American health economy illustrated:
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Washington, DC
AEI Press
2012
|
| Schlagworte: | |
| Online-Zugang: | Contributor biographical information Table of contents only Inhaltsverzeichnis Klappentext |
| Beschreibung: | Includes bibliographical references (p. 295-303) and index |
| Beschreibung: | XXIV, 325 S. graph. Darst., Kt. |
| ISBN: | 9780844772011 9780844772028 |
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| 100 | 1 | |a Conover, Christopher J. |e Verfasser |0 (DE-588)171921976 |4 aut | |
| 245 | 1 | 0 | |a American health economy illustrated |c Christopher J. Conover |
| 264 | 1 | |a Washington, DC |b AEI Press |c 2012 | |
| 300 | |a XXIV, 325 S. |b graph. Darst., Kt. | ||
| 336 | |b txt |2 rdacontent | ||
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| 338 | |b nc |2 rdacarrier | ||
| 500 | |a Includes bibliographical references (p. 295-303) and index | ||
| 650 | 4 | |a Medical care, Cost of |z United States | |
| 650 | 4 | |a Health insurance |x Economic aspects |z United States | |
| 650 | 4 | |a Delivery of Health Care |x economics |z United States | |
| 650 | 4 | |a Health Services |x economics |z United States | |
| 650 | 4 | |a Insurance, Health |x economics |z United States | |
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Datensatz im Suchindex
| _version_ | 1804149691304116224 |
|---|---|
| adam_text | Contents
Acknowledgments
xv
Foreword, Mark
V. Pauly
xvii
Preface
xxiii
Chapter
1 :
Rise of a Massive Health Sector
1
2.
Over eight decades, constant dollar health spending per person increased
five times as much as real output per capita.
4.
Inflation-adjusted health output per capita has increased at least eight-fold
over the past
80
years.
6.
The health sector absorbs an increasing share of national resources.
8.
Health spending per capita is significantly more in the United States than in
other large, rich countries
—18
percent more than second-ranked Norway.
10.
For
80
years, growth in real per capita health spending almost always outpaced
growth in the rest of the economy by as much as
6
percentage points.
12.
In the past
50
years, health spending as a share of GDP has risen in all
advanced countries.
14.
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?
17
18.
Most health spending is for personal health services; for
40
years, such
spending has exceeded
80
percent of all health expenditures.
20.
From
1929
to
2009,
inflation-adjusted personal health spending per capita
has doubled approximately every
25
years.
22.
Insurer administrative costs decline as group size increases and vary by type
of coverage.
24.
The combined percentage of health spending related to hospitals and nursing
homes doubled from
1929
to
1989,
but currently is declining.
26.
More than half of health spending is for chronic diseases; chronic illness
accounts for an increasing share of health spending.
28.
At least half of personal health spending is for behavior, lifestyle, or other
avoidable causes.
Chapter
3:
Who Pays for Health Services?
31
32.
Regardless of how it is measured, the public sector role in U.S. health
financing has increased.
34.
Private health insurance pays for a smaller share of health spending
than public insurance does, even though many more Americans have
private insurance.
36.
For the past
70
years, virtually all growth in health spending relative to
the economy has been financed by public and private health insurance.
38.
Though far less visible to the average American, federal tax subsidies for
health exceed federal spending on Medicaid.
40.
For
80
years, the out-of-pocket share of health spending has declined while
the portion paid by third parties has increased.
42.
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.
44.
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
51
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.
vi
American Health Economy Illustrated
54.
The tax subsidy for employer-provided health insurance increases with income;
high-paid workers get a larger subsidy
—
both in 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 Health Expenditures, Taxes, and Deficits
61
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 was 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
percentage of GDP.
68.
The public sector pays
80
percent of health costs for people who have
poor health.
70.
Taxpayers finance almost half of health spending for the highest-income
families.
72.
Almost all Medicare beneficiaries pay less in payroll taxes than the dollar
amount of benefits they receive from the program.
74.
The Medicaid share of state health spending varies by a factor of three
across states.
Chapter
6:
Health Services and the Family Budget
77
78.
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.
80.
Because so much health spending is hidden, direct family spending on health
care and health insurance premiums has accounted for only
5
percent of
income for
20
years.
82.
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.
Contents
vii
86.
The risk of being uninsured is at least three times as high among young adults
as among children younger than
10
or the elderly.
88.
The average American s chance of being uninsured has declined substantially
over the past
70
years.
90.
Although per capita health costs for people uninsured all year are less than
half the amount spent for those who have private coverage, more than
65
percent of their costs are subsidized.
92.
