Chartbook 2005 Trends in the Overall Health Care Market Chapter 1: Trends in the Overall Health Care...

Chartbook 2005

Trends in the Overall Health Care Market

Chapter 1:Trends in the OverallHealth Care Market

Chartbook 2005


1-2

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chart 1.1:Total National Health

Expenditures1980 - 2003

Bill

ions

Source: Centers for Medicare & Medicaid Services, Office of the Actuary

(1) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers

Inflation-adjusted (1)

Chartbook 2005


Chart 1.2:Percent Change in Total National Health



1-3

16.0

%

12.6

%

10.1

%

10.4

%

9.4%

7.1%

8.9%

12.1

%

11.6

%

11.8

%

9.5%

8.6%

7.4%

5.5%

5.7%

5.0%

5.1%

5.3% 6.

2% 7.2%

8.9% 9.3%

7.7%

0%

5%

10%

15%

20%

81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


$200

$1,200

$2,200

$3,200

$4,200

$5,200

$6,200

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

1-4

Chart 1.3:Per Capita National Health


Per

Capit

a A

mount

Source: Centers for Medicare & Medicaid Services, Office of the Actuary(1) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers


Chartbook 2005


1-5

Chart 1.4:National Health Expenditures

as a Percentage of Gross Domestic Product

1980 - 2003


8.8% 9.1% 9.

9%

10.0

%

9.9%

10.1

%10

.2%

10.5

%

10.9

%

11.4

%

12.0

%

12.7

%

13.0

%

13.3

%

13.3

%

13.4

%

13.3

%

13.2

%13

.2%

13.2

%

13.3

%

14.1

%

14.9

%15

.3%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1980 2003

1-6

Chart 1.5:National Expenditures for Health Services and Supplies(1)

by Category1980 and 2003


(1) Excludes medical research and medical facilities construction

(2) “Other” includes net cost of insurance and administration, government public health activities, and other personal health care

(3) “Other professional” includes dental and other non-physician professional services

Prescription Drugs - 5.2%

Physician Services - 20.2%

Hospital Care - 43.5%

Nursing Home Care - 7.6%

Other(2) - 9.5%

Other Medical Durables and Non-durables - 5.9%

Home Health Care - 1.0%

Other Professional(3) - 7.3%

Other Medical Durables and Non-durables – 3.3%

Prescription Drugs – 11.1%

Home Health Care - 2.5%

Other Professional(3) - 7.6%

Physician Services - 22.9%

Hospital Care - 32.0%

Other(2) – 13.8%

Nursing Home Care – 6.9%

$233.5 B

$1,614.2 B

Chartbook 2005


13.2%

10.7%

9.5%

8.5%

5.0%4.2% 4.0%

6.5%

7.0%

0%

2%

4%

6%

8%

10%

12%

14%

1-7

Chart 1.6:Percent Change in National

Expenditures for Health Services and Supplies(1) by Category

2002 - 2003


(1) Excludes medical research and medical facilities construction(2) “Other” includes government public health activities and other personal

health care(3) “Other professional” includes dental and other non-physician

professional services

Prescription Drugs

Other (2)Physician Services

OtherProfes-sional (3)

HospitalCare

Nursing HomeCare

Home Health Care

OtherMedical Durables

and Non Durables

Admin.and NetCost of

Priv. Health

Insurance

7.6%All Health Services &Supplies

Chartbook 2005


1-8

Chart 1.7:Percent Change in National

Expenditures forSelected Health Services and

Supplies1993 - 2003


Prescription Drugs

Admin. & Net Cost of Private Health Ins.

