An Overview of the U.S. Healthcare System: Two Decades of ... · Private Health Insurance Benefits: ... Dental Hygienists Health Record Technologists & Technicians ... 2000-2010 Over

An Overview of the U.S. Healthcare System:Two Decades of Change, 1980-2000

Centers for Medicare & Medicaid Services

Table 1.1National Health Expenditures and Their

Share of Gross Domestic Product (GDP), 1960-2010National health spending growth is projected to significantly increase as a

share of GDP over the next decade.

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

1960 1970 1980 1985 19901995 1996 1997 1998 1999 2000 2001 2002 2003 2004 20052006 2007 2008 2009 2010

Calendar Year

Bill

ions

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

GDP

Sha

re

NHE Projected NHE GDP Share Projected GDP Share

Actual Projected

Source: CMS, Office of the Actuary, National Health Statistics Group.


Table 1.2National Health Expenditures Per Capita, 1986-2010

Calendar Year

$2,477

$3,183$3,698

$4,177

$5,039

$6,926

$8,228

$1,872

$5,757

$9,216

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

ActualProjected

National health spending per capita is projected to increase rapidly over the next decade.



Table 1.3Personal Health Care Expenditures by Source of Funds:

Selected Years 1960-2000

0

20

40

60

80

100

1960 1970 1980 1990 2000

Calendar Year

Perc

ent


Total Private

Total Public

$23.3 $63.1 $214.5 $609.3 $1,130.4

Over the last several decades, the public sector share of health spending has increased, while the share from out-of-pocket spending has declined.

55.2%39.7% 27.1% 22.5% 17.2%

21.4%15.7%

11.5%

10.0%7.3%

21.4%

22.3%28.3% 33.4% 34.6%

2.0%

2.8%

4.3% 5.0%5.0%

11.5%16.9%

17.6%

19.2%

8.0%

11.9%

11.4% 16.8%

Dollars in Billions

Other PublicMedicareTotal Medicaid, SCHIP expansion and SCHIP

Out-of-PocketOther PrivatePrivate Health Insurance


Table 1.4Sources of Health Insurance Coverage for the

Under 65 Population, 1980-2000Over the last two decades, private coverage has declined, public coverage has stayed

about the same, and the uninsured have grown.

74%

83%

8%

15%10%

0

10

20

30

40

50

60

70

80

90

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

ESI

Any Private

Medicaid

Any Government Uninsured

74%

69%

16%14%

9%

Notes: ESI - Employer Sponsored Insurance. Any Private includes ESI and individually purchased insurance. Any government includes Medicare for the disabled population.

Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.


Table 1.5Distribution of Personal Health Care Expenditures

by Type of Service, 1960-2000The share of health spending on home health and nursing homes has grown. Physician

share has stayed about the same while the hospital share grew and then declined.

Serv

ice

Percent

0

10

20

30

40

50

Hospital Physician Home Health Prescriptions Nursing Home Other

Perc

ent

1960 1980 1990 2000

39.3%

47.3%

41.7%

36.5%

22.9%21.9%

25.9% 25.3%

0.2%1.1%2.1% 2.9%

11.4%

5.6% 6.6%

10.8%

3.6%

8.2% 8.6% 8.2%

22.5%

15.8%15.2%16.4%



Table 1.6Percent Change in Personal Health Care Expenditures for

Medicare, Medicaid and Total: 1971-2010

0

5

10

15

20

25

30

35

40

1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010

PHCE Medicare MedicaidProjected PHCE Projected Medicare Projected Medicaid

Perc

ent

Calendar Year

Medicare ProspectivePayment System (1983)

Projected

Balanced Budget Act(1997)

BalancedBudget

RefinementAct (1999)

Actual

MedicareCatastrophic

CoverageAct of 1988

While the actual percent changes vary, spending overall and for Medicare andfor Medicaid tend to rise and fall together.

Medicare Extended toDisabled & ESRD

(1973)

Medicaid Taxes& Donations

(1991)



Table 1.7Average Annual Growth in Per Enrollee Medicare and Private Health Insurance Benefits: Selected Periods

Over the last 30 years, Medicare has grown a little slower than private health insurance.

