-based plan, 31 percent had no 

health insurance. Young adults are often too old to be covered as dependents on 

their parents’ policies and, as entry-level workers, do not have strong ties to the 

work force. In addition, some may feel that they are in good health and choose 

to remain uninsured, spending their money on other items. After age 25, the 

percentage of people without health insurance decreases. Of those age 65 and 

over, 95 percent were covered by Medicare, and less than 1 percent were 

uninsured for the entire year. The remainder of this section focuses on the 

population under age 65. 

 

1

 Some analysts have suggested that respondents actually may be reporting their coverage status at 

the time of the survey, rather than for the previous year. 
C-35 

TABLE C-22--HEALTH INSURANCE COVERAGE BY TYPE OF 

INSURANCE AND AGE, 2002 

 Type of insurance1 (in percent) 

Uninsured Age Population 

(in millions) Employment 

based2

Private 

nongroup

Medicare

Medicaid 

or other 

public3

Military/ 

Veterans 

coverage Percent Millions 

Under 5 19.8 59.6 4.5 0.8 29.7 3.2 11.1 2.2 

 5-18 57.5 65.4 5.6 0.7 21.3 2.9 12.4 7.1 

19-24 23.5 55.3 5.7 0.7 9.8 2.8 31.4 7.4 

25-34 39.2 63.9 5.3 1.2 7.1 2.4 24.9 9.8 

35-54 84.3 72.7 7.0 2.7 5.9 2.9 15.9 13.4 

55-61 20.6 70.2 10.4 6.7 6.2 5.0 12.6 2.6 

62-64 6.8 61.9 13.6 14.8 7.4 6.7 13.5 0.9 

65+ 34.2 34.4 29.6 95.3 9.6 6.6 0.8 0.3 

Total 285.9 62.7 9.3 13.5 11.6 3.5 15.2 43.6 

1

 People may have had more than one source of health insurance over the course of the year; therefore 

percentages may total more than 100. 

2 Group health insurance through current or former employer or union. Excludes military and veterans 

coverage. 

3

 Nonmilitary. Includes State Children’s Health Insurance Program (SCHIP) and other State programs 

for low-income individuals. 

Source: Congressional Research Service analysis of data from the March 2003 Current Population 

Survey.

Other Demographic Characteristics 

 Table C-23 shows the rate of health insurance coverage by type of 

insurance and selected demographic characteristics — race, family type, region, 

poverty level, and citizenship — for people under age 65. In 2002, whites were 

least likely to be uninsured (12 percent), while Hispanics were most likely (34 

percent). The rate of employment-based health coverage was highest among 

whites (74 percent), and the rate of public coverage was highest among blacks 

(25 percent).2

 People residing in two-parent families were most likely to have 

employment-based health insurance (74 percent) and least likely to be uninsured 

(13 percent). People in a family headed by a single mother were most likely to 

have public coverage (37 percent), compared to other family types, while people 

in a family headed by a single father were most likely to be uninsured 

(28 percent). Although people in single-father families were more likely to have 

employment-sponsored health insurance than those in single-mother families, 

 

2

 “Public coverage” includes Medicare, Medicaid, the State Children’s Health Insurance Program 

(SCHIP) and any other health insurance program for low-income individuals, but excludes military 

and veterans coverage. Hispanics may be of any race. In this report, whites, blacks, and Asians are 

those who are non-Hispanic and report only one race. Among non-Hispanics, individuals who report 

any other single race (e.g., American Indian) or multiple races are categorized as “other.” 
C-36 

that difference was eclipsed by the higher rates of public coverage in singlemother families. 

TABLE C-23--HEALTH INSURANCE COVERAGE BY TYPE OF 

INSURANCE AND DEMOGRAPHIC CHARACTERISTICS FOR PEOPLE 

UNDER AGE 65, 2002 

Type of insurance1 Uninsured 

Population (in millions) Employment 

based2 Public3

 Other4 Percent Millions 

Race/ethnicity: 

White 166.4 74.3 9.4 10.8 12.4 20.7 

Black 31.7 54.0 25.3 6.9 21.5 6.8 

Hispanic 37.3 44.5 20.8 5.1 34.0 12.7 

Asian 10.4 64.3 9.7 11.7 19.7 2.1 

Other 5.8 58.4 21.6 11.0 18.4 1.1 

Family type: 

