November 15, 2013

162017_132140396847214_292624_nIn 2011, U.S. health care employed 15.7% of the U.S. workforce (1 in 25 health care employees is a physician); U.S. health care expenditures were $2.7 trillion; and, there were approximately 800,000 physicians and 2,700,000 nurses in the U.S.  From 1980 to 2011, U.S. health care expenditures doubled as a percentage of U.S. gross domestic product, to 17.9%. While yearly growth of U.S. health care expenditures have decreased since 1970 (and especially since 2002), they exceed any other industry and gross domestic product, at 3%. Government funding of health care in the U.S. increased from 31.1% in 1980 to 42.3% in 2011.

Since 1980, U. S. health care administrative costs have more than doubled, from 3% in 1980 to 7% in 2010 of total spending, with growth at 5.6% per year. However, since 2000, 84% of the increase is attributable to growth of drugs and devices (4% per year), professional services (3.6% per year), and hospital care (4.2% per year), as opposed to the demand for services or the aging of the population. Nonetheless, since 1970, the rate of average yearly increase of total expenditures has generally declined, especially since 2002.

Since 1980, spending on major government programs (Medicare, Medicaid, and federal employee/retiree) increased disproportionately compared with private insurance, with personal out-of-pocket spending declining from 23% in 1980 to 11% in 2011.

Since 1980, there has been an 83% decline in personal spending for physician services and drugs, with government and commercial payers now responsible for more than 90% of hospital and physician costs and 80% of drugs and nursing home care.

Since 1990, total personal out-of-pocket share of payments for care (co-payments) plus payments for insurance premiums increased 2.1% per year, with the largest increase in personal Medicare contributions (5.7% per year).

Since 2000, chronic illnesses account for 84% of health care costs overall among the entire population, not only of the elderly. Chronic illness among those younger than age 65 accounts for 67% of spending. If trauma is added to the mix (including assault, attempted suicide, and motor vehicle crashes), about 80% of total U.S. health care expenditures are for those younger than 65.

The 30 most rapidly increasing chronic and acute conditions (the three leading categories: heart disease, trauma-related disorders, and cancer) account for 44% of total spending, for which costs are increasing by 6% per year for chronic conditions and 4% per year for acute conditions.

The three factors that are responsible for most of the change in health care costs are consolidation (fewer general hospitals and more single-specialty hospitals and physician groups result in financial concentration in health systems, insurers, pharmacies, and benefit managers); information technology; and, the shift to the patient as consumer (including the use of social media, informal networks, new public sources of information, and self-management software to influence consumer choice).

From 2000 to 2011, the increase in price (particularly of drugs, medical devices, and hospital care) and not the intensity of service or demographic change, produced most of the increase in health care’s share of gross domestic product.

From 2000 to 2010, health care costs increased faster than any other industry, at 2.9% per year, with only total government spending exceeding the growth in health care costs, at 3.3% per year.

In 2012, the proportion of uninsured among the U.S. population was 15%. The number of uninsured peaked in 2010 (about 50 million people) and declined through 2012 (estimated at 48 million people).

Physicians have shifted from solo or small group private practice (53% in 2000; 23% in 2012) to either employment by or significantly increased affiliation with hospitals (41% in 2000; 72% in 2010).

The number of health care facilities has increased from 765,729 in 2000 to 935,872 in 2011. The number of general acute care hospitals has decreased from 6,588 in 2000 to 5,836 in 2011, while the number of specialty hospitals (predominantly orthopedic and cardiovascular) has nearly doubled, from 499 to 956.

The U.S. ranks 19th of 25 countries analyzed in number of primary care physicians per 100 000 population and ranks 6th of 25 in medical specialty physicians and 12th of 25 in surgical specialty physicians.


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