In elderly households, the share of household spending for health care is
more for those headed by the non-elderly and has increased faster over time.
94.
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?
97
98.
Compared with the rest of the economy, a much larger share of health output
is provided by non-profit organizations or publicly owned enterprises.
100.
In most subsectors of health care, government-owned firms account for only
approximately
10
percent of activity.
102.
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.
104.
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
107
108.
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.
110.
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.
112.
The share of health-related national income accounted for by proprietors and
rental income has declined steeply in the past
50
years.
114.
Corporate profits before and after taxes have now reached their highest share
of health services income in the past
50
years.
116.
Corporate profits before taxes in the health sector are less than that of other
major sectors and private businesses overall.
118.
Publicly traded health services companies generally have lower profits than do
other firms listed on the stock market.
120.
Pharmaceutical and medical devices have higher profits than do most
industries, reflecting returns for discovery and innovation.
viii
American Health Economy Illustrated
Chapter
9:
Productivity in the Health Sector
123
124.
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.
126.
Productivity growth is less in the health sector than in private business
in general.
128.
Productivity tends to be lower in the health sector despite more education
among health workers compared with those in the rest of the economy.
130.
Information capital per hour has risen far less slowly in ambulatory health
services than in private business overall.
132.
Expenditures for R&D have expanded our scientific and technological
knowledge; this has contributed to the increase in health sector productivity.
134.
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 annual savings, most of the nation s major
competitors save much more than they spend on health care.
136.
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
139
140.
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.
142.
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.
144.
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.
146.
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.
148.
Compared with employees in general, the work-year per full-time equivalent
worker 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.
150.
Increased longevity and a shorter working life have lengthened the period of
retirement for men but not for women.
Contents ¡x
Chapter
11 :
Personal Incomes and Health Care
153
154.
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.
156.
Employee compensation in the health services industry is much more than
the average for other service industries but only slightly more than the
average for all workers.
158.
Real compensation per hour has increased more slowly in the ambulatory
health sector than in the rest of the economy.
160.
Health professionals in the United States have much higher relative incomes
than do their counterparts in other industrialized countries.
162.
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
165
166. 1
percent of the population accounts for approximately
25
percent of
health spending;
5
percent accounts for almost half.
168.
After accounting for all hidden costs and subsidies, the net burden of paying
for health care is
2.5
times as much for the very lowest-income families
compared with the very highest-income families.
170.
The net burden of paying for health care has increased. The relative burden
for low- versus high-income families appears relatively stable in recent decades.
172.
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.
174.
During their reproductive years, women s health costs are much higher than
are men s and only slightly higher in early retirement.
176.
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.
178.
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
181
182.
Millions of people no longer would be categorized as poor if medical
expenditures were handled differently when measuring poverty.
184.
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.
χ
American Health Economy Illustrated
186.
Health status
generally is worse among those who have lower incomes;
poverty status explains only some of the health status differences related
to race.
188.
Poor children are much less likely to have private coverage than any other
age group. Almost seven in
10
poor children have Medicaid/SCHIP coverage.
190.
Fewer than one-third 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
193
194.
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.
196.
Seemingly high levels of concentration in the health insurance industry might
not accurately depict its competitiveness. Concentration is increasing for both
hospitals and health insurers.
198.
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.
200.
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
203
204.
Since the early
1950s,
real health spending per capita has grown
approximately twice as fast as real per capita net worth.
206.
A relatively small fraction of American households incurs annual health
expenditures that exceed their net worth.
208.
Medical bankruptcies account for
25
percent to possibly
35
percent
of all bankruptcies in the United States.
Chapter
16:
Economic Fluctuations and Health
211
212.
Aggregate health spending growth appears to be largely independent of
fluctuations in the business cycle.
214.
Medicaid expenditures tend to be more countercyclical than are other
components of NHE, generally rising faster during recessions than
during recoveries.
216.
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.
Contents
xi
Chapter
17:
Health Services and Quality of Life
219
220.
The value of a typical American s stock of health at birth is several multiples
of his or her lifetime earnings.
222.
In price measurement, the treatment of innovations or new products is
perhaps the most difficult aspect of handling quality change.
224.
Technology has been an important driver of health spending. However,
measuring its precise role has been difficult.
226.
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
229
230.
The United States leads the world in medical innovation.
232.
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.
234.
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 Heahh Care?
237
238.
Health spending in recent decades appears to have been worth it on
average, but this likely masks much wasted spending.
240.
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.
242.
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.
244.
Health spending per capita in the United States is not necessarily more than
expected relative to the pattern seen in other industrialized countries.
246.
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.
XII
American Health Economy Illustrated
248.
