National Health Spending Trends in 1996

Health Affairs

Volumn 17, Issue 1, 1998, Pages 35-51

  Levit, Katharine R ^a   Lazenby, Helen C ^a   Braden, Bradley R ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; FEE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SERVICE; HUMAN; INFORMATION PROCESSING; MEDICAL CARE; UNITED STATES;

DATA COLLECTION; FEES AND CHARGES; HEALTH EXPENDITURES; HUMANS; INSURANCE, HEALTH; MEDICAL ASSISTANCE; PERSONAL HEALTH SERVICES; UNITED STATES;

EID: 0031601658     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.1.35     Document Type: Article

References (50)

1. American Association of Health Plans, 1998 National Directory of Health Plans (Washington: AAHP, 1998), and earlier editions from its predecessor organization, the Group Health Association of America.
2. Simon and P.H. Born, "Physician Earnings in a Changing Managed Care Environment," Health Affairs (Fall 1996): 124-133; S. Guterman, J. Ashby, and T. Greene, "Hospital Cost Growth Down," Health Affairs (Fall 1996): 134-139; and J. Sheils and R. Haught, Managed Care Savings for Employers and Households: Impact on the Uninsured (Fairfax, Va.: Lewin Group, 18 June 1997).
3. Simon and P.H. Born, "Physician Earnings in a Changing Managed Care Environment," Health Affairs (Fall 1996): 124-133; S. Guterman, J. Ashby, and T. Greene, "Hospital Cost Growth Down," Health Affairs (Fall 1996): 134-139; and J. Sheils and R. Haught, Managed Care Savings for Employers and Households: Impact on the Uninsured (Fairfax, Va.: Lewin Group, 18 June 1997).
4. Simon and P.H. Born, "Physician Earnings in a Changing Managed Care Environment," Health Affairs (Fall 1996): 124-133; S. Guterman, J. Ashby, and T. Greene, "Hospital Cost Growth Down," Health Affairs (Fall 1996): 134-139; and J. Sheils and R. Haught, Managed Care Savings for Employers and Households: Impact on the Uninsured (Fairfax, Va.: Lewin Group, 18 June 1997).
5. R.H. Miller, "Competition in the Health System: Good News and Bad News," Health Affairs (Summer 1996): 107-120.
6. Sheils and Haught, Managed Care Savings for Employers and Households.
7. American Hospital Association, National Hospital Panel Survey, various years.
8. Ibid.
9. Ibid.
10. Expenditures for hospital-based nursing home and home health services were estimated from cost reports submitted to the Health Care Financing Administration (HCFA) by hospitals, nursing facilities, and home health agencies. These estimates were developed by Charles Fisher, Jing Xing Health and Safety Resources, Inc., under HCFA contract no. 500-96-0026.
11. A. Sensenig et al., "Health Care Indicators, Hospital, Employment, and Price Indicators for the Health Care Industry: Fourth Quarter 1996 and Annual Data for 1988-96," Health Care Financing Review (forthcoming).
12. A. Goldstein, "President Acts to Curb Home Health Care Fraud," Washington Post, 16 September 1997, A4.
13. D. Emmons and G. Wozniak, "Physicians' Contractual Arrangements with Managed Care Organizations," in Socioeconomic Characteristics of Medical Practice, 1997 (Chicago: American Medical Association, 1997), 7-20; and D. Emmons and C. Simon, "Managed Care: Evolving Contractual Arrangements," in Socioeconomic Characteristics of Medical Practice, 1996 (Chicago: AMA, 1996), 15-25.
14. D. Emmons and G. Wozniak, "Physicians' Contractual Arrangements with Managed Care Organizations," in Sociocconomic Characteristics of Medical Practice, 1997 (Chicago: American Medical Association, 1997), 7-20; and D. Emmons and C. Simon, "Managed Care: Evolving Contractual Arrangements," in Socioeconomic Characteristics of Medical Practice, 1996 (Chicago: AMA, 1996), 15-25.
15. Ibid.
16. D. Emmons and P. Kletke, "An Examination of Practice Size," in Socioeconomic Characteristics of Medical Practice, 1997, 21-30.
