Figure ES-1. International Comparison of Spending on Health, 198 24 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP 7 6 5 4 United States Germany Canada France Australia United Kingdom 16 14 12 1 8 3 2 1 198 1982 1984 1986 1988 199 1992 1994 1996 1998 2 22 24 Data: OECD Health Data 25 and 26. 6 4 2 198 1982 1984 1986 1988 199 1992 1994 1996 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 26. United States Germany Canada France Australia United Kingdom 1998 2 22 24
Figure ES-2. Growth in National Health Expenditures (NHE) Under Various Scenarios NHE, in trillions of dollars 4.25 3.75 Cumulative savings projections, 27 215: One-time savings: $1.31 trillion Slowing trend: $1.39 trillion $4.4 T $3.85 T $3.71 T 3.25 2.75 2.25 1.75 $2.2 trillion in 25 Baseline NHE One-time savings scenario Slowing trend scenario 25 26 27 28 29 21 211 212 213 214 215 Source: Based on C. Borger et al., Health Spending Projections Through 215: Changes on the Horizon, Health Affairs Web Exclusive (Feb. 22, 26):w61 w73. 2
Figure 1. International Comparison of Spending on Health, 198 24 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP 7 6 5 4 United States Germany Canada France Australia United Kingdom 16 14 12 1 8 3 2 1 198 1982 1984 1986 1988 199 1992 1994 1996 1998 2 22 24 6 4 2 198 1982 1984 1986 1988 199 1992 1994 1996 Data: OECD Health Data 25 and 26. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 26. United States Germany Canada France Australia United Kingdom 1998 2 22 24
Figure 2. Growth in National Health Expenditures: Private, Public, and Total Expenditures, 198 25 Average annual percent growth in health expenditures 14 Total NHE Private Public 12 1 8 6 8.6 8.9 8.3 1.3 1.7 1. 6.3 5.4 4.6 8.7 8. 7.2 7.5 6.3 5.3 4 2 198 25 198 1993 1993 1997 1997 2 2 25 Source: A. Catlin et al., National Health Spending in 25: The Slowdown Continues, Health Affairs, Jan./Feb. 27 26(1):142 53.
Figure 3. Health Expenditure Growth 198 25 for Selected Categories of Expenditures Average annual percent growth in health expenditures 2 198 25 198 1993 1993 1997 1997 2 2 25 15 1 5 15.8 11.8 11.9 11.4 11.8 11.9 12. 11.1 1.7 1.9 9.2 1.3 9.2 8.6 8.1 7.5 8. 7.9 6.2 6.1 4.6 4.6 3.6 3.1 1.9 Hospital care Physician & clinical services Nursing home & home health Prescription drugs Prog. admin. & net cost of private health insurance Source: A. Catlin et al., National Health Spending in 25: The Slowdown Continues, Health Affairs, Jan./Feb. 27 26(1):142 53.
Figure 4. Percentage of National Health Expenditures Spent on Health Administration and Insurance, 23 Net costs of health administration and health insurance as percent of national health expenditures 8 7.3 6 4 2 1.9 2.1 2.1 2.6 3.3 4. 4.1 4.2 4.8 5.6 France Finland Japan a b c * Canada United Kingdom Netherlands Austria Australia Switzerland Germany a 22 b 1999 c 21 * Includes claims administration, underwriting, marketing, profits, and other administrative costs; based on premiums minus claims expenses for private insurance. Data: OECD Health Data 25. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 26. United States
Figure 5. Monthly Percentage Change in Health Insurance Stock Price Index, 1996 26 Source: J.C. Robinson, The Commercial Health Insurance Industry in an Era of Eroding Employer Coverage, Health Affairs, Nov. Dec. 26 25(6):1475 86.
Figure 6. Health Expenditures for Selected Type of Services, 2 215 Projected TOTAL 2 25 21 215 Billions $1,353.3 $1,987.7 $2,879.4 $4,31.7 Percent GDP 13.8% 16.% 18.% 2.% BY TYPE OF SERVICE Hospital care $417. $611.6 $882.4 $1,23.9 Physician & clinical services 288.6 421.2 61.7 849.8 Other professional services (dental, etc.) 138.2 2.5 292.6 411.5 Nursing home care 95.3 121.9 16.5 216.8 Home health care 3.5 47.5 72.3 13.7 Prescription drugs 12.8 2.7 299.2 446.2 Other medical products 49.5 58.1 69.1 83.1 Program admin. & net cost of private health insurance 81.2 143. 21.6 289.8 Investment 88.8 126.8 191.3 268.9 Source: A. Catlin et al., National Health Spending in 25: The Slowdown Continues, Health Affairs, Jan./Feb. 27 26(1):142 53; C. Borger et al., Health Spending Projections Through 215: Changes on the Horizon, Health Affairs Web Exclusive (Feb. 22, 26):w61 w73.