9.4

7.0

8.67.2

4.7

11.5

5.7

-0.1

5.2

8.0

4.6

11.0

-2

0

2

4

6

8

10

12

14

16

1969-2000

1985-1991

1991-1993

1993-1997

1997-1999

1999-2000

Perc

ent

Medicare Private Health Insurance

Entire Period Selected Calendar Year Periods

Calendar Years



Table 1.8Concentration of Health Spending, 1980-1996

Health spending remains highly concentrated on a small percentage of people. The top1% of people account for more than a quarter of all health spending.

29 28 27

55 56 55

70 70 69

90 90 9096 97 97

4 3 30

20

40

60

80

100

120

1980 1987 1996

Year

Perc

ent o

f Exp

endi

ture

s

Top 1% Top 5% Top 10% Top 30% Top 50% Bottom 50%Percent of People

Note: Data for 1980 are from the National Medical Care Utilization and Expenditure Survey (NMCUES); for 1987, from the 1987 National Medical Expenditure Survey (NMES); and for 1996, from the 1996 National Medical Expenditure Panel Survey (MEPS).

Source: Berk, Mark and Alan Monheit, “The Concentration of Health Care Expenditures, Revisited,” Health Affairs March/April 2001.


Table 1.9Factors Accounting for Growth in Prescription Drug Spending

per Capita, 1980-2011Growth in spending is projected to return to 1980-1993 levels.

Note: Data for 2000-2011 are projections.”Other” includes quality and intensity of services, and age-gender effects.


9

2.84.6 4.9 4.9

0.9

2.2

5 3.3 2.4

0.8

4.2

6.5

5.1

2.7

0

2

4

6

8

10

12

14

16

18

1980-1993 1993-1997 1997-2000 2000-2003 2003-2011

Calendar Years

Ave

rage

Ann

ual P

erce

nt C

hang

eOtherDrug Utilization (Number of Prescriptions)Drug Prices (Consumer Price Index - Drugs)

10.79.2

16.1

13.3

10.0


Table 1.10Spending for Prescription Drugs by Source of Funds,

1965-2000The share of drug spending covered by public and private sources has grown significantly.

93%

63%

32%

4%

24%

46%

4%14%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1965 1985 2000

Out-of-Pocket Private Health Insurance Public

Note: Percentages may not sum to 100 due to rounding.



Table 1.11Sources of Payment for Long Term Care, 2000

Most long term care is paid for out-of-pocket by patients and their families.

Nursing Home Home Care

Out-of-Pocket46.0%

Private LTC Ins.5.0%

Medicaid41.0%

Medicare8.0%

Out-of-Pocket62.2%

Private LTC Ins.5.0%

Medicaid15.3%

Medicare17.3%

Total Long Term Care Spending in 2000 is $100 Billion



Table 1.12Number of People Employed in Health Care, 1985-2001

Number of people employed in health is growing.

6.3

7.88.2 8.5 8.8 9 9.2 9.5 9.7 9.9 10 10.1 10.3

0

2

4

6

8

10

12

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Empl

oym

ent i

n M

illion

s

Health Services Employment as a % of Non-Farm Private Sector Employment

7.8% 8.6% 9.1% 9.4% 9.5% 9.5% 9.4% 9.5% 9.4% 9.3% 9.2% 9.1% 9.3%

Note: Not seasonally adjusted.

Source: Bureau of Labor Statistics, data extracted from web site at data.bls.gov/labjava/outside.jsp?survey=ee. Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.


Table 1.13Health Care Employment by Occupation, 1983-2000

Health care employment growth exceeded that of the general economy.

Source: Dept. of Labor, Bureau of Labor Statistics. Current Population Survey.