17. Ibid.
18. S. Schondelmeyer and E. Seoane-Vazquez, "Prescription Trends Survey," American Druggist (August 1997): 34; and IMS America, data from the National Prescription Audit.
19. C. Ukens, "Benefit Boost: Health Plan Rx Costs Rise One-Third, Study Reports," Drug Topics (4 August 1997): 51.
20. K. Levit et al., "National Health Expenditures, 1995," Health Care Financing Review (Fall 1996): 175-214; and IMS America, unpublished data from the Method of Payment Report database (Plymouth Meeting, Pa.: IMS America, 1996).
21. K. Levit et al., "National Health Expenditures, 1995," Health Care Financing Review (Fall 1996): 175-214; and IMS America, unpublished data from the Method of Payment Report database (Plymouth Meeting, Pa.: IMS America, 1996).
22. U.S. Department of Labor, "Notes on Current Labor Statistics: Price Data," Monthly Labor Review 120, no. 1 (Washington: U.S. Government Printing Office, 1987).
23. States use Medicaid DSH payments to compensate hospitals for serving a disproportionate share of low-income patients. Because the federal government shares funding for Medicaid, states paid only a share of DSH payments from state funds. T&D schemes allowed states to tax hospital services or required hospitals to donate funds to state governments, increasing state revenues. In many states these receipts sometimes matched the amount of DSH payments. In the early 1990s states used these programs in tandem to generate state funds with which to pay for expanded federal mandates.
24. Medicaid managed care enrollment increased from 10 percent of Medicaid recipients in 1991 to 40 percent in 1996.
25. To constrain the growth in Medicare spending for physician services, Medicare implemented the VPS in 1990 and incorporated it into the Medicare physician fee schedule (based on a resource-based relative value scale) in 1992. The VPS is designed to reward or penalize physicians and other professionals for changes in aggregate per capita utilization that occurred two years earlier. Since volume in 1994 grew faster than specified targets, there was a penalty incorporated into the 1996 payment rates, which accounts, in part, for the deceleration in Medicare spending for physician services. Since 1986, growth in the elderly population age sixty-five and older has been decelerating. Annual growth in 1996 slowed by one-tenth of a percentage point over 1995. However, that trend is expected to reverse itself by the year 2002.
26. Based on Adjusted Community Rating forms submitted to HCFA by risk-type managed care plans. These forms contain per member per month estimates of HMO premiums by category of service. See K. Levit et al., "National Health Expenditures, 1996," Health Care Financing Review (forthcoming).
27. G.A. Jensen et al., "The New Dominance of Managed Care: Insurance Trends in the 1990s," Health Affairs (January/February 1997): 125-136.
28. U.S. Bureau of Labor Statistics, Employee Benefits in Medium and Large Firms, 1993 (Washington: U.S. Department of Labor, 1993 and earlier editions); and KPMG Peat Marwick, Health Benefits in 1996 (Montvale, N.J.: KPMG Peat Marwick, 1996 and earlier editions).
29. U.S. Bureau of Labor Statistics, Employee Benefits in Medium and Large Firms, 1993 (Washington: U.S. Department of Labor, 1993 and earlier editions); and KPMG Peat Marwick, Health Benefits in 1996 (Montvale, N.J.: KPMG Peat Marwick, 1996 and earlier editions).
30. Jensen et al., "The New Dominance of Managed Care."
31. BLS, Employee Benefits in Medium and Large Firms, 1993; and U.S. General Accounting Office, Employment-Based Health Insurance: Costs Increase and Family Coverage Decreases (Washington: GAO, 1997).
