National Health Care Spending Research Articles

Viewpoint: National Healthcare Spending and Fiscal Control: Comparisons among 15 Countries

Viewpoint: National Healthcare Spending and Fiscal Control: Comparisons among 15 Countries

What we say and what we do: county-level public spending for health care.

The purpose of this study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density, population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

An Overview of Health Care Spending Patterns in the United States: Using National Data Sources to Explore Trends in Nursing Services

National health care spending trends have been tracked through the federal governmental for much of the latter half of the 20th century. A review of these spending trends illustrates not only health care's contribution to the overall national economy, but more importantly it allows us to assess our priorities for spending that money. Nursing has long sought information about the "cost" of its care, at the micro-level, and has desired to articulate its share of national expenditures, at the macro-level. This quest has been fueled largely by the profession's desire to more accountably argue the value of its services. This article reviews national health expenditure trends, and explores how the analysis of these trends can be used to shape nursing's own research agenda for assessing the value of its services.

Spending more through “cost control”: Our obsessive quest to gut the hospital

The data presented by Katharine Levit and colleagues in Health Care Spending in 1994: Slowest in Decades ''1 are both reassuring and puzzling. On the one hand, they confirm that the growth of national health care spending has descended markedly from the Congress iona l Budget Office's (CBO's) dire forecast of 1993, according to which health spending in 1994 would have exceeded 15 % of gross domestic product (GDP) (instead of the actual estimated 13.7%)} There is reason to believe that by the year 2000 health spending will remain much below the alarming 18.9% of GDP that had been forecast by the CBO only 3 years ago. At the same time, however, one wonders why the United States still spends close to 14% of its huge GDP on health care, when all other industrialized nations had succeeded in stabilizing that ratio below 10% as early as 1980 and have remained at those much lower levels so far) Much is made in this country of California's

Epilepsy care in Germany: a clinical perspective.

Unified Germany has a population of 81 million people living in 16 states. Based on epidemiologic studies, it has been estimated that 810,000 people have some form of epilepsy and as many as 130,000 to 170,000 people suffer from a severe or disabling epilepsy.1 Current therapies provide only partial control for many of the latter group of individuals.1 The following report briefly describes the principle features of epilepsy care in Germany (table). View this table: Table Principle features of epilepsy care in Germany The German health care system offers almost complete health care coverage to the German population (prevention, treatment, and rehabilitation). The system is supported by a multi-structured network of public and private health care insurers. Costs of this insurance are paid for equally by employers and employees. Approximately one-third of the national health care spending involves hospital expenditures with the remaining funds covering physician fees, clinic visits, and medications.2 Currently, 8.6% of the gross national product is spent on health care. In 1995, the public health insurance system ended with a deficit, prompting politicians to call for a greater contribution by the public unless strong measures could be enacted to reduce costs. Recently, there has been an effort to reduce health care spending by capping both outpatient expenditures for medications and across the board fees for inpatient and outpatient care. At the same time, patients have been asked to pay more toward services and the pharmaceutical industry has been required to reduce prices. The Federal Minister for Health is faced with the challenge of maintaining quality services in an era when progress in, and costs of, medicine and medical technology are accelerating simultaneously with a population that is aging and a worker pool that is declining. This is a daunting task-one that is not unique to Germany. …

Academic medicine meets managed care: a high-impact collision.

The managed care revolution is sweeping the country as a result of intense marketing on the part of managed care organizations and the widespread belief that price-sensitive managed care systems will control health costs. Although few believe that managed care alone can adequately stem the growth of nation health care spending, competition based on price has emerged as a powerful force in the health care sector. Academic health center (AHCs) stand to suffer with this new managed care regime because their special missions of teaching, research, and highly specialized clinical care make them more expensive than nonacademic hospitals and place them at a noncompetitive disadvantage. The traditional focus of the acute care hospital with individual departmentally designed programs will be narrow. Major changes will be required on the part of AHCs if they are to survive and preserve patient volume, maintain the integrity of medical education, advance scientific research, and provide highly specialized care. AHCs will have to make unprecedented adjustments in virtually every phase of their operations, particularly in the areas of clinical decision making and speedy patient-related information flow. A premium will be placed on multidisciplinary, inclusive medical services that can assume total health care risks for large populations. New ways of educating students in ambulatory settings with an emphasis on outcomes and population-based health will be needed along with the traditional responsibility of pursuing new approaches to the diagnosis, treatment, and prevention of disease. The extent to which managed care will ultimately alter the traditional role of AHCs in the American health care system is unclear, but successful adaptation in the short term will require them to respond broadly, flexibly, and in a timely fashion to the anticipated health care scene.