0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200

Managers, Medicine & Health

Medical Scientists

Physicians

Dentists

Optometrists

Health Diagnosing Practitioners

Licensed Practial Nurses

Registered Nurses

Pharmacists

Dietitians

Respiratory Therapists

Occupational Therapists

Physical Therapists

Speech Therapists

Physicians' Assistants

Clinical Laboratory Technologists & Technicians

Dental Hygienists

Health Record Technologists & Technicians

Radiologic Technicians

Employment (Thousands)

1983 1990 2000

Percent Change 1990-02

32.0%

-75.4%

28.7%

14.8%

7.5%

39.4%

61.9%

56.5%

48.6%

23.8%

16.9%

21.6%

26.6%

-15.2%

30.4%

5.0%

24.6%

95.3%

332.2%

13.8% Total Employment

. . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . .


Table 1.14Health Care Employment Growth Projections, 2000-2010

Over the next decade, health care employment is expected to grow at a rapid rate.

15%19%

3%

25%

33%

62%57%

53%47%

26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

To ta lEm plo ym e nt

Gro wth

S e rv ic eS e c to r

M a nufa c turingS e c to r

He a lth C a reP ra c t it io ne rs& Te c hnic a lOc c upa t io ns

He a lth C a reS uppo rt

Oc c upa t io ns

P e rs o na l &Ho m e C a re

A ide s

M e dic a lA s s is ta nts

P hys ic ia nA s s is ta nts

Ho m e He a lthA ide s

R .N .s

2000

-201

0 Em

ploy

men

t Gro

wth

General Health Care Occupations

Fastest Growing* Specific Health Care Occupations

*Note: Five of the nation’s top 10 fastest growing occupations are in health care.

Source: Dept. of Labor, Bureau of Labor Statistics. Monthly Labor Review. November 2001.


Table 1.15Physician Income Compared to All Workers, Selected Years Physician income continues to be much higher than that of all full-time workers.

$94,000

$166,000$160,000

$17,836$25,480 $27,196

$0

$30,000

$60,000

$90,000

$120,000

$150,000

$180,000

1985 1996 1998

Median Physician Net Income

Median Full-Time Worker Income

Notes: Median Full-Time Worker Income reflects median weekly earnings of full-time workers multiplied by 52.

Source: 1998 Median Physician Net Income from Modern Healthcare, “Follow the Money, AMA’s Long-Delayed Annual Report Offers Unsettling News on Physicians’ Incomes” (January 1, 2001), p. 12.

Wage & salary information for full-time workers from U.S. Census Bureau, Statistical Abstract of the United States, 1995-2000, Census web site at www.census.gov/prod/www/statistical-abstract-us.html.

1985 and 1996 physician salary data from Kaiser Family Foundation analysis of data published by the American Medical Association, Physician Marketplace Statistics, and U.S. Census Bureau, Statistical Abstract of the United States as shown in Trends and Indicators in the Changing Health Care Marketplace Chartbook, Kaiser Family Foundation (August 1998), Exhibit 6.10, p.65.

Trends and Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.


Table 1.16HMO Enrollment by Ownership Status, 1981-2000

The proportion of HMO enrollees in for-profit plans grew over the past decade.

74.0%

53.8% 47.8%36.7% 36.3% 36.0% 36.5%

88.0%

46.2%

26.0%12.0%

63.5%64.0%63.7%63.3%52.2%

0%

20%

40%

60%

80%

100%

1981 1985 1989 1993 1997 1998 1999 2000

% Non-Profit % For-Profit

Total Enrollment (in millions)

10.27 18.89 32.49 42.07 72.23 78.78 80.81 79.66

Note: HMO enrollment includes enrollees in both traditional HMOs and point-of-service (POS) plans through: group/commercial plans, Medicare, Medicaid, the Federal Employees Health Benefits Program, direct pay plans, supplemental Medicare plans, and unidentified HMO products.

Source: Trends & Indicators in the Changing Health Care Marketplace, 2002 -- Chartbook.


Table 1.17Concentration of Managed Care Enrollment, 1988-2000

Two-thirds of managed care enrollees are enrolled in the nation’s 10 largestmanaged care firms.

45.8

54.6 56.2

65.0 64.1 65.2 66.5

0

10

20

30

40

50

60

70

80

1988 1991 1994 1997 1998 1999 2000

Perc

ent E

nrol

led

in 1

0 La

rges

t Firm

s

Note: The largest national managed care firms include Blue Cross and Blue Shield plans, Aetna US Healthcare, Kaiser Permanente, United Health, and PacifiCare. HMO enrollment includes enrollees in both traditional HMOs and point of service plans.

