Objectives

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• Objectives
• Review Economic Trends and Consumer
  Satisfaction
• Review the components of Health Care
• Compare Health Insurance Plans

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(No Transcript)
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Table 1.2 National Health Expenditures Per
Capita, 1986-2010
National health spending per capita is projected
to increase rapidly over the next decade.
Actual
Projected
Calendar Year
Source CMS, Office of the Actuary, National
Health Statistics Group.
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Table 1.3 Personal Health Care Expenditures by
Source of Funds Selected Years 1960-2000
Over the last several decades, the public sector
share of health spending has increased, while the
share from out-of-pocket spending has declined.
Dollars in Billions
63.1
23.3
214.5
1,130.4
609.3
17.2
22.5
27.1
39.7
5.0
5.0
55.2
4.3
34.6
2.8
33.4
28.3
22.3
2.0
7.3
11.9
10.0
21.4
15.7
19.2
16.9
17.6
21.4
11.5
16.8
11.5
11.4
8.0
Other Public Medicare Total Medicaid, SCHIP
expansion and SCHIP
Out-of-Pocket Other Private Private Health
Insurance
Total Public
Total Private
Source CMS, Office of the Actuary, National
Health Statistics Group.
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Table 1.4 Sources of Health Insurance Coverage
for the Under 65 Population, 1980-2000
Over the last two decades, private coverage has
declined, public coverage has stayed about the
same, and the uninsured have grown.
Any Private
74
ESI
69
Uninsured
16
Any Government
14
9
Medicaid
Notes ESI - Employer Sponsored Insurance. Any
Private includes ESI and individually purchased
insurance. Any government includes Medicare for
the disabled population. Source Tabulations of
the March Current Population Survey files by
Actuarial Research Corporation, incorporating
their historical adjustments.
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Table 1.5 Distribution of Personal Health Care
Expenditures by Type of Service, 1960-2000
The share of health spending on home health and
nursing homes has grown. Physician share has
stayed about the same while the hospital share
grew and then declined.
47.3
41.7
39.3
36.5
25.9
25.3
22.9
21.9
22.5
Service
15.8
16.4
15.2
11.4
10.8
8.6
8.2
8.2
6.6
5.6
3.6
2.9
2.1
Percent
1.1
0.2
Source CMS, Office of the Actuary, National
Health Statistics Group.
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Table 1.8 Concentration of Health Spending,
1980-1996
Health spending remains highly concentrated on a
small percentage of people. The top1 of people
account for more than a quarter of all health
spending.
Percent of People
Note Data for 1980 are from the National Medical
Care Utilization and Expenditure Survey (NMCUES)
for 1987, from the 1987 National Medical
Expenditure Survey (NMES) and for 1996, from the
1996 National Medical Expenditure Panel Survey
(MEPS). Source Berk, Mark and Alan Monheit,
The Concentration of Health Care Expenditures,
Revisited, Health Affairs March/April 2001.
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Table 1.12 Number of People Employed in Health
Care, 1985-2001
Number of people employed in health is growing.
Health Services Employment as a of
Non-Farm Private Sector Employment 7.8 8.6
9.1 9.4 9.5 9.5 9.4 9.5 9.4 9.3
9.2 9.1 9.3
Note Not seasonally adjusted. Source Bureau
of Labor Statistics, data extracted from web site
at data.bls.gov/labjava/outside.jsp?surveyee.
Trends and Indicators in the Changing Health Care
Marketplace, 2002 Chartbook.
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Table 1.13 Health Care Employment by Occupation,
1983-2000
Health care employment growth exceeded that of
the general economy.
Percent Change 1990-02 32.0 -75.4 28.7 14.8 7.
5 39.4 61.9 56.5 48.6 23.8 16.9 21.6 26.6
-15.2 30.4 5.0 24.6 95.3 332.2
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13.8 Total Employment
Source Dept. of Labor, Bureau of Labor
Statistics. Current Population Survey.
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Table 1.16 HMO Enrollment by Ownership Status,
1981-2000
The proportion of HMO enrollees in for-profit
plans grew over the past decade.
Total Enrollment (in millions) 10.27
18.89 32.49 42.07 72.23
78.78 80.81 79.66
Note HMO enrollment includes enrollees in both
traditional HMOs and point-of-service (POS) plans
through group/commercial plans, Medicare,
Medicaid, the Federal Employees Health Benefits
Program, direct pay plans, supplemental Medicare
plans, and unidentified HMO products. Source
Trends Indicators in the Changing Health Care
Marketplace, 2002 -- Chartbook.
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Table 1.17 Concentration of Managed Care
Enrollment, 1988-2000
Two-thirds of managed care enrollees are enrolled
in the nations 10 largestmanaged care firms.
Note The largest national managed care firms
include Blue Cross and Blue Shield plans, Aetna
US Healthcare, Kaiser Permanente, United Health,
and PacifiCare. HMO enrollment includes enrollees
in both traditional HMOs and point of service
plans. Source Trends Indicators in the
Changing Health Care Marketplace, 2002
Chartbook.
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Table 1.18 Managed Care Enrollment by Type of
Plan, 1984-2000
Mixed model HMO plans have shown rapid growth.
80.1
63.3
38.8
31.4
15.1
NA 19.5 23.3 43.6 13.6
NA 43.0 18.0 25.4 13.6
17.3 41.7 10.0 24.8 6.2
36.4 43.4 5.3 13.7 1.2
Mixed IPA Network Group Staff
40.0 41.9 8.9 8.8 0.4
Source Trends Indicators in the Changing
Health Care Marketplace, 2002 Chartbook.
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Table 1.21 Out-of-Pocket Spending for Health Care
as a Percent of Income by Age and Income Level,
2000
Those over 65 and those with incomes under
20,000 spend a higher percentage of their income
on health than other groups.
By Income Level
By Age Group
Age Group
Income Level
Source Dept. of Labor, Bureau of Labor
Statistics, Consumer Expenditure Survey.
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Table 1.22 Growth in the Overall Consumer Price
Index (CPI) and Medical-Specific Consumer Price
Index (MCPI), 1993-2001
Medical prices have risen faster than overall
consumer prices.
Source Dept. of Labor, the Bureau of Labor
Statistics.
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• Almost 45 million Americans were uninsured in
  2003 (44.7 million under the age of 65)growing
  by 1.4 million from the previous year and a total
  of over 5 million since 2000.
• Both adults and children experienced significant
  decreases in the share with job-based coverage.
  The proportion of children with
  employer-sponsored insurance dropped from 62 in
  2000 to 57 by 2003.
• The 2001 recession, brief as it was, triggered a
  sharp downtick in job-based coverage and it
  continued to affect health insurance coverage
  even in 2003, as employment was slow to recover,
  job opportunities shifted, and family incomes
  declined.
• Health Insurance Coverage in America Chartbook
  2003 Kaiaser