Two parents 112.7 74.0 10.5 9.6 12.6 14.2 

Single dad with children 7.3 50.5 20.8 6.7 28.0 2.0 

Single mom with 

children 30.4 44.8 37.1 4.8 20.1 6.1 

No children 101.3 65.8 8.9 10.9 20.7 20.9 

Region: 

Northeast 46.8 69.7 13.8 6.6 15.0 7.0 

Midwest 57.0 73.0 11.8 8.1 13.2 7.5 

South 89.3 63.1 13.9 10.8 19.8 17.7 

West 58.6 62.9 13.8 11.2 19.0 11.2 

Income-to-poverty ratio:5

 

Less than 100 31.0 20.0 44.3 7.3 33.6 10.4 

100-149 21.6 35.7 30.5 8.6 32.2 7.0 

150-199 21.2 52.4 19.5 8.5 26.8 5.7 

200+ 177.2 80.3 5.1 10.1 11.3 20.0 

Citizenship: 

Native 221.9 68.8 13.8 9.8 14.5 32.3 

Naturalized 10.3 64.4 9.2 9.5 21.6 2.2 

Non-Citizens 19.5 41.5 10.4 5.9 45.3 8.8 

Total 251.7 66.50 13.40 9.50 17.20 43.3 1 People may have more than one source of coverage; percentages may total to more than 100. 

2 Group health insurance through current or former employer or union. Excludes military and 

veterans coverage. 

3 Includes Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other 

state programs for low-income individuals. Excludes military and veterans coverage. 

4

 Private nongroup health insurance, military or veterans coverage. 

5

 In 2002, the poverty threshold for a family of four with two children was $18,244. Approximately 

616,000 children are excluded from CPS-based poverty analyses because they are living with a 

family to which they are unrelated. These are usually foster children. 

Source: Congressional Research Service analysis of data from the March 2003 Current Population 

Survey.

 People were less likely to be uninsured if they lived in the Midwest 

(13 percent) or the Northeast (15 percent) than if they lived in the South 

(20 percent) or West (19 percent). At least 70 percent of those living in the 

Northeast and Midwest had employment-based health insurance, compared to 

63 percent in the South and the West. 
TABLE C-24--HEALTH INSURANCE COVERAGE BY EMPLOYMENT CHARACTERISTICS1 FOR PEOPLE 

UNDER AGE 65, 2002 

 Type of insurance2 Uninsured Population 

(millions) From 

own job3

From 

other’s job3 Other4 Percent Million

People in families with a worker5 216.5 36.2 38.0 18.2 16.3 35.3 Firm size1, 5

 Under 10 37.0 19.7 20.4 31.1 34.3 12.7 

 10-24 18.5 30.2 28.8 21.3 26.0 4.8 

 25-99 27.4 36.9 35.4 17.6 18.5 5.1 

 100-499 31 40.8 42.4 14.1 11.9 3.7 

 500-999 12.6 42.3 45.7 12.3 9.4 1.2 

 1,000 + 90.1 41.6 45.3 14.7 8.8 7.9 

Industry1, 5

 Arts, entertainment, recreation, food services, accommodation 14.4 26.3 20.5 25.2 33.7 4.9  Agriculture, forestry, fishing and hunting 3.2 19.2 23.6 32.7 30.9 1.0  Other services 8.9 26.4 24.5 26.5 29.4 2.6  Construction 18.4 25.9 31.8 19.3 29 5.3  Wholesale, retail trade 29.1 35.9 34.6 19.6 18.3 5.3  Professional, management, administrative services 21.6 35.3 36.1 18.7 18.2 3.9 

 Transportation, utilities 13 36.7 44.3 14.1 13.5 1.7  Manufacturing 32 38.9 45.8 11.8 11.3 3.6  Educational, health, and social services 40.5 42.6 40.1 17.6 10.5 4.2  Mining 1.3 35.7 51.4 13.9 9.5 0.1  Finance, insurance, real estate, rental and leasing 15.4 39.9 44.7 14.7 9.4 1.4 

 Information 6.4 42.4 44.2 12.8 9.0 0.6 

 Public administration 10.5 45.9 48.5 11.8 5.1 0.5  Armed forces, military 1.8 16.0 28.8 100.0 0.0 0.0 

