Christopher J Conover

American Health Economy Illustrated

• Broschiertes Buch

Produktbeschreibung

With 150 original color charts and graphs, The Illustrated Guide to the American Health Care Economy is an attractive, user-friendly, one-of-a-kind resource on the economics of health care in the United States. Covering topics such as 'How Is Each Health Care Dollar Spent?' and 'Who Pays for Health Services?, ' this comprehensive, accessible guide will be of interest to everyone concerned about the future of health care in America

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Produktdetails

• Verlag: AEI Press
• Seitenzahl: 352
• Erscheinungstermin: 16. Februar 2012
• Englisch
• Abmessung: 253mm x 179mm x 24mm
• Gewicht: 1034g
• ISBN-13: 9780844772028
• ISBN-10: 084477202X
• Artikelnr.: 33770946

Autorenporträt

Christopher J. Conover is a research scholar at the Center for Health Policy and Health Inequalities Program at Duke University.

Inhaltsangabe

Acknowledgments Foreword, Mark V. Pauly Preface   Chapter 1: Rise of a
Massive Health Sector 4. Over eight decades, constant dollar health
spending per person increased five times as much as real output per capita.
6. Inflation-adjusted health output per capita has increased at least
8-fold over the past 80 years. 8. The health sector absorbs an increasing
share of national resources. 10. Health spending per capita is
significantly more in the United States than in other large "rich"
countries-18 percent more than second-ranked Norway. 12. For 80 years,
growth in real per capita health spending almost always outpaced growth in
the rest of the economy by as much as six percentage points. 14. In the
past 50 years, health spending as a share of GDP has risen in all advanced
countries. 16. Most of the world's population live in countries where
health spending per capita is much less than that of the United States, yet
the gap has been increasing for some of the largest countries in recent
years.   Chapter 2: How is Each Health Dollar Spent? 20. Most health
spending is for personal health services; for 40 years, such spending has
exceeded 80 percent of all health expenditures. 22. From 1929 to 2009,
inflation-adjusted personal health spending per capita has doubled
approximately every 25 years. 24. Insurer administrative costs decline as
group size increases and vary by type of coverage. 26. The combined
percentage of health spending related to hospitals and nursing homes
doubled from 1929 to 1989 but currently is declining. 28. More than half of
health spending is for chronic diseases; chronic illness accounts for an
increasing share of health spending. 30. At least half of personal health
spending is for behavior, lifestyle, or other avoidable causes.   Chapter
3: Who Pays for Health Services? 34. Regardless of how it is measured, the
public sector role in U.S. health financing has increased. 36. Private
health insurance pays for a smaller share of health spending than public
insurance does, even though many more Americans have private insurance. 38.
For the past 70 years, virtually all growth in health spending relative to
the economy has been financed by public and private health insurance. 40.
Though far less visible to the average American, federal tax subsidies for
health exceed federal spending on Medicaid. 42. For 80 years, the
out-of-pocket share of health spending has declined while the portion paid
by third parties has increased. 44. Despite a much lower publicly financed
share of health spending, the U.S. out-of-pocket share of spending is among
the lowest in the world. 45. The elderly and disabled constitute 25 percent
of Medicaid enrollees but more than 75 percent of Medicaid spending. 46.
Beneficiaries directly pay less than 15 percent of Medicare costs, but
Medicare also covers less than half of all their health spending. 48. From
30 to 65 percent of all health spending by individuals who are uninsured
all year is subsidized by taxpayers or private payers.   Chapter 4: The
Employer Role in U.S. Health Care 52. A growing share of worker
compensation is paid in the form of wage and salary supplements, including
social insurance-such as Medicare-and private health insurance. 54. The tax
subsidy for employer-provided health insurance increases with income;
high-paid workers get a larger subsidy-in both dollar terms and in the
fraction of premiums subsidized-than do low-paid workers. 56 For a variety
of reasons, workers in small firms, health care and retail trade are least
likely to be offered health coverage at work. 58. Despite relatively stable
health insurance offer rates, there has been a secular decline in
employer-based health coverage across almost all firm-size categories.  
Chapter 5: Government Expenditures, Taxes, and Deficits 62. Real government
expenditures for health rose 30-fold during the past 50 years-or 17-fold in
per capita terms. Between 1966 and 2007, the entire increase in
government's share of GDP is attributable to growth in tax-financed health
care. 64. Tax-financed health expenditures have risen much faster than
government spending on defense, income support and education. 66.
Tax-financed health expenditures explain little of the difference between
the United States and its major competitors in public sector spending as a
percent of GDP. 68. The public sector pays 80 percent of health costs for
people in poor health. 69. Taxpayers finance almost half of health spending
for the highest-income families. 70. Almost all Medicare beneficiaries pay
less in payroll taxes than the dollar amount of benefits they receive from