Hospital Care

Nursing Home Care

Home Health Care

-5%

0%

5%

10%

15%

20%

25%

93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1-9

Chart 1.8:National Health Expenditures(1)

1980 - 2014


(1) Years 2004 – 2014 are projections

Bill

ions

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

80 90 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Chartbook 2005


1-10

Chart 1.9:Consumer Out-of-Pocket Payments for

National Health Expenditures1990 - 2003


Bill

ions

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200

$220

$240

90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1-11

Chart 1.10:Total Prescription Drug

Spending1980 - 2003

Source: Centers for Medicare & Medicaid Services, Office of the Actuary(1) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for All Urban

Consumers

Bill

ions


$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1-12

Chart 1.11:Growth in Total Prescription Drug Spending as a Percentage of Total Growth in National Health



0%

5%

10%

15%

20%

25%

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1-13

Chart 1.12:Consumer Out-of-Pocket Spending vs. Private Health Insurance Spending for

Prescription Drugs1980 - 2003


Out-of-Pocket

Private Health Insurance

Bill

ions

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


80 90 03

1-14

Chart 1.13:Distribution of National Health Expenditures by Source

of Payment1980, 1990, and 2003


Medicare - 15.2%

Total Medicaid -

10.6%

Other Government - 16.9%

Other Private - 5.9%

Out of Pocket - 23.7%

Private Insurance - 27.8%

$245.8 B $696.0 B

$1,678.9 B

19.7%

6.1%

33.5%

14.2%

10.6%

15.8%

Out ofPocket

OtherPrivate

PrivateInsurance

Other Government

Total Medicaid

Medicare

Out of Pocket – 13.7%

Other Private – 4.9%

Private Insurance – 35.8%

Other Government - 12.8%

Total Medicaid – 15.9%

Medicare – 16.9%

Chartbook 2005


3.5%

12.4%

13.7%

15.2%

3.5%

11.6%

13.4%

13.9%

4.0%

9.7%

13.0%

73.2%

15.6%

68.6%69.6%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Uninsured

Other Government

Medicaid

Medicare

Private

1-15

Chart 1.14:Distribution of Health Insurance

CoveragePercentage of Population Covered

by Payer1990, 2002, and 2003(1)

1990 2002 2003

Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2003

(1) 2002 and 2003 data use population estimates based on Census 2000.

Chartbook 2005


0

5

10

15

20

25

30

35

40

45

50

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 030%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1-16

Chart 1.15:Number and Percent

Uninsured(1)

1985 - 2003


(1) 1999 - 2003 data use population estimates based on Census 2000

Num

ber

of

Unin

sure

d(M

illio

ns)

Perc

ent

of

Tota

l Popula

tion

Number Percent

Chartbook 2005


1-17

Chart 1.16:Average Percent Uninsured by

State2001-2003


< 10.0%

10.0% - 14.9%

15.0% - 19.9%

20.0%

RI 9.3%DE 10.1%DC 13.3%

Chartbook 2005


1-18

Chart 1.17:Medicare Enrollees(1)

1980 - 2003

Mill

ions

Source: Centers for Medicare & Medicaid Services

(1) Hospital insurance (Part A) enrollees only; includes all persons (aged and disabled)

28.1

28.6

29.1

29.6

30.0

30.6

31.2

31.9

32.4

33.0

33.7

34.4

35.2

35.9

36.5

37.1

37.7

38.1

38.4

38.7

39.2

39.6

40.1

40.7

0

5

10

15

20

25

30

35

40

45

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


0

5

10

15

20

25

30

35

40

45

50

55

1990 1995 2000 2001 2002 2003

1-19

Source: Centers for Medicare & Medicaid Services; 2002 data, CBO March 2003 Baseline; 2003 data, CBO March 2004 Baseline

(1) Does not include S-CHIP Enrollees

Chart 1.18:Medicaid Enrollees(1)

1990, 1995, 2000 - 2003

Mill

ions

Aged

Blind/Disabled

Children

Adults

Other Title XIX

25.3 M

36.3 M

46.1 M42.5 M

50.9 M52.4 M

Chartbook 2005


1,959,330

3,333,879

4,622,204

5,353,812

5,874,259

FY 1999 FY 2000 FY 2001 FY 2002 FY 2003

1-20

Chart 1.19:National SCHIP Enrollment(1)

FY 1999 - FY 2003

Source: Centers for Medicare & Medicaid Services

(1) Number of children enrolled at any point in the year

Chartbook 2005


1-21

Chart 1.20:Percent Change in SCHIP Enrollment

By StateFY 2002 - FY 2003

Source: Centers for Medicare & Medicaid Services, Revised FY 2003 Number of Children Ever Enrolled in SCHIP by Program Type, August 5, 2004