Labor force attachment1, 5

 Full time, full year 171.7 38.2 41.5 15.0 13.8 23.7 
TABLE C-24--HEALTH INSURANCE COVERAGE BY EMPLOYMENT CHARACTERISTICS1 FOR PEOPL

UNDER AGE 65, 2002-continued

Type of insurance2 Uninsured Population 

(millions) From own job3 From other’s job3 Other4 Percent Million

 Full time, part year 25.6 32.2 27.8 27.1 23.8 6.1 

 Part time, full year 11.1 26.8 23.3 30.4 27.4 3.0 

 Part time, part year 8.2 20.9 16.5 41.2 30.2 2.5 

People in families without a worker5 28.0 13.86 9.6 54.6 28.5 8.0 

People with coverage outside the home 7.2 7.7 100 17.1 0.0 0.0 

Total 251.7 32.9 36.6 22.2 17.2 43.3 

1 The employment characteristics are those of the policyholder. In families without private coverage, “workers” are the family head or, if the head is 

employed, the spouse. For “dependents,” the employment characteristics are those of the person providing dependent coverage or, if the dependent 

no private health insurance, of the head of household or spouse. 

2 People may have more than one source of health insurance during the year; therefore percentages may total more than 100. 3 Group health insurance through current or former employer or union. 4 Medicare, Medicaid, the State Children's Health Insurance Program (SCHIP), and other government coverage, nongroup health insurance, and mili

and veterans coverage. 

5 For persons who worked and their dependents and who did not receive private coverage through a person not in the household. 6 Nearly 90 percent of these policyholders (i.e., those who did not work during the year but had employment-based coverage in their name) were reti

were ill or disabled, or were at home with the family and probably received coverage through their former employer. Source: CRS analysis of data from the March 2003 CPS.
C-39 

 Among individuals with incomes at least two times the poverty level, 

11 percent went without health insurance compared to 34 percent of the poor 

(i.e., those with incomes below the poverty level). Only 20 percent of the poor 

received health coverage through employment, and 44 percent had public 

coverage. Eighty percent of people with incomes at least two times the poverty 

level were covered through an employer, and only 5 percent had public 

coverage. 

 Non-citizens were more likely to be uninsured than people born with 

U.S. citizenship (i.e., “native”) — 45 percent versus 15 percent, respectively. 

Non-citizens accounted for 8 percent of the population under 65 but were 

20 percent of the uninsured. About 42 percent of non-citizens were covered 

through employment, compared to 69 percent of native citizens. 

Employment characteristics

 For the second year in a row, the prevalence of job-related health 

insurance fell, to 67 percent among the nonelderly in 2002. Table C-24 shows 

the rate of health insurance coverage by the employment characteristics of the 

primary worker in the family. In 2002, only 9 percent of workers in large firms 

(1,000 or more employees) and their dependents were uninsured, compared to 

34 percent in small firms (less than 10 employees). People who reported 

working in small firms and their dependents accounted for 15 percent of the 

under 65 population but 29 percent of the uninsured. Insurance coverage varied 

according to industry, as well. The category of arts, entertainment, recreation, 

accommodation and food services had the highest proportion of uninsured 

workers and dependents (34 percent). Only 5 percent of those associated with 

employment in public administration were uninsured, and none of those 

associated with employment in the armed forces were uninsured. 

CHARACTERISTICS OF THE UNINSURED POPULATION 

UNDER AGE 65 

 People who lack health insurance differ from the population as a whole: 

they are more likely to be young adults, poor, Hispanic, or employees in small 

firms. Chart C-2 illustrates selected characteristics of those under age 65 who 

were uninsured for 2002. Approximately 17 percent of the uninsured were 19 to 

24 years old, even though this age group represents less than 9 percent of the 

under 65 population. 

 Although Hispanics were more likely to be uninsured than any other racial 

or ethnic group, they made up less than 30 percent of the uninsured. Whites 

(non-Hispanics who report being only white) were the most numerous racial or 

ethnic group among the uninsured. 

 More than half (55 percent) of the uninsured were full time, full year 

workers or their spouses and children. Approximately 18 percent had no 

attachment to the labor force. More than three-quarters of the uninsured were 

above the poverty level. Even though the poor accounted for only 12 percent of 
C-40 

the under 65 population, they represented 24 percent of the uninsured. For the 

second year in a row, more than a quarter of the uninsured were not native-born 

citizens (that is, they were either not citizens or were naturalized citizens). 