DOCTORS PLANNING BATTLE AGAINST HEALTH-CARE PLAN

CHICAGO, June 14—Leaders of the American Medical Association laid the groundwork today for an aggressive legal and political campaign against two important elements of the health plan being developed by President Clinton: limits on national health-care spending and on doctors' charges. The association's board warned that there would be significant constitutional problems if the Government tried to impose price controls or an overall limit on health spending, both of which have been advocated by the White House ... Doctors across the country plan to distribute a list of questions to be used by patients in evaluating President Clinton's health-care plan. Among the questions, drafted by the medical association, are these: "Will I still be able to see my own doctor? Will I have to pay extra? "I have a group insurance policy through my employer. Will that change? Will my premiums, deductibles and copayments go up? "Will I be able to choose my own type of health insurance? And can I buy extra insurance if I want it? "Will the quality of care my family receives be maintained under a new system? "I'm retired and on a fixed income. Will my Medicare coverage be affected? "Will everybody in America have health insurance? And if so, how will we pay for this?"

Health System Reform: Let's Not Miss Our Chance

Support for reform is at its highest level, but criticism of President Bill Clinton's plan is widespread. Nevertheless, the core components of the Clinton plan should be supported. These include (1) building on existing employer-based health insurance with a mandate that employers offer coverage to all workers and pay a substantial portion of the premium; (2) requiring that coverage be universal and benefits comprehensive; and (3) controlling total health care spending via a national expenditure limit. This paper does, however, suggest three changes to strengthen the plan: developing a broader base than Medicare and Medicaid to pay for reform; setting the national health care spending limit at a higher level (gross domestic product plus 1 percent); and strengthening the powers of the regional health alliances.

National Health Care Spending

National Health Care Spending

National Health Care Spending in 1991

The United States spent $751.8 billion on health in 1991, an increase of 11.4 percent over 1990 levels. National health expenditures consumed 13.2 percent of gross domestic product (GDP). The 11.4 percent growth rate in spending is four times the rate of growth in the general economy. Medicaid contributed substantially to overall spending in 1991. Consumers' out-of-pocket payments grew only 5.7 percent to a total of $144.3 billion, accounting for 19.2 percent of national health expenditures (the lowest share ever reported). Economywide price inflation accounted for 36 percent of health spending growth in 1991; increases in use and intensity of health services accounted for 30 percent of total spending growth; excess medical price inflation accounted for 25 percent, an amount that is consistent with its share throughout the 1980s.

National Health Care Spending, 1989

DataWatch Health AffairsVol. 10, No. 1 National Health Care Spending, 1989Katharine R. Levit, Helen C. Lazenby, Suzanne W. Letsch, and Cathy A. Cowan AffiliationsNational Health Accounts Branch, Division of Health Cost Analysis, Office of National Health Statistics, at the Health Care Financing Administration Office of the Actuary.PUBLISHED:Spring 1991No Accesshttps://doi.org/10.1377/hlthaff.10.1.117AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSCosts and spendingMedicareMedicaidNursing homesCost growthNational health expendituresPremiumsPrivate health insuranceHospital careWellness Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 25 History Published online 1 January 1991 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.ACKNOWLEDGMENTSThe views expressed in this DataWatch are those of the authors, and no endorsement by the Health Care Financing Administration is intended or should be inferred.PDF downloadCited byNo Room for Compromise: Business Interests and the Politics of Health care ReformTraumatismos craneoencefálicos. Escalas de valoración para la medida de resultados en rehabilitaciónRehabilitación, Vol. 36, No. 6Markets, Medicare, and Making Do: Business Strategies After National Health Care ReformJournal of Health Politics, Policy and Law, Vol. 22, No. 2Clinical radiopharmacy: Principles and practicesSeminars in Nuclear Medicine, Vol. 26, No. 2Nature or Nurture? Sources of Firm Preference for National Health Reform2 September 2013 | American Political Science Review, Vol. 89, No. 4Perinatal Nurse Practitioners Health Care ReformJournal of Obstetric, Gynecologic & Neonatal Nursing, Vol. 24, No. 7The impact of managed care on clinical practicePsychiatric Quarterly, Vol. 65, No. 3A Sociodemographic Comparison of Families of Very Low-Birthweight Infants: 1982-1991Public Health Nursing, Vol. 11, No. 3The United States' health care system: Problems and solutionsSurvey of Ophthalmology, Vol. 38, No. 3Together Again: Business, Government, and the Quest for Cost ControlJournal of Health Politics, Policy and Law, Vol. 18, No. 2America's Health Care System and its Future: The View of a Despairing Optimist18 August 2016 | Medical Care Review, Vol. 50, No. 1Perspectives on functional assessment: its use for policy making28 July 2009 | Disability and Rehabilitation, Vol. 15, No. 1Developments in Alcoholism TreatmentThe limits of health care resourcesThe American Journal of Emergency Medicine, Vol. 10, No. 6Forces for reforming the U.S. health care system: A review of the cost and access issuesHealth Economics, Vol. 1, No. 3Health Policy Dilemmas Related to High Technology Infertility Services2 October 2007 | Image: the Journal of Nursing Scholarship, Vol. 24, No. 3Problems of health insurance coverage and health care in the United States: public and private solution strategiesCadernos de Saúde Pública, Vol. 8, No. 3Underinsurance in AmericaNew England Journal of Medicine, Vol. 327, No. 4Task force 1: Scope of the problemJournal of the American College of Cardiology, Vol. 19, No. 7The Oregon Medicaid Demonstration Project — Will It Provide Adequate Medical Care?New England Journal of Medicine, Vol. 326, No. 5Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitalsJournal of Continuing Education in the Health Professions, Vol. 12, No. 3Why Almost Any Cost To Others To Preserve The Life Of The Irreversibly Comatose Constitutes An Extraordinary BurdenFrom Quality Assurance To Total Quality ManagementAmerican Journal of Audiology, Vol. 1, No. 1The Health Care Industry: Where Is It Taking Us?New England Journal of Medicine, Vol. 325, No. 12Perspective: Diversity And Transition In Health Insurance PlansRobert H. Miller and Harold S. Luft24 July 2017 | Health Affairs, Vol. 10, No. 4

