Health Care Resources: Costs. Peterson-Kaiser Health System Tracker

Transcription

1 Health Care Resources: Costs

2 Why is cost an ethical question? We live in a world of limited resources Stewardship: What I/we do reflects our moral commitments Living with Limits Social Justice: How we organize society What does this tell us about how we view Medicine?

3 Total health expenditures have increased substantially over the past several decades Total national health expenditures, US $ Billions, $3,500.0 $3,000.0 Total National Health Expenditures In In Constant Dollars $3.2 Trillion $2,500.0 $2,000.0 $1,500.0 $1,000.0 $500.0 $365.8 Billion In 2015 Dollars $74.6 Billion $

4 On a per capita basis, health spending has grown substantially Total national health expenditures, US $ per capita, $12,000 $10,000 Total National Health Expenditures Per Capita In In Constant Dollars Dollars $9,990 Per capita $8,000 $6,000 $4,000 $1,742 Per capita in constant 2015 dollars $2,000 $355 Per capita $

5 Health spending growth has outpaced growth of the U.S. economy Total national health expenditures as a percent of Gross Domestic Product, % 18% 17.8% 16% 14% 12% 10% 8% 6.9% 6% 4% 2% 0%

6 Health spending growth has slowed, and is now more on pace with economic growth Average annual growth rate of GDP per capita and total national health spending per capita, % GDP Health Spending 12% 12.2% 10% 9.2% 10.1% 8% 6% 6.6% 5.4% 5.7% 4% 4.3% 2.9% 2.9% 3.6% 2% 0% 1970s 1980s 1990s 2000s Source: OECD (2015), "OECD Health Data: Health expenditure and financing: Health expenditure indicators", OECD Health Statistics (database). doi: /data en (Accessed on December ).

7 Spending on hospitals, physicians, and prescriptions has grown at varying rates Average annual growth rate for select service types, % Prescriptions Hospitals Physicians/Clinics 14% 12% 14.0% 12.8% 12.9% 12.8% 11.6% 10% 9.6% 8% 6% 4% 8.1% 5.2% 6.2% 7.7% 7.1% 5.9% 5.1% 4.7% 4.4% 2% 0% 1970s 1980s 1990s 2000s

8 Hospital and physician services represent half of total health spending Relative contributions to total national health expenditures, 2015 Home Health Care, 3% Dental, 4% Nursing Care, 5% Hospitals, 32% Prescriptions, 10% Other health, 26% Physicians/Clinics, 20%

9 Out-of-pocket spending represents a smaller portion of total expenditures than it did in 1970 Total national health expenditures, 1970 and Other 24% Out-ofpocket 33% Other 15% Out-ofpocket 11% Public Insurance 22% Private Insurance 21% Public Insurance 41% Private Insurance 33%

10 Per capita out-of-pocket expenditures have grown since 1970 Per capita out-of-pocket expenditures, $1,200 $1,000 Total OOP NHE Per Capita In In Constant Dollars Dollars $1,054 Per capita $800 $600 $583 Per capita in constant 2015 dollars $400 $200 $119 Per capita $

11 On average, larger shares of household budgets are devoted to health expenses than 10 years ago Average portion of household budget devoted to health (nonelderly families), % 5.0% 4.0% 3.0% 4.4% Total health expenses: 5.2% Insurance premiums: 3.1% 2.0% 1.0% Out-of-pocket costs: 2.1% 0.0% Source: Kaiser Family Foundation analysis of Consumer Expenditure Survey

12 A larger portion of household spending on health is on insurance premiums, and smaller portion on OOP costs Average household expenditures on health (nonelderly families with no Medicare beneficiaries), 2002 and Prescription drugs 14% Med sup. 3% Prescription drugs 10% Med Sup. 3% Medical services 32% Health insurance 51% $1,827 $2,754 Medical services 28% Health insurance 59% Source: Kaiser Family Foundation analysis of Consumer Expenditure Survey

13 Health insurance represents a growing share of total health expenditures, particularly public programs Total national health expenditures, 1970 and Other 24% Out-ofpocket 33% Other 15% Out-ofpocket 11% Public Insurance 22% Private Insurance 21% Public Insurance 41% Private Insurance 33% Notes: Public insurance in 1970 includes Department of Veterans Affairs, Department of Defense, Medicare, and Medicaid. In 2015, public insurance includes the same categories listed for 1970 with the addition of CHIP.

14 Medicare and private insurance growth have been similar, but Medicare growth has slowed recently Average annual growth rate of spending per enrolled person in Private Insurance vs. Medicare 8% 7% Private Insurance 7.2% Medicare 6.8% 6% 5.9% 5.8% 5% 4% 3% 3.2% 2% 1% 0% 1990s 2000s %

15 Public and private health spending have both grown substantially, but public spending has grown faster Total national health expenditures, US $Trillions, $2.0 $1.8 $1.6 Private Public $1.4 $1.2 $1.0 $0.8 $0.6 $0.4 $ $

16 Administrative costs have risen over time but have recently moderated Net cost of health insurance and administration, as a share of total health expenditures, % 8% 7.9% 7% 6% 5% 4% 3% 3.5% 2% 1% 0%

17 Spending on public health has increased, particularly by state and local governments Local and federal expenditures on public health, US $Millions, $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 Federal State and Local $

18 Prices have historically driven health services spending growth, but it s now a mix of price and use Annual change in price and quantity indexes of health services, index numbers 2009=100 14% Real personal consumption expenditure quantity index Price index for personal consumption expenditure 12% 10% 8% 6% 5.3% 4% 2% 0% 0.6% Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis data

19 Growth in the use of pharmaceuticals has outpaced price growth for most of the past 2 decades Annual change in price and quantity indexes of pharmaceutical and other medical products, index numbers 2009=100 14% Pharmaceutical and other medical products quantity indexes Pharmaceutical and other medical products price indexes 12% 10% 8% 6% 4% 2% 0% -2% Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis data

20 Growth in per captia health spending has consistently been higher than overall economic growth Percent change in total health expenditures per capita, , Consumer Price Index % 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% -2.0% 14.9% 14.1% 13.5% 10.3% 11.7% 9.0% 6.2% 3.2% 9.2% 8.3% 6.2% 4.3% 4.1% 3.6% 3.6% 1.9% 11.1% 10.2% 10.6% 8.6% 7.5% 7.6% 6.3% 6.1% 5.5% 4.6% 5.3% 5.8% 5.5% 5.0% 4.1% 4.8% 3.5% 4.2% 3.0% 3.1% 3.2% 2.8% 3.2% 4.4% % 2.2% 2.6% 3.0% 2.3% 3.4% 2.7% 3.4% 3.8% 2.8% 3.2% 2.2% 2.8% 1.6% 1.6% 2.3% 1.6% 3.2%2.1%1.5% 1.6% 0.1% -0.4% 7.8% 8.0% 7.1% 6.1% 4.8% 5.4% 4.4% 4.5% NHE Per Capita % Change Annual % change in CPI Kaiser Family Foundation analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services, Office of the and CPI data from Bureau of Labor Statistics at (All Urban Consumers, All Items, =100, Not Seasonally Adjusted, U.S. city average).

21 Why is Cost an ethical question? We live in a world of limited resources Stewardship: What I/we do reflects our moral commitments Living with Limits Social Justice: How we organize society What does this tell us about how we view Medicine?