Trends in the Overall Health Care Market

1
Chapter 1 Trends in the OverallHealth Care
Market
2
Chart 1.1Total National Health
Expenditures1980 2004(1)
Billions
Inflation-adjusted (2)
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf. (2) Expressed in 1980
dollars adjusted using the overall Consumer
Price Index for Urban Consumers
1-2
3
Chart 1.2Percent Change in Total National
Health Expenditures1981 2004(1)
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-3
4
Chart 1.3Per Capita National Health
Expenditures1980 2004(1)
Per Capita Amount
Inflation-adjusted (2)
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf. (2) Expressed in 1980
dollars adjusted using the overall Consumer
Price Index for Urban Consumers
1-4
5
Chart 1.4National Health Expendituresas a
Percentage of Gross Domestic Product1980
2004(1)
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-5
6
Chart 1.5National Expenditures for Health
Services and Supplies(1) by Category1980 and
2004(2)
1,753.0 B
233.5 B
Other(3) - 9.5
Other(3) 14.0
Nursing Home Care - 7.6
Nursing Home Care 6.6
Other Medical Durables and Non-durables - 5.9
Other Medical Durables and Non-durables 3.2
Prescription Drugs - 5.2
Home Health Care - 1.0
Prescription Drugs 10.8
Other Professional(4) - 7.3
Home Health Care 2.5
Other Professional(4) 7.7
Physician Services - 20.2
Physician Services 22.8
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) Excludes medical
research and medical facilities
construction (2) CMS completed a benchmark
revision in 2006, introducing changes in methods,
definitions and source data. For more
information on this revision, http//www.cms.hhs.g
ov/NationalHealthExpendData/downloads/benchmark.pd
f. (3) Other includes net cost of insurance and
administration, government public health
activities, and other personal health
care (4) Other professional includes dental and
other non-physician professional services
Hospital Care - 43.5
Hospital Care 32.6
1-6
7
Chart 1.6Percent Change in National
Expenditures for Health Services and Supplies(1)
by Category2003 2004(2)
7.9All Health Services Supplies
Other (4)
Other Profes-sional (3)
Hospital Care
Physician Services
Admin.and NetCost ofPriv. HealthInsurance
Nursing HomeCare
PrescriptionDrugs
Other Medical Durablesand Non Durables
HomeHealthCare
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) Excludes medical
research and medical facilities
construction (2) CMS completed a benchmark
revision in 2006, introducing changes in methods,
definitions and source data. For more
information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf. (3) Other includes
government public health activities and other
personal health care (4) Other professional
includes dental and other non-physician
professional services
1-7
8
Chart 1.7Percent Change in National
Expenditures forSelected Health Services and
Supplies1994 2004(1)
Home Health Care
Admin. Net Cost of Private Health Ins.
Hospital Care
Prescription Drugs
Nursing Home Care
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-8
9
Chart 1.8National Health Expenditures(1)1980
2015(2)
Billions
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) Years 2005
2015 are projections (2) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-9
10
Chart 1.9Consumer Out-of-Pocket Payments
forNational Health Expenditures1990 2004(1)
Billions
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-10
11
Chart 1.10Total Prescription Drug Spending1980
2004(1)
Billions
Inflation-adjusted (2)
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf. (2) Expressed in 1980
dollars adjusted using the overall Consumer
Price Index for All Urban Consumers
1-11
12
Chart 1.11Growth in Total Prescription Drug
Spending as a Percentage of Total Growth in
National Health Expenditures1980 2004(1)
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-12
13
Chart 1.12Consumer Out-of-Pocket Spending vs.
Private Health Insurance Spending for
Prescription Drugs1980 2004(1)
Billions
Out-of-Pocket
Private Health Insurance
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-13
14
Chart 1.13Distribution of National Health
Expenditures by Source of Payment1980, 1990, and
2004(1)
245.8 B
696.0 B
1,877.6 B
Out ofPocket
19.7
Out of Pocket - 23.7
Out of Pocket 12.6
Other Private 7.3
OtherPrivate
6.1
Other Private - 5.9
Private Insurance 35.1
PrivateInsurance
33.5
Private Insurance - 27.8
Other Government
Other Government - 13.2
Other Government - 16.9
14.2
Total Medicaid
Total Medicaid 15.5
10.6
Total Medicaid - 10.6
15.8
Medicare 16.5
Medicare - 15.2
Medicare
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) CMS completed a
benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-14
15
Chart 1.14Distribution of Health Insurance
CoveragePercentage of Population Covered by
Payer1990, 2003, and 2004(1)
Source US Census Bureau, Income, Poverty, and
Health Insurance Coverage in the United States
2004 (1) 2003 and 2004 data use population
estimates based on Census 2000
1-15
16
Chart 1.15Number and Percent Uninsured1985 -
2004(1)
Number of Uninsured(Millions)
Percent of Total Population
Number Percent
Source US Census Bureau, Income, Poverty, and
Health Insurance Coverage in the United States
2004 (1) 1999 - 2004 data use population
estimates based on Census 2000
1-16
17
Chart 1.16Average Percent Uninsured by
State2002-2004
RI 10.5 DE 11.8 DC 13.5
lt 10.0
10.0 - 14.9
15.0 - 19.9
³ 20.0
Source US Census Bureau, Income, Poverty, and
Health Insurance Coverage in the United States
2004
1-17
18
Chart 1.17Medicare Enrollees(1)1981 - 2004
Millions
Source Centers for Medicare Medicaid
Services (1) Hospital insurance (Part A)
enrollees only includes all persons (aged and
disabled)
1-18
19
Chart 1.18Medicaid Enrollees(1)1990, 1995,
2000 - 2004
57.3 M
Other Title XIX
52.4 M
50.9 M
48.4 M
Adults
44.5 M
36.3 M
Millions
Children
25.3 M
Blind/Disabled
Aged
Source Centers for Medicare Medicaid Services
2002 Baseline 2002 data, CBO March 2003
Baseline 2003 data, CBO March 2004 Baseline
2004 data, CBO March 2005 Baseline (1) Does not
include S-CHIP Enrollees
1-19
20
Chart 1.19National SCHIP Enrollment(1) FY 1999
- FY 2004
Source Centers for Medicare Medicaid
Services (1) Number of children enrolled at any
point in the year
1-20
21
Chart 1.20Percent Change in SCHIP Enrollment By
StateFY 2003 - FY 2004
RI 4 DE 4 DC 4
0
1 - 9
10 - 19
20 - 29
³ 30
Unknown
Source Centers for Medicare Medicaid Services,
Revised FY 2004 Number of Children Ever Enrolled
in SCHIP by Program Type, May 23, 2005 Note Due
to a new system, Colorado was only able to
provide CMS with accurate data for 10.5 months of
FY2004 therefore a percent change was not
calculated and Colorado is being reported as
Unknown. Arkansas did not report data to CMS
via the Statistical Enrollment Data System in FY
2003, therefore a percent change could not be
calculated so it is being reported as Unknown.