TRENDS IN HEALTH INSURANCE COVERAGE 

 Historical trends in coverage by type of insurance for the 

noninstitutionalized U.S. population under age 65 are shown in Table C-25. 

Because of changes in the CPS questionnaire, direct comparisons of the years 

shown can only be made within these three time periods: 1987-1993, 1994-

1999, and 1999-2002. 

 Beginning with 1994 data, the survey included additional questions about 

private coverage and the order of questions was altered such that questions about 

private coverage preceded questions about other forms of health insurance. 

Consequently, differences in coverage between 1993 and 1994 are a function of 

changes in the CPS questionnaire in addition to actual changes in coverage. It is 

not possible to assess the impact of each on the estimate for 1994. Beginning 

with 1999 data, the survey included a followup question to those who reported 

no source of insurance to confirm that they were indeed uninsured. This 

question resulted in the release of new estimates for 1999, reducing the number 

of uninsured estimated through the survey. Table C-25 first shows the 1999 

results before the verification question was asked, followed by the results that 

reflect the impact of the verification question, which is now standard in the 

survey. 

 Between 1987 and 1993, the percentage of nonelderly Americans without 

health insurance increased by about 3 percentage points, from about 14 percent 

to 17 percent. During this period, the percent with employment-based coverage 

declined steadily, the percent with Medicare or Medicaid increased, and the 

percent uninsured continued to steadily increase. 

 Between 1994 and 1999, the percent with employment-based coverage 

increased by 2.5 percentage points from 65.3 to 67.8 percent. Between 2000 

and 2002, the percent with employment-based coverage declined for the first 

time since the early 1990s. From 1999 to 2002, the number of people with 

government-provided health insurance increased by 5.1 million. Following 

declines in the number of uninsured from 1998 to 2000, the number of uninsured 

rose in 2001 and 2002 — to 43.3 million (17.2 percent of the nonelderly 

population) in 2002. 
C-41 

CHART C-2--CHARACTERISTICS OF THE UNINSURED POPULATION 

UNDER AGE 65, 2002 

AGE

Under 5

5%

5-18

16%

19-24

17%

25-34

23%

35-54

31%

55-64

8%

RACE/ETHNICITY

White

47%

Black

16%

Asian

5%

Hispanic

29%

Other

3%

TIES TO WORK FORCE

Full time, full year

55%

Part time, or part year

27%

No worker in family

18%

INCOME-TO-POVERTY RATIO

Less than 100%

24%

100% to 149%

16%

150% to 199%

13%

200% or more

47%
C-42 

CHART C-2--CHARACTERISTICS OF THE UNINSURED POPULATION 

UNDER AGE 65, 2002-continued 

Note-Totals may not sum to 100 percent due to rounding. Hispanics may be of any race. In this 

chart, whites, blacks and Asians are those who are non-Hispanic and report only one race. Among 

non-Hispanics, individuals who report any other single race (e.g., American Indian) or multiple races 

are categorized as “other.” “Firm size” and “ties to work force” reflect the employment 

characteristics of the primary worker in families where someone is working. Those characteristics 

were applied to those individuals' “dependents” — their spouses and children. Employed 

policyholders of private coverage are first to be assigned as primary workers. For those in families 

without private coverage, persons' employment characteristics are those of the family head or, if the 

head is not employed and the spouse is, the spouse. 

Source: Congressional Research Service analysis of data from the March 2003 Current Population 

Survey. 

 

CITIZENSHIP

Native

75%

Naturalized

5%

Non-citizen

20%

FIRM SIZE

No worker in family

18%

Less than 10

29%

10-24

11%

25-99

12%

100-499

9%

599-999

3%

1000+

18%
TABLE C-25--HEALTH INSURANCE COVERAGE FOR THE NONINSTITUTIONALIZED 

 U.S. POPULATION UNDER 65, 1987-20021 

[Numbers in Millions]

Employment based 2 Government 3 Other 4 Uninsured Total Year Number Percent Number Percent Number Percent Number Percent Number Percent