the program. 72. The Medicaid share of state health spending varies by a
factor of three across states.   Chapter 6: Health Services and the Family
Budget 76. Health care is currently the second largest component of
personal consumption. Since 1929, the share going to health care has risen
faster than any other major category of personal consumption. 78. Because
so much health spending is hidden, direct family spending on health care
and health insurance premiums has accounted for only five percent of income
for 20 years. 80. In the past 25 years, the relative burden of paying for
health care has grown slightly faster among families that have the highest
incomes. 84. The elderly and children rely more heavily than others do on
tax-financed health coverage. 85. The risk of being uninsured is at least
three times as high among young adults as among children younger than 10 or
the elderly. 86. The risk of being uninsured is substantially higher among
young adults than among children or the elderly. 86. The average American's
chance of being uninsured has declined substantially over the past 70
years. 88. Although per capita health costs for persons uninsured all year
are less than half the amount spent for those with private coverage, more
than 65 percent of their costs are subsidized. 90. In elderly households,
the share of household spending for health care is both more for those
headed by the non-elderly and has increased faster over time. 92. Despite
higher health costs, real non-health spending per person in elderly
households is higher than in households headed by younger people.   Chapter
7: Who Produces Health Services? 96. Compared with the rest of the economy,
a much larger share of health output is provided by non-profit
organizations or publicly owned enterprises. 98. In most subsectors of
health care, government-owned firms account for only approximately 10
percent of activity. 100. The increasing share of final demands related to
health care has been a major factor in the growth of the service share of
national output after World War II. 102. Over the past 80 years, the
increase in health services output was almost 50 percent higher than was
the increase in economy-wide output.   Chapter 8: Health Services and the
Distribution of National Income 106. Health-related supplements accounted
for almost 12 cents of every dollar of national income in 2008 compared
with less than three cents four decades earlier. 108. More than 80 percent
of 2009 national income for health services was for compensation of
employees compared with only 50 percent in 1963. Reflecting the decline of
physicians in solo practice or partnerships, the share of health-related
national income accounted for by proprietors' and rental income has fallen
steeply in the past 50 years. 110. The share of health-related national
income accounted for by proprietors' and rental income has declined steeply
in the past 50 years. 112. Corporate profits before and after taxes have
now reached their highest share of health services income in the past 50
years. 114. Corporate profits before taxes in the health sector are less
than that of other major sectors and private businesses overall. 116.
Publicly traded health services companies generally have lower profits than
do other firms listed on the stock market. 118. Pharmaceutical and medical
devices have higher profits than do most industries, reflecting returns for
discovery and innovation.   Chapter 9: Productivity in the Health Sector
122. Only recently has the increase in real health services output exceeded
the increase in the input of labor or the combined increase in the inputs
of labor and capital. Output per unit of input is called productivity. 124.
Productivity growth is less in the health sector than in private business
in general. 125. Productivity tends to be lower in the health sector
despite more education among health workers compared with those in the rest
of the economy. 126. Information capital per hour has risen far less slowly
in ambulatory health services than in private business overall. 128.
Expenditures for R&D have expanded our scientific and technological
knowledge; this has contributed to the increase in health sector
productivity. 130. Since 1982, increased personal health spending alone can
explain approximately 80 percent of the decline in personal savings.
Although U.S. health spending matches its gross savings, most of the
nation's major competitors save much more than they spend on health care.
132. In many parts of the health sector, output generally has increased
more slowly than the combined inputs of labor, capital and other factors of
production.   Chapter 10: The Labor Force and Employment in the Health
Sector 136. Since 1930, if health services employment had increased only as
fast as in the rest of the economy, the health sector would have employed
nearly 11 million fewer workers in 2009. Employment has increased faster in
ambulatory health services than in hospitals or nursing homes. 138. The
health sector as a share of total employment is higher in the United States
than in other industrialized countries. The industry's growth relative to
all employment appears comparable with other G7 nations in recent years.
140. Whether the opportunity cost of health sector employment in the United
States is more or less than in the rest of the G7 depends on how it is
measured. 142. Females account for more than 75 percent of health sector
employees but constitute fewer than half of employees in the
goods-producing part of the health sector. 144. Compared with employees in