Tennessee has not reported data to CMS via the
Statistical Enrollment Data System in FY 2003,
therefore a percent change could not be
calculated so it is being reported as Unknown.
1-21
22
Chart 1.21Percentage of Employees with
Employer-based CoverageWho Can Choose
Conventional, PPO, HMO and POS Plans1988 - 2005
Conventional
PPO
HMO
POS
(1)
Source The Kaiser Family Foundation and Health
Research and Educational Trust, Survey of
Employer-Sponsored Health Benefits 1999, 2002,
2005 KPMG Survey of Employer-Sponsored Health
Benefits 1988, 1993, 1996 (1) Point-of-service
plans not separately identified
1-22
23
Chart 1.22Distribution of Employer-sponsored
Health Insurance Enrollment by Type of Plan1988
- 2005
POS
HMO
PPO
Conventional
(1)
Source The Kaiser Family Foundation and Health
Research and Educational Trust, Survey of
Employer-Sponsored Health Benefits 1999, 2002,
2005 KPMG Survey of Employer-Sponsored Health
Benefits 1988, 1993, 1996 (1) Point-of-service
plans not separately identified
1-23
24
Chart 1.23Percentage of Medicare Beneficiaries
Enrolledin Medicare Managed Care(1)1991 - 2005
Source Centers for Medicare Medicaid Services,
Office of the Actuary (1) Percentages are risk
enrollees divided by enrollees who have both
hospital insurance and supplementary medical
insurance
1-24
25
Chart 1.24Percent Growth in Medicare Spending
per Beneficiary vs.Private Health Insurance
Spending per Enrollee1980 2004(1)
Private Health Insurance
Medicare
Source Centers for Medicare Medicaid
Services, Office of the Actuary (1) CMS completed
a benchmark revision in 2006, introducing changes
in methods, definitions and source data. For
more information on this revision, see
http//www.cms.hhs.gov/NationalHealthExpendData/do
wnloads/benchmark.pdf.
1-25
26
Chart 1.25Percentage of Medicaid Beneficiaries
Enrolledin Medicaid Managed Care1992 - 2004
Source Centers for Medicare Medicaid Services,
Office of the Actuary
1-26
27
Chart 1.26Percentage of Medicaid Beneficiaries
Enrolledin Medicaid Managed Care by State2004
RI 69.2 DE 73.7 DC 63.8
0
1 - 24
25 - 49
50 - 74
75 - 100
Source Centers for Medicare Medicaid Services,
Office of the Actuary
1-27
28
Chart 1.27Annual Change in Health Insurance
Premiums1988 - 2005
Source The Kaiser Family Foundation and Health
Research and Educational Trust, Employer Health
Benefits 2000, 2001, 2002, 2003, 2004, 2005
Annual Surveys KPMG Survey of Employer
-Sponsored Health Benefits 1988, 1993, 1996
1-28
29
Chart 1.28HMO Plan Median Operating
Margins1990 - 2004
Source Interstudy Competitive Edge Part II
Managed Care Industry Report, using data as of
January 1, 2005 Due to changes in the financial
reporting requirements that took effect in many
states in 2001, Interstudy recalculated the
ratios for 2001 and 2002 according to the
formulas used with the current HMO Financial
Database, to ensure that data over the past three
years is trended according to a consistent
methodology
1-29
30
Chart 1.29Operating Margins of the Top
Insurers2000 - 2004
(1)
(2)
Source Robinson J. Consolidation and the
transformation of competition in health
insurance. Health Affairs 200423(6)11-24 for
2000 2003 data and Hoovers Annual Income
Statement for 2004 data.
(1) 2004 operating margin data for Anthem are not
available due to the merger of Anthem with
WellPoint in November 2004 (2) 2004 operating
margin data for WellPoint include both pre- and
post-merger data for the merger with Anthem in
November 2004
1-30