Source: Trends & Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.


Table 1.18Managed Care Enrollment by Type of Plan, 1984-2000

Mixed model HMO plans have shown rapid growth.

2.1 4.3 2.46.6

8 9.7 8.7 7

3.55.6 3.9

3.3 7.12.9

13.5 16.2 27.533.5

6.7

23.1

32.1

0.40.80

10

20

30

40

50

60

70

80

1984 1988 1992 1996 2000

Enro

llees

(in

mill

ions

)Staff Group Network IPA Mixed

31.4

38.8

63.3

80.1

15.1

NA19.5%23.3%43.6%13.6%

NA43.0%18.0%25.4%13.6%

17.3%41.7%10.0%24.8%6.2%

36.4%43.4%5.3%13.7%1.2%

40.0%41.9%8.9%8.8%0.4%

MixedIPANetworkGroupStaff

Source: Trends & Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.


Table 1.19Number of Dedicated Health Care Mutual Funds and

Amount of Fund Assets, 1992-2002The number of dedicated health care funds has grown from 10 in 1992 to 190 today.

$4,299$8,440

$11,641

$20,270

$24,641

$48,510

$44,172$42,387

190

177

107

554033

2110$0

$10,000

$20,000

$30,000

$40,000

$50,000

1992 1996 1997 1998 1999 2000 2001 April,2002

Fund

Ass

ets

($ in

Mill

ions

)

0

50

100

150

200

250

# of

Fun

ds

Total Health Care Fund Assets Total # Dedicated Health Care Funds

Source: J.P. Morgan and AMG Data as cited in CMS Market Update Report on acute care hospitals, April 29, 2002.


As stock prices took a downward turn and merged entities confronted management difficulties, the number of health company mergers fell sharply in recent years.

Table 1.20Number of Mergers and Acquisitions Among

Health Services Companies and HMOs, 1990-2000

120

159

297

347

390

508

561

367

253

157

305

0

100

200

300

400

500

600

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Mergers and Acquisitions Among HealthServices Companies HMO Mergers and Acquisitions

1

10

15

9

21

16

32

10

19

14

8

0

5

10

15

20

25

30

35

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Note: Includes completed transactions sorted by date of transaction announcement. Health services companies include those with Standard Industrial Classification (SIC) codes 8000 through 8099: offices and clinics of doctors of medicine or osteopathy, dentists, or other health care providers; nursing and personal care facilities; hospitals; medical and dental laboratories, home health care services; and miscellaneous health and allied services. HMO companies include companies identified as primarily HMO companies (does not include multi-line property/casualty insurance companies that may have an HMO line that represents less than half of its business), as well as other companies classifying themselves as medical services plans (SIC 6324).

Source: Analysis prepared for the Kaiser Family Foundation by Securities Data Company, June 2001.


Those over 65 and those with incomes under $20,000 spend a higher percentage of their income on health than other groups.

Table 1.21Out-of-Pocket Spending for Health Care as a Percent of Income

by Age and Income Level, 2000

By Income LevelBy Age Group

12.9%

5.2%3.3%2.7%

02468

10121416

Under 35 35 to 54 55 to 64 65 andover

Perc

ent o

f Inc

ome

Spen

t on

Heal

th

2.6%4.0%

6.2%

15.2%

02468

10121416

Less than$20,000

$20,000 to$49,999

$50,000 to$69,999

$70,000and above

Perc

ent o

f Inc

ome

Spen

t on

Hea

lth

Age GroupIncome Level

Source: Dept. of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.


Table 1.22Growth in the Overall Consumer Price Index (CPI) and

Medical-Specific Consumer Price Index (MCPI), 1993-2001Medical prices have risen faster than overall consumer prices.

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

1993 1994 1995 1996 1997 1998 1999 2000 2001

CPI MCPI

Source: Dept. of Labor, the Bureau of Labor Statistics.


Table 1.23Health Care Spending Per Capita by OECD Country, 1960-1999

U.S. spending is significantly higher than other OECD countries.