1987 143.5 67.5 19.9 9.4 26.0 12.2 30.7 14.4 212.5 100.0 1988 144.1 67.2 20.4 9.5 25.0 11.7 32.4 15.1 214.5 100.01989 144.7 66.9 20.8 9.6 25.6 11.8 33.0 15.3 216.4 100.01990 142.5 65.2 23.8 10.9 25.7 11.8 34.4 15.7 218.6 100.01991 142.4 64.5 26.2 11.9 25.0 11.4 35.1 15.9 220.6 100.01992 5 141.3 62.5 28.9 12.8 26.0 11.5 38.2 16.9 226.1 100.01993 140.4 61.3 31.4 13.7 27.7 12.1 39.3 17.2 229 100.01994 1 150.7 65.3 31.2 13.5 20.7 8.9 39.4 17.1 230.8 100.01995 152.1 65.4 31.6 13.6 19.1 8.2 40.3 17.3 232.7 100.01996 153.9 65.5 31.1 13.3 18.6 7.9 41.4 17.6 234.9 100.01997 157.1 66.3 27.8 11.7 24.5 10.3 43.1 18.2 237 100.01998 160.8 67.2 26.9 11.3 24.0 10.0 43.9 18.4 239.3 100.01999 1,6 164.8 67.8 26.9 11.1 23.1 9.5 43.1 17.7 243.3 100.01999 7 167.3 68.8 28.6 11.8 23.4 9.6 40.0 16.4 243.3 100.02000 170.5 69.3 29.6 12.0 22.7 9.2 39.6 16.1 246 100.02001 168.8 68.0 31.9 12.8 22.8 9.2 40.9 16.5 248.3 100.02002 167.4 66.5 33.7 13.4 23.9 9.5 43.3 17.2 251.7 100.01 Questionnaire changes effective in 1994 and 1999 make numbers not strictly comparable over time. Beginning with 1994 data, the survey include

additional questions about private coverage and the order of questions was altered such that questions about private coverage preceded questions abo

other forms of health insurance. Beginning with 1999 data, the survey included a followup question to those who reported no source of insurance to 

confirm that they were indeed uninsured. This question resulted in the release of new estimates for 1999, reducing the number of uninsured estimatethrough the survey. The table first shows the 1999 results before the verification question was asked followed by the results that reflect the impact o

the verification question, which is now standard in the survey. 

2 Group health insurance through current or former employer or union. Excludes military or veterans coverage. 3 Medicare or Medicaid. For 1999 and after, this also includes other State programs for low-income individuals. 

4 Private nongroup health insurance, military and veterans coverage. 5 Based on revised weights from the 1990 Census. 
TABLE C-25--HEALTH INSURANCE COVERAGE FOR THE NONINSTITUTIONALIZED 

 U.S. POPULATION UNDER 65, 1987-20021 -continued 6 Based on expanded sample size and on revised weights from the 2000 Census. 

7 Includes impact of verification question in the revised CPS questionnaire. 

 Note-Persons may have more than one type of coverage; percentages may total to more than 100.  Source: Congressional Research Service analysis of data from the March Current Population Surveys, various years. 
C-45 

INTERNATIONAL HEALTH SPENDING 

 This section analyzes trends in health expenditures for the 29 Organization 

for Economic Cooperation and Development (OECD) countries from 1960 to 

2000. Table C-26 illustrates total health expenditures as a percentage of gross 

domestic product (GDP). Of the countries reporting data in 1960, the mean 

percent of GDP spent on health care was 4.0 percent. In 2000, the mean percent 

of GDP spent on health care by OECD countries was 8.1 percent. For all years 

for which data are available, the share of GDP spent on health care by the 

United States was higher than the OECD average. Since 1982, the United States 

has spent a larger share of its GDP on health care than any other OECD nation. 

 In terms of dollars per capita, the United States spent $4,631 on health 

care in 2000, more than double the OECD average of $1,967. The per capita 

amount spent in the United States was the highest of all the OECD countries for 

which data are available. Switzerland spent $3,222 per capita on health care, the 

second-highest amount of all OECD nations. 