general, the work year per FTE is several hundred hours shorter for health
services employees. Recently, annual work hours per employee generally have
declined in long-term care facilities while increasing in hospitals. 146.
Increased longevity and a shorter working life have lengthened the period
of retirement for men but not for women.   Chapter 11: Personal Incomes and
Health Care 150. For the average American worker, growth in real hourly
earnings has in recent decades lagged behind growth in real compensation
per hour, due in part to rising health costs. 152. Employee compensation in
the health industry is much more than the average for other service
industries but only slightly more than the average for all workers. 154.
Real compensation per hour has increased more slowly in the ambulatory
health sector than in the rest of the economy. 156. Health professionals in
the United States have much higher relative incomes than do their
counterparts in other industrialized countries. 157. Physicians in the
United States enjoyed rising rates of return for medical education for
decades. Although such returns might have fallen recently, they appear to
be similar for those who pursue careers in law or business.   Chapter 12:
Distribution of Health Services 162. One percent of the population accounts
for approximately 25 percent of health spending; five percent accounts for
almost half. 164. After accounting for all hidden costs and subsidies, the
net burden of paying for health care is 2¿ times as much for the very
lowest-income families compared with the very highest-income families. 166.
The net burden of paying for health care has increased. The relative burden
for low- versus high-income families appears unchanged. 168. Per capita
health spending generally increases with age; annual health costs for the
elderly are at least four times as high as for children and young adults.
170. During their reproductive years, women's health costs are much higher
than are men's and only slightly higher in early retirement. 172. Regional
differences in both health spending per capita and income per capita have
widened somewhat since 1980. Before that time, per capita income
differences had been narrowing for at least 50 years. 174. Regional
differences in the financial burden of health spending narrowed between
1980 and 1987 but have increased in subsequent years.   Chapter 13: Poverty
and Health 178. Millions of people no longer would be categorized as poor
if medical expenditures were handled differently when measuring poverty.
180. Approximately half of those below poverty are covered by government
insurance (primarily Medicaid). Approximately 30 percent are uninsured. The
chances of being uninsured decline steadily with increasing income. 182.
Health status generally is worse among those who have lower incomes;
poverty status explains only some of the health status differences related
to race. 184. Poor children are much less likely to have private coverage
than any other age group. Almost seven in 10 poor children have Medicaid
coverage. 186. Fewer than 30 percent of non-elderly adults who are poor are
covered through Medicaid. More than 40 percent are uninsured. Although more
than 90 percent of the elderly poor have government coverage, approximately
three in 10 have some sort of private insurance.   Chapter 14: The
Structure of the Health Sector 190. More than half of U.S. health sector
workers are employed by firms that have fewer than 500 workers. The share
of employment accounted for by large firms varies significantly across
health industry subsectors. 192. Seemingly high levels of concentration in
the health insurance industry might not accurately depict its
competitiveness. Concentration is increasing in both hospitals and health
insurers. 194. The health sector is more highly regulated than almost any
other segment of the U.S. economy. However, the extent of regulation varies
widely across states. 196. Unionization rates in the health industry are
comparable to the economy-wide rate. The unionization rate within some
health occupations is much higher.   Chapter 15: Health, Wealth and Debt
200. Since the early 1950s, real health spending per capita has grown
approximately twice as fast as real per capita net worth. 202. A relatively
small fraction of American households incurs annual health expenditures
that exceed their net worth. 204. "Medical" bankruptcies account for 25
percent to possibly 35 percent of all bankruptcies in the United States.  
Chapter 16: Economic Fluctuations and Health 208. Aggregate health spending
growth appears to be largely independent of fluctuations in the business
cycle. 210. Medicaid expenditures tend to be more countercyclical than are
other components of NHE, generally rising faster during recessions than
during recoveries. 212. Unemployment rates for workers in the health sector
are lower for males but not for females, compared with workers in the rest
of the economy.   Chapter 17: Health Services and Quality of Life 216. The
value of typical Americans' stock of health at birth is several multiples
of their lifetime earnings. 218. In price measurement, the treatment of
innovations or new products is perhaps the most difficult aspect of
handling quality change. 220. Technology has been an important driver of
health spending. However, measuring its precise role has been difficult.
222. If premature mortality and morbidity are measured in terms of lost
production, the social burden of illness has increased since 1963; however,
if the intangible value of human life is taken into account, the social