$14 $74 $89 $26 $48 $87 $64 $53 $72 $109 $90 $136 $144$83 $144$270

$130 $151 $240 $159 $130 $206 $260 $223 $288 $349$328$444

$850

$522$658 $662 $577

$701 $710$824 $881

$1,058$813

$972

$1,492

$1,083$1,321 $1,300 $1,206 $1,245

$1,517$1,676 $1,600

$1,836

$2,739

$1,469$1,666 $1,748 $1,844 $1,882

$2,058 $2,061 $2,144 $2,226$2,428 $2,451

$3,080

$4,373

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

SpainUnite

d Kingdom

Sweden

***

Japan

Italy*

*

Australi

a***

Austria

Belgium

France

Canad

a

German

y

Switzerl

and

United S

tates

1960 1970 1980 1990 1999

Median: $64 $146 $591 $1,270 $1,798

*Expenditures in U.S. dollars using purchasing power parity rates.**For some years, no data was available.***1998 data was used because 1999 was not available.Note: The data is arrayed by expenditure levels for 1999. The medians include all OECD countries.Source: OECD Health Data 2002.


Table 1.24Average Annual Growth in Per Capita Spending by Decade

by OECD Country, 1960-1999

*For some years, no data was available.**1998 data was used because 1999 was not available.Note: Each bar represents the average annual nominal growth over the decade. The data is arrayed by spending growth from 1990 to1999. The medians include all OECD countries.Source: OECD Health Data 2002.

Health spending growth over the last decade is lower in OECD countries than in prior decades.

11.7

19.5

9.49.5

17.5

7.8

9.59.3

11.1

9.1

6.9

10.7

14.7

16.1

11.8

14.0

11.7

13.0

10.6

12.2 11.9

15.314.9

10.69.5

8.08.2

6.27.67.67.06.9

10.0

8.09.0

5.86.8

6.26.26.16.15.95.95.55.34.44.2

2.0

0

2

4

6

8

10

12

14

16

18

20

Sweden

**

Canad

a

France

United S

tates

German

y

Australi

a**

Switzerl

and

Japan

Austria

United K

ingdom

Belgium

Spain

Perc

ent

1960-1969 1970-1979 1980-1989 1990-1999

Median: 10.7% 13.3% 8.0% 6.1%


Table 1.25Percent of GDP Spent on Health Care by OECD Country, 1960-1999

*For some years, no data was available.**1997 data was used because 1999 was not available.Note: The data is arrayed by spending growth from 1990 to 1999. The medians include all OECD countries.

Source: OECD Health Data 2002.

The U.S. has had a higher share of GDP spent on health than the OECD median forthe past four decades.

5.14.95.4

4.34.34.5

3.6

1.5

3

3.94.5

6.9

5.66.3

76.1

5.65.3

6.9

5.1

3.6

4.5

8.7

7.6

8.8

7.16.67

7.6

9.1

5.4

6.4

5.6

11.9

8.58.79

7.57.87.1

8.58

6.65.96

10.3

8.78.5

13

10.7

9.2

8.17.97.87.77.47.1

0

2

4

6

8

10

12

14

United K

ingdom

Japan

Spain Italy*

Sweden

**

Austria

Australi

a**

Greece

*

Canad

a

German

y*,**

Switzerl

and

United S

tates

Perc

ent

1960 1970 1980 1990 1999

Median: 3.9% 5.1% 6.8% 7.5% 7.9%


Table 1.26Per Capita Health Spending by Type of Service

by OECD Country, 1980-1999Health spending is moving to outpatient settings.

$1,229

$697 $834 $697$971

$504$824

$1,270

$382

$821$1,022

$340$604

$761

$288

$852

$1,429

$279

$580

$852

$233

$475

$625

$275

$487

$709

$176

$358

$507

$183

$322

$589

$437

$635

$151

$289

$458

$103

$7

$7

$12

$27

$57

$5

$18

$31

$11

$75

$124

$10

$50

$63

$6

$21

$99

$15

$66

$84

$556$338$274$358

$161

$1,352

$879

$418

$1,766

$525

$178

$79

$1

$46

$6

$4

$5

$4

$4

$20

$119

$9

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999

Inpatient Outpatient Ancillary Home Health

United States Switzerland Japan Germany* France** Denmark Canada Australia*

*The data for 1999 was missing, so 1998 data was used.**The data for 1980 came from the 2001 OECD Health Data.