National Health Care Spending Trends: 1988

DataWatch Health AffairsVol. 9, No. 2 National Health Care Spending Trends: 1988Katharine R. Levit, Mark S. Freeland, and Daniel R. Waldo AffiliationsOffice of National Cost Estimates, Health Care Financing Administration (HCFA) Office of the Actuary. In the same office, Mark Freeland, also an economist, is director of the Division of Statistical Analysis Division of Catastrophic Drug Insurance. The DataWatch on national health expenditures is published each year in Health Affairs . PUBLISHED:Summer 1990No Accesshttps://doi.org/10.1377/hlthaff.9.2.171AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSPrivate health insuranceCosts and spendingPremiumsNational health expendituresDeductiblesTaxesPaymentOut-of-pocket expensesPrescription drugsElderly care Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 22 History Published online 1 January 1990 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited ByPracticing psychology in the era of managed care: Implications for practice and training.1 January 2003 | American Psychologist, Vol. 58, No. 2Perinatal Nurse Practitioners Health Care ReformJournal of Obstetric, Gynecologic & Neonatal Nursing, Vol. 24, No. 7The impact of Medigap insurance on out-of-pocket health expenditures by older Americans over the 1980sJournal of Economics and Finance, Vol. 19, No. 2Long-Term Care Insurance and MedicaidMarc A. Cohen, Nanda Kumar, and Stanley S. Wallack24 July 2017 | Health Affairs, Vol. 13, No. 4Single-Payer Health Care Reform: Combining Increased Access and Cost Containment11 June 2009 | Cancer Investigation, Vol. 12, No. 2Forces for reforming the U.S. health care system: A review of the cost and access issuesHealth Economics, Vol. 1, No. 3Health Policy Dilemmas Related to High Technology Infertility Services2 October 2007 | Image: the Journal of Nursing Scholarship, Vol. 24, No. 3The transformation of American midwifery: 1975 to 1988.American Journal of Public Health, Vol. 82, No. 5ErrataAmerican Journal of Public Health, Vol. 82, No. 5ErrataAmerican Journal of Public Health, Vol. 82, No. 5ErrataAmerican Journal of Public Health, Vol. 82, No. 5Private Insurance Reform in the 1990s: Can it Solve the Health Care Crisis?1 January 1995 | International Journal of Health Services, Vol. 22, No. 2A survey of state insurance mandates covering alcohol and other drug treatmentThe Journal of Mental Health Administration, Vol. 19, No. 1Expanding Health Insurance Coverage and the Implications for DentistryJournal of Public Health Dentistry, Vol. 52, No. 2The crisis in health care cost in the United States: Some implications for radiation oncologyInternational Journal of Radiation Oncology*Biology*Physics, Vol. 23, No. 1The Olmsted County Benchmark Project: Primary Study Findings and Potential Implications for Corporate AmericaMayo Clinic Proceedings, Vol. 67, No. 1Choosing between apples and applesJournal of General Internal Medicine, Vol. 7, No. 1National Health Care and the Public's Oral HealthJournal of Public Health Dentistry, Vol. 51, No. 4Geriatric Home Health Care: Conceptual and Demographic ConsiderationsClinics in Geriatric Medicine, Vol. 7, No. 4Health Care Rationing and Insured Access: Does the Catholic Tradition Have Anything to Say?1 August 1991 | The Linacre Quarterly, Vol. 58, No. 3The Timing and Course of Health Care ReformNew England Journal of Medicine, Vol. 325, No. 3Trends In Retail Prescription ExpendituresStephen W. Schondelmeyer and Joseph Thomas24 July 2017 | Health Affairs, Vol. 9, No. 3

AGE AND MEDICAL SPENDING

On average, 85% of an individual's health care expenses are in the last two years of life, reports Business Week magazine, adding that the 11% of the population older than 65 years of age now accounts for 35% of the nation's health care spending. By the year 2040, Americans older than 65 will account for 20% of the population.