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Recent Findings on Public Attitudes Towards
Patients Rights and Managed Care Kaiser
Foundation 2001
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• Rank the following organizations, from highest to
  lowest, according the statement I have a
  favorable opinion of
• Airlines
• Banks
• Doctors
• Health Insurance Companies
• HMOs
• Hospitals
• Oil Companies
• Pharmaceutical companies
• Tobacco companies

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• In general, do you think managed care health
  plans are doing a good job or a bad job in
  serving health care consumers?

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• In the past few years have you or someone you
  know
• Needed more information about how the health plan
  operates in order to choose among different
  plans?
• Had difficulty getting a health plan to pay for
  an emergency room bill?
• Had difficulty getting permission from a health
  plan or regular doctor to see a medical
  specialist?
• Wanted to file an appeal to an independent
  reviewer when a health plan denied coverage for a
  particular medical treatment?
• Had difficulty getting permission from a health
  plan or regular doctor to see a gynecologist?
• Wanted to sue a health plan for malpractice?

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• Do you think this issue is very important for the
  President and the Congress to deal with?
• Making prescription drugs more affordable for
  people age 65 and over
• Making Medicare more financially sound for future
  generations
• Helping families with the cost of caring for an
  elderly or disabled family member who needed
  long-term care
• Protecting patients rights in HMOs and managed
  care plans
• Increasing the number of Americans covered by
  health insurance
• Which one of these would you say is the most
  important issue?

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• Objectives
• Review Economic Trends and Consumer
  Satisfaction
• Review the components of Health Care
• Compare Health Insurance Plans

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• Primary Care
• Preventive and Treatment measures
• Often provided by a physician or nurse
  practitioner

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• Secondary Care
• Services available both in community hospitals
  and physicians offices
• Surgeries
• Specialists, e.g.. Cardiologists, GI, Derm

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• Tertiary Care
• Highly specialized care
• Often at large medical centers
• Transplants
• Open-heart surgery
• Neonatal wards
• Chemo- Radiotherapy

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• Consumers
• US Population
• Minors, Aged, Disabled, Others
• Employed, Not-employed, working poor
• Family
• Caregivers
• Representatives of Consumers
• Activists
• Associations - AARP

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• Providers of Care
• Physicians
• Nurses, PAs, Others (SW, Pharm, RDs, PTs)
• Diagnostic and Laboratory Technicians
• Associations / Trade Organizations

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• Institutions that Provide Care
• Hospitals, Medical Centers
• Specialty Clinics
• Rehab
• Drug / Substance Abuse
• Long-term care facilities
• Associations
• American Hospital Association

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• Government Federal, State, Local
• Regulatory Role
• Political Process - set regulations, respond to
  electorate
• Reimbursement
• Medicare, Medicaid (States)
• Public Health System

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• Insurance Groups
• Blues
• Associations / Trade Organizations

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• Support Industries
• Pharmaceutical Companies and Distributors
• Medical Devices
• Medical Equipment

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• Employers
• Economists
• Judiciary Legal Support
• Information / Technology Industry
• WebMD
• Higher Education

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• Objectives
• Review Economic Trends and Consumer
  Satisfaction
• Review the components of Health Care
• Compare Health Insurance Plans

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• Concept Checks Define
• HMO
• PPO
• Conventional Fee for Service
• Point of Service (POS)
• How do they differ?
• Be prepared to describe the strengths and
  weaknesses of each.

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• Concept Checks Define
• What are the distinctions between Medicare and
  Medicaid?
• Where would you find information on the inclusion
  of nutrition services under Medicare and/or
  Medicaid?