RI 26%DE 2%DC 16%

10% - 19%

1% -9%

0%

20% - 29%

30%

Unknown

Chartbook 2005


1-22

Chart 1.21:Percentage of Employees with Employer-

based CoverageWho Can Choose Conventional, PPO, HMO and

POS Plans1988 - 2004

(1)

Source: The Kaiser Family Foundation and Health Research and Educational Trust, Survey of Employer-Sponsored Health Benefits: 2002, 2003,2004; KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1993, 1996

(1) Point-of-service plans not separately identified

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1988 1993 1996 1999 2002 2003 2004

Conventional

PPO

HMO

POS

Chartbook 2005


1-23

Source: The Kaiser Family Foundation and Health Research and Educational Trust, Survey of Employer-Sponsored Health Benefits: 1999, 2002, 2003,2004; KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1993, 1996

(1) Point-of-service plans not separately identified

Chart 1.22:Distribution of Employer-sponsored Health

Insurance Enrollment by Type of Plan1988 - 2004

Conventional

PPO

HMO

POS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1988 1993 1996 1999 2002 2003 2004(1)

Chartbook 2005


1-24

Chart 1.23:Percentage of Medicare Beneficiaries

Enrolledin Medicare Managed Care(1)

1991 - 2004


(1) Percentages are risk enrollees divided by enrollees who have both hospital insurance and supplementary medical insurance

4% 4%

5%

6%

8%

10%

13%

16% 17

%

17%

15%

13%

13%

12%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

91 92 93 94 95 96 97 98 99 00 01 02 03 04

Chartbook 2005


-2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

1-25


Chart 1.24:Percent Growth in Medicare Spending per

Beneficiary vs.Private Health Insurance Spending per Enrollee

1980 - 2003

Private Health Insurance

Medicare

Chartbook 2005


1-26

Chart 1.25:Percentage of Medicaid Beneficiaries

Enrolledin Medicaid Managed Care

1991 - 2003


10%12%

14%

23%

29%

40%

48%

54%56% 56% 57% 58% 59%

0%

10%

20%

30%

40%

50%

60%

70%

91 92 93 94 95 96 97 98 99 00 01 02 03

Chartbook 2005


1-27

Chart 1.26:Percentage of Medicaid Beneficiaries

Enrolledin Medicaid Managed Care by State

2003


25% - 49%50% - 74%75% - 100%

1% - 24%

0%

RI 66.8%DE 71.3%DC 66.6%

Chartbook 2005


1-28

Source: The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 2000, 2001, 2002, 2003, 2004 Annual Surveys; KPMG Survey of Employer -Sponsored Health Benefits: 1988, 1993, 1996

Chart 1.27:Annual Change in Health Insurance

Premiums1988 - 2004

12.0%

8.5%

0.8%

3.7%

5.3%

8.2%

10.9%

12.9%13.9%

11.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

1988 1993 1996 1998 1999 2000 2001 2002 2003 2004

Chartbook 2005


1-29

Source: Interstudy Competitive Edge: Part II: Managed Care Industry Report, using data as of January 1, 2004

* 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

Chart 1.28:HMO Plan Median Operating

Margins1990 - 2003

2.1% 2.2%2.5% 2.4%

1.2%

-0.9%

-3.5%-3.5%

-1.3%

-0.6%

1.2%

2.8%

-0.05%

2.1%

-4%

-3%

-2%

-1%

0%

1%

2%

3%

90 91 92 93 94 95 96 97 98 99 00 01* 02* 03

Chartbook 2005


1-30

Source: Robinson J. Consolidation and the transformation of competition in health insurance. Health Affairs 2004;23(6):11-24.

Chart 1.29:Operating Margins of the Top Insurers

2000 - 2003

-2%

0%

2%

4%

6%

8%

10%

12%

Aetna Wellpoint Anthem UnitedHealthGroup

Cigna

2000 2001 2002 2003

Chartbook 2005 Trends in the Overall Health Care Market Chapter 1: Trends in the Overall Health Care...

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