Table 1.27National Health Spending by Source of Funds by OECD Country, 2000

2% 6%

66%

29%

78%70%

82%

8%

27%

60%

13%

74%64%

11%

74% 69%

10%

15%

1%

69%43%

15%

63%

6%

33%

13% 13% 7%

35%

11%7%

3%3%

7%

1% 2% 6%6% 2%

5% 5% 2%

5%

10% 11% 11% 15% 15% 16% 16% 17% 19% 21% 21% 23% 26%

44%1%

2%6%2%3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

France

German

yIre

land

United S

tates

New Zealand

Canada (

1999)

DenmarkJa

pan (1

999)

AustriaFinlan

dHungary Ita

lySpain

(199

9)Korea (

1999)

Perc

ent o

f Tot

al H

ealth

Exp

endi

ture

Out-of-PocketPaymentsAll Other PrivateFundsPrivate Insurance

Social SecuritySchemesGeneral Government,Excl. Social Security

Source: OECD Health Data 2002 2nd ed.

Source of funding varies significantly by country. For instance, out-of-pocket spending ranges from 10% to 44% of health spending with the U.S. at about the average.


Table 1.28Per Capita Spending on Pharmaceuticals and Other Non-Durables

by OECD Country, 1970-1999Per capita drug spending varies significantly across countries.

$18$25 $21 $31 $36 $29 $22$43

$65 $57 $53

$110

$60 $63$96

$55

$131

$228$191

$280$252

$117$120$104

$236

$492

$227$218

$388

$344$312

$239

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

Greece Sweden UnitedKingdom

Australia Germany Canada Italy UnitedStates

1970 1980 1990 1999

Drug Spending asPercent of GDP** (1999): 0.7% 1.0% 1.0% 1.1% 1.3% 1.3% 1.7% 1.4%

(1997)(1997)

(1998, 1969) (1979)(1998)

Expenditures in U.S. dollars using purchasing power parity rates.**Reinhart, et. Al., 2002.Note: Data is arrayed by spending levels for 1999.



Table 1.29Medical Technology and Use of High-Technology Medical Procedures

by OECD Country, 1999Japan has the highest rates of diagnostic high-tech procedures, the U.S. has the

highest rate of heart procedures.

3.186.5*339*203*13.2*7.6*United States

2.331.6555412.04.1Median

_27.035*41*6.14.5United Kingdom

1.0*26.5*65*60*19.0*13.2*Switzerland

1.825.4*_54*13.8*6.8*Sweden

5.843.720*15*11.64.6Spain

_119.75*17*0.4*0.4*Poland

1.6*26.472*60*9.0*3.9*Netherlands

0.228.8212.00.3Mexico

_155.7__84.423.2Japan

6.831.6*674619.66.7Italy

1.012.5*27685.21.5Hungary

_48.2*28*61*6.1*1.2*Greece

_58.5*86*38*17.1*6.2*Germany

_37.0*73*35*9.7*2.5*France

0.7*36.3826410.25.5Denmark

3.9*42.2*70*65*8.21.8*Canada

4.735.953*40*25.710.9Austria

5.131.597*93*20.8*4.5Australia

Bone MarrowTransplants per 100,000 People

Patients UndergoingDialysis per

100,000 People

Coronary AngioplastyProcedures per 100,000 People

Coronary BypassProcedures per100,000 People

CT Scanners per Million People

MRIs per Million People

*Earlier data used.

Source: Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson. Cross-National Comparisons of Health Systems Using OECD Data, 1999. Health Affairs. May/June 2002.


Table 1.30Selected Indicators of Morbidity by OECD Country, Selected Years

Risky behaviors vary significantly by country: the U.S. has higher rates of obesity;Western Europe has higher rates of smoking.

