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Health Care
Dr. Robert SonoraAssociate Director | Director Health ResearchBureau of Business and Economic ResearchSenior Research Professor
University of Montana
Overview
Price of Health Care is Rising
CPI Less Medical Care
0.98
Medical care 1.15
Health Insurance
1.05
0.9
1.0
1.1
1.2
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Pric
e re
lativ
e to
cor
e C
PI (I
ndex
)
Waste in health care Source: Shrank, Rogstad, and Parekh N. “Waste in the US Health Care System: Estimated Costs and Potential for Savings” Journal of the American Medical Association (10/2019)
Waste: $760-935 billion
“A-Medic-a” is growing: 5th largest global economy
US Medical Care
Forecast Trend
Germany
the UK
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2000 2003 2006 2009 2012 2015 2018 2021
Billions $s
US Expenditure and Life Expectancy
20002001
20022003
200420052006
2007 2008
20092011
2013 20142015 2016
2017
76.5
77
77.5
78
78.5
79
79.5
12.0 13.0 14.0 15.0 16.0 17.0 18.0
Years
HC Expenditure % GDP
Health Expenditure and Life Expectancy: OECD
Australia
AustriaBelgiumCanada
Chile
Czech Republic
Denmark
Estonia
Finland
France
GermanyGreece
Hungary
IcelandIreland
IsraelItaly
Japan
Korea
Latvia
Lithuania
Luxembourg
Mexico
NetherlandsNew Zealand
Norway
Poland
Portugal
Slovak Republic
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
Life Expectancy = 0.9 (HC Spend/GDP) + 73.29
74
76
78
80
82
84
86
88
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
Years
HC Expenditure % GDP
Health Expenditure and Life Expectancy: OECD
Australia
AustriaBelgiumCanada
Chile
Czech Republic
Denmark
Estonia
Finland
France
GermanyGreece
Hungary
IcelandIreland
IsraelItaly
Japan
Korea
Latvia
Lithuania
Luxembourg
Mexico
NetherlandsNew Zealand
Norway
Poland
Portugal
Slovak Republic
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States
Life Expectancy = 0.5 (HC Spend/GDP) + 76.5
74
76
78
80
82
84
86
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
Years
HC Expenditure % GDP
Other Health Care Impacts
US: Chapter 7 and % Uninsured
Nationally, 66% personal bankruptcy due to medical reasons
Health care and foreclosure
• 13% of foreclosures due to medical expenses and illness
• Uninsured more likely to go into foreclosure
Montana Health Care
Medicaid extension passed, HB0658
• BBER study: 2016 – 2020 – $1.6 billion economic impact– 6,000 jobs
• Additional requirements– Work, education, caretaker, increase in premiums and
paperwork– Expected ≈ 4,000 Montanans lose coverage (4%) →
could reduce economic impact
Uninsured Montana
% Uninsured
8.9%
Number Uninsured
96k
0
20
40
60
80
100
120
140
160
180
200
4.0%
8.0%
12.0%
16.0%
20.0%
2008 2010 2012 2014 2016 2018 2020
Num
ber U
nins
ured
Thousands
Perc
ent U
nins
ured
Lost insurance with additional requirements
AR: 25%NH: 40%
Percent private firms offer insurance, 2018
(source: Kaiser Family Foundation)
34.7%
Cumulative growth in Western states 1999 - 2019
132%
Employer Family Premium
270%
93%
Employee Contribution
163%
1%Real Personal
Income 13%
-50%
0%
50%
100%
150%
200%
250%
300%
1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
Average annual family premium 2018
$5,208
(source: Kaiser Family Foundation)
Insurance premium contributions
23.1% 24.3% 26.6%
76.9%75.7%
73.4%
$-
$4,000
$8,000
$12,000
$16,000
$20,000
2013 2015 2018
Prem
ium
Montana
Employee Employer
27.6% 27.2% 27.8%
72.4%72.8%
72.2%
$-
$4,000
$8,000
$12,000
$16,000
$20,000
2013 2015 2018
Prem
ium
US
Employee Employer
MT: Health Care, Real GSP, Population
Population
117.5
Real Health Care Spending
208.9
Real GSP
142.8
80.0
100.0
120.0
140.0
160.0
180.0
200.0
220.0
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Index: 2000 = 100
Healthcare share of household expenditures
MT
US
13%
14%
15%
16%
17%
18%
19%
1997 2000 2003 2006 2009 2012 2015 2018
% household expenditures
129%
90%
170%
136%
-10% 20% 50% 80% 110% 140% 170%
Ag & Mining
Cons & Manuf
Health
Tourism
Wages since 2017 2015 2010 2001
34%
16%
49%
30%
-10% 10% 30% 50% 70% 90% 110% 130%
Ag & Mining
Cons & Manuf
Health
Tourism
Employment since 2017 2015
Cumulative growth by sector from 20_ to 2018
(Source: Kaiser Family Foundation, green/red better/worse than national average)
US Montana% Children Immunized 70.4% 66.2%Smoking 16.4% 17.2%Alcohol Dependence 5.8% 8.0%Opioid Misuse 4.3% 4.4%Life Expectancy (years) 78.7 78.6Physical Activity 73.4% 75.0%Adult Obesity 65.4% 62.2%Infant Mortality (per 1,000) 5.9 5.8Heart Disease (per 100,000) 165.0 155.0Diabetes (per 100,000) 21.5 21.6Firearms (per 100,000) 12.0 22.5Suicide (per 100,000) 14.0 28.9Cancer (per 100,000) 152.5 152.6Hypertension 32.4% 29.0%Hospital inpatient expenses/day $2,424 $1,070
MT Health “Score Card”
Urban RuralAge-Adjusted Mortality (per 1,000) 349.0 348.6Infant Mortality Rate (per 1,000) 5.4 8.0% Frequent Physical Distress 10.3 10.8% Frequent Mental Distress 10.7 11.1% Diabetic 8.0 9.2% Food Insecure 12.7 12.5% Uninsured 14.2 19.0Costs $7,616 $7,708 Firearm Fatalities Rate (per 1,000) 20.1 28.6
Urban = <35% rural and Rural = >75% rural
MT: Urban-Rural Divide
ACA premium Silver with 40 yrold with income $40,000
- average age in MT is 40
- Median real per capita income in MT is $46k
- “Silver Loading”
ACA premium Gold with 40 yrold with income $40,000