Health care innovation: a progress report.

Each quarter, Health Affairs reports on new developments in one of four sectors of the health sphere: health care innovation in Summer, national health care spending in Fall, health personnel in Winter, and health status and health care utilization in Spring. In this issue, J. Leighton Read and Paul M. Campbell update trends in health care technology and manufacturing and discuss the impact of competition. Pamela Farley Short of the National Center for Health Services Research and Health Care Technology Assessment reports on trends in employee benefits. Finally, Lynn Gruber, Maureen Shadle, and Cynthia Polich of InterStudy trace the history of the health maintenance organization (HMO) movement from the 1970s to the present.

Health status and medical care utilization.

Each quarter, Health Affairs reports on new developments in one of four sectors of the health sphere: health status and health care utilization in Spring, health care innovation in Summer, national health care spending in Fall, and health personnel in Winter. In this issue, Gerry Hendershot offers an update of health status and the use of medical care in the U.S. Bruce Vladeck and colleagues of the United Hospital Fund report on consumers and hospital mortality data. Finally, Allan Dobson and Elizabeth Hoy of the Consolidated Consulting Group reassess how hospitals are profiting under Medicare prospective payment.

Competition among physicians, revisited.

Ten years ago we developed a model of demand inducement in the physician services market and explored the properties of that model. We found that predictions concerning physicians' prices, workloads, and income were ambiguous and in many cases were consistent with those derived from a standard monopoly pricing model. Spurred in part by our work, numerous empirical studies of the demand inducement model have been conducted. These studies found little evidence of demand inducement for primary care physician services. Demand inducement may exist in the market for surgical services, but its extent is less than previously estimated. We disagree with those who say that physicians generate demand to avoid price controls and that national health care spending is proportional to the number of physicians; the evidence does not support these arguments. Substantial uncertainty may surround the physician's choice of diagnosis and treatment mode. However, this does not imply a breakdown of the agency relationship. In this paper we extend our earlier model of demand inducement to include variations in the quantity of services (which was previously assumed to be less than socially ideal). Using the model, we conclude that the major objection to government price setting is not that physicians will get around the controls by inducing demand; rather, price controls result in a quantity and quality of physicians' services that is not ideal and may be inferior to those provided in an unregulated monopoly.

Trends in health personnel.

Each quarter, Health Affairs reports on new developments in one of four sectors of the health sphere: health personnel in Winter, health status and health care utilization in Spring, health care innovation in Summer, and national health care spending in Fall In this issue, we offer an update on trends in physician supply, health personnel, and medical education. In a related DataWatch, a group of American Medical Association researchers compares the practice characteristics of male and female physicians. Next, Dennis Andrulis and colleagues of the National Association of Public Hospitals and the Council of Teaching Hospitals provide data on Medicaid policies and AIDS. Finally, Glen Misek and Lucy Hynds Karnell of the American College of Surgeons look at surgical residents.

National medical care spending.

Each quarter, Health Affairs reports on new developments in one of four sectors of the health sphere: national health care spending in Fall, health personnel in Winter, health status and health care utilization in Spring, and health care innovation in Summer. In this issue, Gerard Anderson and Jane Erickson of The Johns Hopkins Center for Hospital Finance and Management report on national medical care spending. Anderson has furnished these reports for Health Affairs for the past three years. Fitting into the theme of health expenditures is the DataWatch by George Schieber and Jean-Pierre Poullier of the Organization for Economic Cooperation and Development in Paris, who update their 1986 report of trends in international health care spending.

Investment in health care innovation.

Each quarter, Health Affairs reports on new developments in four sectors of the health sphere: health care innovation in Summer; national health care spending in Fall; health personnel in Winter; and health status and health care utilization in Spring. In this issue, Michael R. Pollard and Gary S. Persinger, both of the Pharmaceutical Manufacturers Association, report on recent trends in health research and development. Ira Burney and Julia Paradise, of the Health Care Financing Administration, offer the latest data on Medicare physician participation and assignment rates. The next DataWatch by Janet Mitchell, of the Massachusetts-based Center for Health Economics Research, and colleagues discusses reform of the Medicare physician reimbursement system. The section concludes with a study of long-term care IRAs by University of California, San Diego researchers Dennis E. Smallwood, Harold J. Simon, and Barbara L. Brody.

Technology innovation in health care.

Each quarter, Health Affairs explores the trends of a significant sector of the health care sphere: national health care spending in Fall, health manpower in Winter, health status and health care u...