 The public sector plays a relatively small role in financing U.S. health care 

costs compared to other OECD countries. In 2000, 44.3 percent of health care in 

the United States was financed by the government. This share is smaller than 

any other OECD country. By contrast, the public sector funded 91.4 percent of 

health care in the Czech Republic in 2000. This share is larger than any other 

OECD country. 
TABLE C-26 -- TOTAL HEALTH EXPENDITURES AS A PERCENTAGE OF GROSS DOMESTIC PRODUCT, P

CAPITA HEALTH SPENDING AND PERCENTAGE OF MEDICAL EXPENDITURES PUBLICLY FUNDED, 

OECD COUNTRIES FOR SELECTED CALENDAR YEARS 1960-2000 

Percent of GDP Per capita Percent p

Country 1960 1965 1970 1975 1980 1985 1990 1995 1999 2000 2000 2000

Australia 4.3 -- -- 7.2 7.0 7.4 7.8 8.2 8.4 8.3 2,211 72.4Austria 4.3 4.5 5.3 7.1 7.6 6.6 7.1 8.6 8.1 8.0 2,162 69.7 Belgium -- -- 4.0 5.8 6.4 7.2 7.4 8.7 8.7 8.7 2,269 71.2 Canada 5.4 5.9 7.0 7.1 7.1 8.2 9.0 9.1 9.2 9.1 2,535 72.0 Czech Republic -- -- -- -- -- 5.0 7.3 7.2 7.2 1,031 91.4 Denmark -- -- -- 8.9 9.1 8.7 8.5 8.2 8.5 8.3 2,420 82.1 Finland 3.9 4.9 5.6 6.2 6.4 7.2 7.9 7.5 6.9 6.6 1,664 75.1 

France -- -- -- -- -- -- 8.6 9.6 9.4 9.5 2,349 76.0 Germany 4.8 5.1 6.3 8.8 8.8 9.3 8.7 10.6 10.7 10.6 2,748 75.1 Greece -- -- 6.1 -- 6.6 -- 7.5 8.9 8.7 8.3 1,399 55.5 Hungary -- -- -- -- -- -- -- 7.5 6.8 6.8 841 75.7 

Iceland 3.3 3.9 4.9 5.8 6.1 7.2 7.9 8.2 8.7 8.9 2,608 84.4 Ireland 3.6 4.0 5.1 7.4 8.4 7.6 6.6 7.2 6.8 6.7 1,953 75.8 Italy -- -- -- -- -- -- 8.0 7.4 7.8 8.1 2,032 73.7 Japan 3.0 4.5 4.5 5.6 6.4 6.6 5.9 7.0 7.4 7.8 2,012 76.7 Korea -- -- -- -- -- 4.3 4.8 4.7 5.6 5.9 893 44.4 

Luxembourg -- -- 3.6 4.9 5.9 5.9 6.1 6.4 6.0 -- -- -- 

Mexico -- -- -- -- -- -- 4.4 5.6 5.4 5.4 490 46.4 

Netherlands -- -- -- 7.2 7.5 7.3 8.0 8.4 8.2 8.1 2,246 67.5 New Zealand -- -- 5.1 6.6 5.9 5.2 6.9 7.2 7.9 8.0 1,623 78.0 Norway 2.9 3.5 4.4 5.9 7.0 6.7 7.8 8.0 8.8 7.8 2,362 85.2 

Poland -- -- -- -- -- -- 5.3 6.0 6.2 -- -- -- 

Portugal -- -- 2.6 5.4 5.6 6.0 6.2 8.3 8.4 8.2 1,441 71.2 Slovak Republic -- -- -- -- -- -- -- -- 5.8 5.9 690 89.6 

Spain 1.5 2.5 3.6 4.7 5.4 5.4 6.6 7.7 7.7 7.7 1,556 69.9 

Sweden 4.5 5.3 6.9 7.7 9.1 8.7 8.5 8.1 -- -- -- -- 
Switzerland 4.9 4.6 5.6 7.2 7.6 8.0 8.5 10.0 10.7 10.7 3,222 55.6 

Turkey -- -- 2.4 2.7 3.3 2.2 3.6 3.4 -- -- -- -- 

United Kingdom 3.9 4.1 4.5 5.5 5.6 5.9 6.0 7.0 7.1 7.3 1,763 81.0 

United States 5.1 5.6 6.9 7.8 8.7 10.0 11.9 13.3 13.0 13.0 4,631 44.3 

OECD Average /1/ 4.0 4.5 5.0 6.5 6.9 6.9 7.2 7.9 8.0 8.1 1,967 71.5 

1 Represents only those countries that have data reported for the given year.Note: Foreign per capita amounts converted to U.S. dollars using purchasing power parities (PPPs). Source: Organization for Economic Cooperation and Development. OECD Health Data 2002. OECD average calculated by Congressional Research 
C-48 

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