Chartbook: health care spending November 2017 CT Health Policy Project November 2017 1
Earlier this year, the US Centers for Medicare and Medicaid Services released updated State Health Expenditures through the National Health Expenditure Accounts. The data includes aggregate and per capita personal health care spending by state by the type of good or service (hospital care, physician and clinical services, retail prescription drugs, etc.) and by source of funding (Medicare and Medicaid). The new data release covers spending from 1991 to 2014. Analysis of the data was also published in July 2017 -- D Lassman, et. al., Health Spending by State 1991 2014: Measuring Per Capita Spending by Payers and Programs, Health Affairs. The CT Health Policy Project s analysis of the data focuses on health spending in to provide insight into how resources are used and to support informed policymaking. CT Health Policy Project November 2017 2
residents spend more per person on health care across payers than most Americans. However, per person health costs are rising more slowly in than in most states, particularly for Medicaid members. In 2014 devoted 14.4% of the state s economy to personal health care services, very close to the national average of 14.8% Over half of health spending in is consumed by hospitals, physicians and clinics. Drug costs are the main driver of rising health costs in, growing faster than any other sector. Since 2003, drug costs have grown faster in than the rest of the nation Beginning in 2009, Medicare and Medicaid s combined share of s health spending outpaced private health insurance. And the gap is growing. Medicare and Medicaid pay for the majority of home health and nursing home care in, as well as almost half of hospital bills. CT Health Policy Project November 2017 3
Per capita health spending $12,000 $10,000 Health spending is rising for both residents and all Americans $8,000 $6,000 $4,000 $2,000 $0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 4
Health care share of GDP 16% 14% 12% 10% 8% In 2014 devoted 14.4% of its economy to health care, slightly below the US rate of 14.8% 6% 4% 2% 0% 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 United States CT Health Policy Project November 2017 5
Per capita health spending, 2014 $14,000 $12,000 residents spend more on health care across payers than most Americans $10,000 $8,000 $6,000 $4,000 $2,000 $0 All payers Medicaid Medicare private insurance United States CT Health Policy Project November 2017 6
Per capita spending, average annual growth 2001 to 2014 6 5 4 Medicaid per person spending from 2001 through 2014 decreased while nationally costs have risen percent growth 3 2 1 0 Total Medicaid Medicare Private health insurance -1 United States CT Health Policy Project November 2017 7
40% 35% Share of total health spending, 2014 Private insurance is the main payer of health care in 30% 25% 20% 15% 10% 5% 0% Medicaid Medicare Private insurance CT Health Policy Project November 2017 8
Medicare per capita spending $14,000 $12,000 $10,000 Medicare per person health costs for residents are similar to the national average $8,000 $6,000 $4,000 $2,000 $0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 9
Medicaid per capita health spending $12,000 $10,000 $8,000 $6,000 Until 2009 Medicaid costs were much higher than the US average Since then the gap has narrowed $4,000 $2,000 $0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 10
Private health insurance spending per capita $6,000 $5,000 $4,000 Costs of care for privately insured residents are higher than for most Americans and are rising slightly faster $3,000 $2,000 $1,000 $0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 11
40% 35% 30% 25% 20% 15% 10% Share of total health spending by payer In 2014, private health insurance s share of total health spending was 34% Medicaid s share was 20% Medicare s share was 21% 5% 0% Y1991 Y1992 Y1993 Y1994 Y1995 Y1996 Y1997 Y1998 Y1999 Y2000 Y2001 Y2002 Y2003 Y2004 Y2005 Y2006 Y2007 Y2008 Y2009 Y2010 Y2011 Y2012 Y2013 Y2014 Medicare Medicaid Private health insurance CT Health Policy Project November 2017 12
45% 40% 35% 30% 25% 20% Share of total health spending Medicare + Medicaid, Private health insurance In 2009, public coverage programs share of total CT health spending began to outpace private insurance And that gap is growing 15% 10% 5% 0% Y1991 Y1992 Y1993 Y1994 Y1995 Y1996 Y1997 Y1998 Y1999 Y2000 Y2001 Y2002 Y2003 Y2004 Y2005 Y2006 Y2007 Y2008 Y2009 Y2010 Y2011 Y2012 Y2013 Y2014 Private health insurance Medicare + Medicaid CT Health Policy Project November 2017 13
State rank While s relative per capita health care costs are high among states, the rate of growth is much lower, particularly for Medicaid Per capita 2014 Average annual growth 1991 to 2014 CT Health Policy Project November 2017 14
Per capita spending by service, 2014 drugs, nondurable products 14.97% DME 1.43% Other 8.01% hospital 33.74% Over half of health spending goes to hospitals and physicians, clinics nursing homes 8.66% home health care 3.00% dental 4.76% Other professionals 3.27% physicians, clinics 22.17% CT Health Policy Project November 2017 15
40% 35% 30% 25% Share of per capita spending by service Drugs consume a growing share of s health care spending, surpassing nursing home care in 2001 20% 15% 10% 5% 0% 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 hospital physicians, clinics dental home health care nursing homes drugs, nondurable products CT Health Policy Project November 2017 16
8% 7% 6% 5% Per capita average annual growth by service, 1991 to 2014 Drugs and other nondurable products are the main driver of growing health costs in 4% 3% 2% 1% 0% total hospital physicians, clinics dental home health care nursing home drugs, nondurable products CT Health Policy Project November 2017 17
80% 70% 60% 50% 40% 30% Share of total spending by service, 2014 Medicare and Medicaid pay for the majority of home health and nursing home care in and almost half of hospital bills in our state 20% 10% 0% hospital physician, clinic other professionals dental home health drugs, nondurable products DME nursing homes other Medicaid Medicare CT Health Policy Project November 2017 18
Drug, nondurable product spending per capita $1,600 $1,400 $1,200 $1,000 $800 Drug and other nondurable product spending is higher for residents than most Americans And the gap is growing $600 $400 $200 $0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 19
Drugs, nondurable products share of total per capita spending 20.00% 18.00% 16.00% 14.00% Since 2003 spending on drugs and other nondurable products have grown faster in than nationally 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 United States CT Health Policy Project November 2017 20
November 2017 Source: National Health Expenditure Data, cms.gov, https://www.cms.gov/research-statistics-data-and- Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html Health Policy Project www.cthealthpolicy.org @cthealthnotes Phone 203-427-8242 CT Health Policy Project November 2017 21