7.619.922.6*87.4144.0403.8United States

6.327.011.460.09.1293.1Median

7.627.021.0_13.8242.5United Kingdom

6.333.0*6.8*_25.3_Switzerland

4.319.19.351.56.1_Sweden

6.2*33.1*12.9*56.5*66.8_Spain

6.029.6*11.4*_2.6268.1*Poland

4.735.09.439.16.0417.8Netherlands

9.425.1__46.292.0Mexico

8.434.32.9_2.6205.4*Japan

6.0*24.78.6109.133.7_Italy

8.530.1 (2000)19.4140.42.7319.4*Hungary

8.137.0*_41.1*11.9273.0*Greece

6.524.7 (1999)11.5*77.68.2412.3Germany

6.427.0 (2001)9.6_27.9261.0*France

5.5*31.07.6*60.810.0319.4*Denmark

5.623.814.6*45.620.9401.5*Canada

6.529.3*8.5*129.89.6249.2Austria

6.222.820.8*51.213.0302.3Australia

1999Percentage of Total Live Births That are

Low-birthweight Births

1998Percentage of

Population That are Daily Smokers

2000Percentage of

Population That is Obese (BMI >30)

1999Total Surgeries on

an In-patient Basis, per 1,000

2000Incidence of AIDS

in Population,per 1,000,000

1997Incidence of Cancer

(All Types of Malignant

Neoplasms)per 100,000

*Earlier data used.Median includes all OECD countries.Source: OECD Health Data 2002.


Table 1.31Selected Indicators of Mortality by OECD Country, 1998

The U.S. and Mexico are high on homicide and HIV infection rates. Japan and Europe are high on suicide rates. European nations are high on cancer mortality rates.

4.325.86.810.7174.9United States

0.62.31.212.3177.1Median

0.32.0 (1999)0.76.9188.8United Kingdom

3.2*3.0*1.4*16.3*155.9*Switzerland

0.31.71.111.9152.3Sweden

4.21.70.86.9165.7Spain

0.3 (1999)3.4 (1999)2.5*13.3*200.2*Poland

0.72.7 (1999)1.18.5192.4Netherlands

18.4*55.2*19.1*3.8*133.8*Mexico

0.00.5 (1999)0.620.3155.6Japan

2.03.41.26.3174.8Italy

0.21.7 (2000)2.927.3264.1Hungary

0.32.21.23.2150.4Greece

0.61.5 (1999)0.911.7179.2Germany

1.51.00.715.4180.0France

0.60.80.912.1211.9Denmark

1.8*3.6*1.4*11.4*177.1*Canada

0.71.0 (2000)1.116.5168.6Austria

0.73.4 (1999)1.513.4168.6Australia

HIV Mortality Rates for Total Population Due to

HIV Infection,per 100,000

Homicide Rates forYoung Males 20-29,

per 100,000

Homicide Rates for Total Population,

per 100,000

Suicide Rates for Total Population,

per 100,000Cancer Mortality Rates,

per 100,000

*Earlier data used.Median includes all OECD countries.Source: OECD Health Data 2002.


Table 1.32Infant Mortality Rates (per 1,000 Live Births) by OECD Country,

1960-2000OECD country infant mortality rates have declined significantly since 1960.

0

5

10

15

20

25

30

35

40

45

1960 1970 1980 1990 2000

MedianJapanSwedenFranceSwitzerlandDenmarkCanadaGreeceUnited StatesSlovak Republic