burden of illness has declined despite the large increase in health
expenditures during this period.   Chapter 18: U.S. Health Care in a Global
Economy 226. The United States leads the world in medical innovation. 228.
Among the top 10 global funders of pharmaceutical R&D, the United States
accounts for more than 50 percent to 65 percent of total spending. 230.
Despite its global dominance in pharmaceutical R&D, the United States
accounts for a small share of pharmaceutical exports among industrialized
nations. Conventional measures of U.S. trade provide an incomplete picture
of the contribution of the health sector to imports, exports or the
country's overall balance of trade.   Chapter 19: Do Americans Get Good
Value for Money in Health Care? 234. Health spending in recent decades
appears to have been "worth it" on average, but this likely masks much
wasted spending. 236. Geographic differences in broad health outcomes
generally are associated with higher health spending both across countries
and within the United States. Because higher spending also is associated
with higher incomes, it is difficult to untangle the separate contribution
of higher income to better health. 238. In Medicare, there are sizable
geographic variations in spending and spending growth. Only a relatively
small part of geographic variations in Medicare spending can be explained
by differences in health status, income or race. Most of the difference
relates to "practice style." 240. Health spending per capita in the United
States is not necessarily more than expected relative to the pattern seen
in other industrialized countries. 242. Increased spending in the United
States cannot be explained by higher use of health services, although
Americans do have greater access to some expensive technologies than do
those in other industrialized countries. 244. Compared with some major
competitors, the United States relies more on specialists than on primary
care doctors. 246. Americans pay higher prices for brand-name
pharmaceuticals but lower prices for over-the-counter drugs than do
residents in other major industrialized countries. 248. The American system
of medical malpractice likely accounts for some, but assuredly not all, of
the difference in health expenditures between the United States and its
competitors. 250. Excluding deaths due to violence, the United States
generally leads the world in life expectancy at birth. 252. Few countries
match the performance of the United States in saving the lives of pre-term
infants. The higher rate of pre-term births in the United States is an
important contributor to its low international ranking for infant mortality
overall. 254. On average, Americans who have various types of cancer have
markedly better chances of surviving five years compared with cancer
patients in other industrialized nations. For several reasons, survival
rates for blacks trail these averages. 256. Despite its superiority in many
health outcomes related to medical care, the United States has relatively
more avoidable deaths amenable to health care than do many other
industrialized countries. 258. Most "avoidable" deaths are related to
lifestyle or behavior. 260. The nation's obesity rate is the highest in the
world, but smoking is somewhat less common among adults in the United
States compared with most other industrialized countries. There are big
differences in obesity and smoking rates across states. 262. Comparing
health system performance across states poses many of the same challenges
as comparisons across countries.   Chapter 20: Are Health Spending Trends
Sustainable? 266. Over the next 75 years, health benefits as a share of
worker compensation could more than quadruple. Despite this, real cash
wages per worker will be 7.5 times as much as the amount in 2008. 268.
Technology has been a far more important driver of health spending growth
during the past 60 years than has been population growth or aging. 270. The
excess cost ratio measures how much faster per capita health
spending-adjusted for changes in age and gender-increased relative to
growth in per capita GDP. Historical variations in the excess cost ratio
make predicting future health spending difficult, especially over a long
time. 272. Over the next 50 years, the country can "afford" growth in
health spending that exceeds growth in the general economy only if the
difference is not too much. Continuing historical rates of excess growth in
health spending could result in a decline in real GDP per capita within 30
years. 274. Much uncertainty exists in 75-year forecasts of health
spending; yet if even one percent excess cost growth persists, almost 90
percent of GDP growth will be devoted to health care by 2085. 276. In
today's dollars, the long-term unfunded liabilities associated with health
entitlements exceed $66 trillion-approximately four times as much as the
unfunded liabilities related to Social Security. 278. The projected 75-year
increase in mandatory federal health spending exceeds current revenues from
the three largest sources of federal tax revenue. 280. U.S. competitors
have already had to confront the challenge of an increasing number of
dependents-both children and elderly-per working adult. For the United
States, much of this challenge still lies in the future. 282. Projected
increases in government-related health spending could, within 50 years,
eradicate the margin of advantage that the United States currently has over
its major European competitors in terms of the burden of government.  
Glossary References Sources About the Author Index