Transcript Document

Excess cost growth in Medicare, Medicaid, and all other health
care spending
3.5
3.5
Medicare
3.0
Medicaid
3.0
All Other
Percentage Points
2.5
Total
2.5
2.0
2.0
1.5
1.5
1.0
1.0
0.5
0.5
0.0
0.0
1975-1990
1990-2005
Source: CBO, A Federal Perspective on Health Care Policy and Costs, 2008.
1975-2005
National Health Expenditures as a Percent of GDP
17
16.5
16.2
15.9
16
16.0
15.4
15
14
13.8
13
1993
2002
2003
2004
Sources: Center for Medicare and Medicaid Services, Bureua of Economic Analysis
2005
2006
the U.S. Spends More on Health Care Than
ANY Other Developed Nation
Total Health Expenditures Per Capita, U.S. and Selected Countries
$6,000
$5,000
U.S.
Australia
Canada
Denmark
France
Japan
Norway
Sweden
U.K.
$4,000
$3,000
$2,000
$1,000
$1970
1980
1990
Source: Kaiser Family Foundation, Snapshots: Health Care Costs, 2007.
2003
Increases in Health-Insurance Prices Compared to Other Indicators
16%
14%
12%
10%
8%
6%
4%
2%
0%
2000
2001
2002
Health Insurance Premiums
2003
2004
Workers' Earnings
Source: Henry J. Kaiser Family Foundation and the Health Research and Educational Trust
2005
2006
2007
Consumer Price Inflation
Employers and employees are spending more on premiums
Average Annual Employee and Employer Contributions to
Premiums for Family Coverage
1999
$1,543
2000
$1,619
2001
$1,787
2002
$4,247
$4,819
$5,269
$2,137
2003
$2,412
2004
$2,661
2005
$2,713
2006
$2,973
2007
$3,281
2008
Employee Contribution
Employer Contribution
$5,866
$6,667
$7,289
$8,167
$8,508
$8,824
$3,354
$0
$2,000
$9,325
$4,000
$6,000
$8,000
Source: Kaiser Family Foundation, Employer Health Survey, 2008.
$10,000
$12,000
$14,000
Deductibles are rising
Average Aggregate Deductible for Workers with Family Coverage,
2006-2008
$2,000
$1,800
2006
2007
2008
$1,600
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
HMO
PPO
Plan Type
Source: Kaiser Family Foundation, Employer Health Survey, 2008.
POS
Higher copayments increase the burden on insured workers
Distribution of Copayments for an office visit with a Primary Care Physician
2004
$5
$10
2005
$15
$20
2006
$25
$30
2007
Other
2008
0%
10%
20%
30%
40%
50%
60%
Source: Kaiser Family Foundation, Employer Health Survey, 2008.
70%
80%
90%
100%
Percentage of Americans Not Covered
16%
15%
14%
13%
1999
2000
2001
2002
2003
2004
2005
2006
2007
Percent Under 65 Covered By Employers
69%
68%
67%
66%
65%
64%
63%
62%
1999
2000
2001
2002
2003
2004
2005
2006
2007
Coverage Under Employer Insurance
Is Flat…
175,000
170,000
165,000
160,000
155,000
150,000
1999
2000
2001
2002
2003
2004
2005
2006
2007
…In a Growing Eligible Population
175,000
265,000
Covered
170,000
260,000
165,000
255,000
160,000
250,000
Population Under 65
155,000
245,000
150,000
240,000
1999
2000
2001
2002
2003
2004
2005
2006
2007
Percentage of Firms Offering Health Benefits
71
69
69
68
67
66
66
65
63
63
61
61
60
60
59
2000
2001
2002
2003
2004
2005
Source: Henry J. Kaiser Family Foundation and the Health Research and Educational Trust
2006
2007
Small Firms Are Less Likely To Offer
Health Benefits
Percentage of Firms Offering Health Benefits
100%
90%
80%
70%
60%
50%
40%
1999
2000
2001
2002
2003
Small Firms (3-199 workers)
Source: Kaiser Employer Health Survey, 2008.
2004
2005
2006
2007
Large Firms (200+ workers)
2008
Health-Insurance Coverage Is Lower in
Small Firms
Workers Covered by Employers’ Health Benefits
100
Percentage Covered
90
80
70
60
50
40
1999
2000
2001
2002
2003
Small Firms (3-199 workers)
Source: Kaiser Employer Health Survey, 2008.
2004
2005
2006
2007
Large Firms (200+ workers)
2008
Employer Coverage Is Falling;
Uninsured Percentage Is Rising
18%
69%
68.3%
17%
Under 65, Covered
By Employer
68%
67.9%
67.1%
16%
65.7%
14.7%
15%
14%
67%
15.8%
15.1%
15.3%
15.3%
14.9%
14.1%
14.0%
66%
65%
13.7%
64.4%
13%
64%
63.9%
Uninsured
63.5%
62.9%
12%
62.9%
11%
63%
62%
1999
2000
Source: U.S. Census Bureau.
2001
2002
2003
2004
2005
2006
2007
Infant mortality rate in the U.S. is higher than in other
developed countries
Infant Mortality Rates, 2004
Japan
2.8
Sweden
3.1
3.5
Spain
France
3.9
Germany
4.1
Australia
4.7
England and Wales
5.0
Canada
5.3
United States
6.8
0
1
2
3
4
5
Infant deaths per 1,000 live births
Source: National Center for Health Statistics, Health, United States, 2007.
6
7
8
Few Private Employee-Enrollees Can Save By
Choosing a Less-Expensive Insurance Carrier
Choice with full
savings, 6%
Choice but only
partial savings,
8%
Choice but zero
potential savings,
9%
No choice of
carrier, 77%
Source: Marquis and Long, “Trends in Managed Care and Managed Competition, 1993-97,” Health Affairs, 18, no. 6 (1999).
Medicare Spending per Beneficiary,
by Hospital Referral Region, 2005
Source: Peter Orszag, CBO, Presentation to the Center for Public Health, Stanford University
Cost and Performance at Three High-Quality
Medical Centers
$50,522
19.2
52.1
17.7
Massachusetts
General Hospital
42.2
$40,181
90
UCLA Medical
Center
2.9
86
12.9
Mayo Clinic
$26,330
23.9
1.0
Total Medicare
Spending*
Hospital Days*
Physician Visits*
1.1
Ratio, medical
specialist/primary care*
*Care Delivery and Spending Among Medicare patients in last 6 months of life.
**CMS Composite Quality Score: an aggregate of all quality measures within each clinical area.
Source: Elliot Fisher, Dartmouth Medical School.
82
CQS**
Health Care Is Less Expensive in the
Upper-Midwest
Total Medicare reimbursements per enrollee: U.S. vs Upper-Midwest
$9,000
$8,000
$7,000
$6,000
$5,000
US
IA
$4,000
MN
WI
$3,000
$2,000
1995
1997
1999
Source: The Dartmouth Atlas of Health Care, 1995-2005.
2001
2003
2005