Decrease in InfantMortality Rate

1960 1970 1980 1990 2000 1960-2000Median 27.5 20.1 12.1 7.9 5.0 22.25Australia 20.2 17.9 10.7 8.2 5.2 -15.0Austria 37.5 25.9 14.3 7.8 4.8 -32.7Canada 27.3 18.8 10.4 6.8 5.3* -22.0Czech Republic 20.0 20.2 16.9 10.8 4.1 -15.9Denmark 21.5 14.2 8.4 7.5 5.3 -16.2France 27.5 18.2 10.0 7.3 4.5 -23.0Germany 35.0 22.5 12.4 7.0 4.4 -30.6Greece 40.1 29.6 17.9 9.7 6.1 -34.0Hungary 47.6 35.9 23.2 14.8 9.2 -38.4Italy 43.9 29.6 14.6 8.2 5.1 -38.8Japan 30.7 13.1 7.5 4.6 3.2 -27.5Netherlands 17.9 12.7 8.6 7.1 5.1 -12.8Poland 54.8 36.7 25.5 19.3 8.1 -46.7Slovak Republic 28.6 25.7 20.9 12.0 8.6 -20.0Spain 43.7 28.1 12.3 7.6 4.6 -39.1Sweden 16.6 11.0 6.9 6.0 3.4 -13.2Switzerland 21.1 15.1 9.1 6.8 4.9 -16.2United Kingdom 22.5 18.5 12.1 7.9 5.6 -16.9United States 26.0 20.0 12.6 9.2 7.1* -18.9

Note: The medians include all OECD countries. The decrease from 1960-2000 is in percentage points.*1999 data.Source: OECD Health Data 2002.


Table 1.33Number of In-Patient Beds and Admissions per 1,000 Persons

by OECD Country, 2000Admission rates generally track bed supply.

57.8

75.9

101.8

115

120

124

132

147.6

150.9

154

155.4

160

180.4

199.9

209

230

235.1

243.2

267

304

0 50 100 150 200 250 300 350

Mexico

Turkey

Canada

Spain

Portugal

United States

New Zealand

Ireland

United Kingdom

Greece

Poland

Australia

Italy

Denmark

Czech Repub

France

Germany

Hungary

Finland

Austria

1.1

2.6

3.9

4.1

3.9

3.6

6.2

9.7

4.1

4.9

4.9

7.9

4.9

4.5

8.8

8.2

9.1

8.2

7.5

8.6

0 2 4 6 8 10 12

Mexico

Turkey

Canada

Spain

Portugal

United States

New Zealand

Ireland

United Kingdom

Greece

Poland

Australia

Italy

Denmark

Czech Repub

France

Germany

Hungary

Finland

Austria

Admissions Number of Beds



Table 1.34Male and Female Life Expectancy at Birth by OECD Country,

1960-1999

Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.


75.1

77.3

78.1

79

79.4

81.8

81.9

82.5

59.5

73.4

74.4

70.2

73.6

74.9

73.9

73.1

70.1

70

73.9

77.3

78.8

78.4

77.4

78.1

72.7

78.884

0 30 60 90

Hungary

Mexico

Czech Republic

Denmark

United States

Australia

Sweden

France

Japan

Year

1960 1980 1999

65.965.566.3

72.8

71.4

74.2

73.9

76.2

77

75

71.2

70.4

67.9

56.2

66.6

67.9

67

65.3

72.8

71

71.2

66.8

70

64

70.2

73.477.1

0 30 60 90

Hungary

Mexico

zech Republic

Denmark

United States

Australia

Sweden

France

Japan

Year

1960 1980 1999

Male Female

Median = 67.2 70.0 74.6 Median = 72.5 76.6 80.6

C


Table 1.35Male and Female Life Expectancy at Age 65 by OECD Country,

1960-1999

Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.


13.8

14.5

15.3

15.8

15.6

15.6

14.1

14.4

14.6

14.3

17.6

18.3

18.2

17.9

17.7

16.5

15.8

16.9

18.1

19.1

21

20.2

21.9

18.9

0 10 20 30

Hungary

Czech Republic

Denmark

United States

France

Australia

Japan

Mexico

Year

1960 1980 1999

12.3

12.5

13.7

12.8

12.5

12.5

11.6

13.8

11.6

11.2

13.6

14.1

13.6

13.7

14.6

15.3

12.1

13.6

14.9

16.1

16.5

16.6

17

17.7

0 10 20

Hungary

Czech Republic

Denmark

United States

France

Australia

Japan

Mexico

Year

1960 1980 1999

Median = 12.6 13.2 15.4 Median = 14.8 16.8 19.2

Male Female

Documents

An Overview of the U.S. Healthcare System: Two Decades of ... · Private Health Insurance Benefits: ... Dental Hygienists Health Record Technologists & Technicians ... 2000-2010 Over