32. BLS, Employee Benefits in Medium and Large Firms, 1993; and U.S. General Accounting Office, Employment-Based Health Insurance: Costs Increase and Family Coverage Decreases (Washington: GAO, 1997).
33. BLS, unpublished data from the Consumer Expenditure Survey.
34. National Center for Health Statistics, Health, United States, 1996-97 (Washington: U.S. Government Printing Office, July 1997).
35. N. Jeffrey, "New Medicare Rules Offer More Options - and Worries," Wall Street Journal, 13 August 1997, C1.
36. Fu Associates, Ltd., conducted a study of 1992-1996 HMO cost accounting forms submitted to HCFA. The study showed that many HMOs waive coinsurance amounts and offer additional benefits at low or no cost to enrollees.
37. HCFA, unpublished data from the Office of Strategic Planning.
38. P.B. Ginsburg and J.D. Pickreign, "Tracking Health Care Costs: An Update," Health Affairs (July/August 1997): 151-155.
39. The difference between premiums earned and benefits incurred is a measure of net cost, which includes insurers' costs of paying bills, advertising, sales commissions, and other administrative costs; net additions to reserves; rate credits and dividends; premium taxes; and profits or losses.
40. Center for Studying Health System Change, Issue Brief (Washington: CSHSC, May 1997), 9.
41. Board of Trustees, Federal Hospital Insurance Trust Fund, 1997 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund (24 April 1997).
42. K. Levit et al., "National Health Expenditures, 1994," Health Care Financing Review (Spring 1996): 205-242.
43. Out-of-pocket spending excludes premiums paid by employees or individuals, which are counted instead as part of private health insurance.
44. Jensen et al., "The New Dominance of Managed Care."
45. Congressional Budget Office, The Economic and Budget Outlook: Fiscal Years 1998-2007, CBO Projections of National Health Expenditures through 2007, Appendix H (Washington: CBO, January 1997); Ginsburg and Pickreign, "Tracking Health Care Costs;" and S. Barr, "U.S. Employees Face 8.5 Percent Rise in Health Bill," Washington Post, 27 September 1997, A1.
46. Congressional Budget Office, The Economic and Budget Outlook: Fiscal Years 1998-2007, CBO Projections of National Health Expenditures through 2007, Appendix H (Washington: CBO, January 1997); Ginsburg and Pickreign, "Tracking Health Care Costs;" and S. Barr, "U.S. Employees Face 8.5 Percent Rise in Health Bill," Washington Post, 27 September 1997, A1.
47. Congressional Budget Office, The Economic and Budget Outlook: Fiscal Years 1998-2007, CBO Projections of National Health Expenditures through 2007, Appendix H (Washington: CBO, January 1997); Ginsburg and Pickreign, "Tracking Health Care Costs;" and S. Barr, "U.S. Employees Face 8.5 Percent Rise in Health Bill," Washington Post, 27 September 1997, A1.
48. For a current discussion of approaches to solving Medicare's fiscal woes, see Congressional Budget Office, "Medicare and Medicaid: Deficit Reduction and Program Restructuring," in Reducing the Deficit: Spending and Revenue Options (Washington: CBO, March 1997), chap. 5; and S. Altman, U. Reinhardt, and D. Shactman, eds., Policy Options for Reforming the Medicare Program: Papers from the Princeton Conference on Medicare Reform (Princeton, N.J.: Robert Wood Johnson Foundation, 1997).
49. For a current discussion of approaches to solving Medicare's fiscal woes, see Congressional Budget Office, "Medicare and Medicaid: Deficit Reduction and Program Restructuring," in Reducing the Deficit: Spending and Revenue Options (Washington: CBO, March 1997), chap. 5; and S. Altman, U. Reinhardt, and D. Shactman, eds., Policy Options for Reforming the Medicare Program: Papers from the Princeton Conference on Medicare Reform (Princeton, N.J.: Robert Wood Johnson Foundation, 1997).
50. Guterman et al., "Hospital Cost Growth Down."