Figure 7. States with Higher Medicare Spending per Enrollee Do Not Have Lower Rates of Mortality, 23 Medicare spending per enrollee $4,5 $5,5 $6,5 $7,5 $8,5 2.5% HI Mortality rate of Medicare enrollees 3.5% 4.5% 5.5% MN CO AK OR UT ID ND IA SD NM WY NH AZ DC DE WI VT MTWA VA IN SC KS US NE ME NC WV KY OH IL AR GA MO AL MS TN OK NV FLMD CA MI PA TX CT RI NY MA LA NJ 6.5% Source: Data from The Dartmouth Atlas of Health Care, www.dartmouthatlas.org.
Figure 8. Costs of Care for Medicare Beneficiaries with Multiple Chronic Conditions, by Hospital Referral Regions, 21 Average annual reimbursement Ratio of percentile groups Average 1th percentile 25th percentile 75th percentile 9th percentile 9th to 1th 75th to 25th All 3 conditions (Diabetes + CHF + COPD) $31,792 $2,96 $23,973 $37,879 $43,973 2.1 1.58 Diabetes + CHF $18,461 $12,747 $14,355 $2,592 $27,31 2.14 1.43 Diabetes + COPD $13,188 $8,872 $1,34 $15,246 $18,24 2.3 1.48 CHF + COPD $22,415 $15,355 $17,312 $25,23 $32,732 2.13 1.45 CHF = Congestive heart failure; COPD = Chronic obstructive pulmonary disease. Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of 21 Medicare Standard Analytical Files (SAF) 5% Inpatient Data. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 26.
Figure 9. Growth in National Health Expenditures (NHE) Under Various Scenarios NHE, in trillions of dollars 4.25 3.75 Cumulative savings projections, 27 215: One-time savings: $1.31 trillion Slowing trend: $1.39 trillion $4.4 T $3.85 T $3.71 T 3.25 2.75 2.25 1.75 $2.2 trillion in 25 Baseline NHE One-time savings scenario Slowing trend scenario 25 26 27 28 29 21 211 212 213 214 215 Source: Based on C. Borger et al., Health Spending Projections Through 215: Changes on the Horizon, Health Affairs Web Exclusive (Feb. 22, 26):w61 w73. 11
Figure 1. Percent of Different Physicians Seen by Patients in Academic Medical Centers Varies Average percentage of patients seeing 1+ different physicians in first year of care within AMC hospitals Lowest quintile Middle quintiles Highest quintile 4 35 32 3 2 2 16 15 17 25 18 25 1 Hip Fracture Colorectal Cancer Acute Myocardial Infarction Note: Quintiles of practice intensity ( treatment groups ) corresponded closely to regional differences in price and to illness-adjusted Medicare spending. Source: E.S. Fisher et al., Variations in the Longitudinal Efficiency of Academic Medical Centers, Health Affairs Web Exclusive (Oct. 7, 24):var-19 var-32.
Figure 11. Improvements in Use of Beta Blockers After a Heart Attack 1 8 6 4 9th percentile Commercial mean 1th percentile 2 1996 1997 1998 1999 2 21 22 23 24 25 Source: National Committee for Quality Assurance, The State of Health Care Quality: 26 (Washington, D.C.: NCQA, 26).
Figure 12. Health Care Costs Concentrated in Sick Few Sickest 1 Percent Account for 64 Percent of Expenses Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 23 % 1% 1% 5% 1% Expenditure threshold (23 dollars) 2% 3% 24% $36,28 4% 5% 5% 49% $12,46 6% 7% 8% 64% $6,992 9% 1% 97% $715 U.S. Population Health Expenditures Source: S. H. Zuvekas and J. W. Cohen, Prescription Drugs and the Changing Concentration of Health Care Expenditures, Health Affairs, Jan./Feb. 27 26(1):249 57.
Figure 13. Primary Care Doctors Use of Electronic Patient Medical Records, 26 Percent 1 98 92 89 79 75 5 42 25 28 23 NET NZ UK AUS GER US CAN Source: 26 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.