Compared with some major competitors, the United States relies more on
specialists than on primary care doctors.
250.
Americans pay higher prices for brand-name pharmaceuticals but lower prices
for generic and over-the-counter drugs than do residents in other major
industrialized countries.
252.
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.
254.
Excluding deaths due to violence, the United States generally leads the world
in life expectancy at birth.
256.
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.
258.
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.
260.
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.
262.
Most avoidable deaths are related to lifestyle or behavior.
264.
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.
266.
Comparing health system performance across U.S. states poses many of the
same challenges as do comparisons across countries.
Chapter
20:
Are Health Spending Trends Sustainable?
269
270.
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.
272.
Technolog)*
has been a far more important driver of health spending growth
during the past
60
years than has population growth or aging.
274.
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.
Contents
XIII
276.
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.
278.
Much uncertainty exists in 75-year forecasts of health spending; yet if even
1
percent excess cost growth persists, almost
90
percent of annual GDP
growth will be devoted to health care by
2085.
280.
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.
282.
The projected 75-year increase in mandatory federal health spending exceeds
current revenues from the three largest sources of federal tax revenue.
284.
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.
286.
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
289
References
295
Sources
305
Index
311
About the Author
325
xiv
American Health Economy Illustrated
•
From
ì
929
to
2009,
inflation-adjusted personal health
spending per capita has doubled approximately every
25
years.
•
The risk of being uninsured is at least three times as high
among young adults as among children younger than
10
or the elcteriy.
•
After accounting for ait hidden costs and subsidies, the
net burden of paying for health care is
2.5
times as much
for the very lowesHncome families compared with the
very highest-income Families.
•
The health sector as a share of total empioyment is higher
m
the United States than in other industrialized countries.
•
Health professionals in She United States have much higher
rebtive incomes than do their counterparts in other industri¬
alized countries.
How much does the overage American spend on health
care? Are costs and quality of health care equal ocross
U.S. states? Do Americans get good value for money
spent on health services compared with citizens of other
developed nations? Are current health spending trends
sustainable through the twenty-first century?
AH too often, policymakers and the public alike form
judgments about health core based on myths and
misconceptions. A
common
refrain
is that U.S. health
care is too expensive
—
both in costs to the taxpayer
and costs to the consumer. But few realize that despite
its lack of national health insurance, the United States
leads nearly all other industrialized nations in the share
of health spending paid by third parties, whether public
or private. Americans, therefore, are less sensitive to
health care prices than citizens of other nations.
American Health Economy Illustrated sifts through nearly
a century of data to examine
—
and debunk
—
the most
common myths about the U.S. health care system.
With an unbiased, just-the-facts approach and hundreds
of color illustrations, Christopher J. Conover assesses
the strengths and weaknesses of the current system
and evaluates whether today s health cost trends are
sustainable. Wide-ranging, accessible, and provocative,
this book is a must-read for anyone concerned with the
future of American health care.
1
J. Conowr is a scholar at Duke University s
Center for Health Policy and inequalities Research and an
adjunct scholar at the American Enterprise Institute. He is an
editor for the Journal of Heahh Politics, Pdicy and Law and
the U.S. Health Policy Gateway.
|
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| discipline | Soziologie Medizin |
| format | Book |
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| geographic | USA USA (DE-588)4078704-7 gnd |
| geographic_facet | USA |
| id | DE-604.BV040601363 |
| illustrated | Illustrated |
| indexdate | 2024-07-10T00:27:03Z |
| institution | BVB |
| isbn | 9780844772011 9780844772028 |
| language | English |
| lccn | 2011020295 |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-025429103 |
| oclc_num | 815718678 |
| open_access_boolean | |
| owner | DE-355 DE-BY-UBR DE-188 |
| owner_facet | DE-355 DE-BY-UBR DE-188 |
| physical | XXIV, 325 S. graph. Darst., Kt. |
| publishDate | 2012 |
| publishDateSearch | 2012 |
| publishDateSort | 2012 |
| publisher | AEI Press |
| record_format | marc |
| spelling | Conover, Christopher J. Verfasser (DE-588)171921976 aut American health economy illustrated Christopher J. Conover Washington, DC AEI Press 2012 XXIV, 325 S. graph. Darst., Kt. txt rdacontent n rdamedia nc rdacarrier Includes bibliographical references (p. 295-303) and index Medical care, Cost of United States Health insurance Economic aspects United States Delivery of Health Care economics United States Health Services economics United States Insurance, Health economics United States Gesundheitsökonomie (DE-588)4130935-2 gnd rswk-swf USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Gesundheitsökonomie (DE-588)4130935-2 s DE-604 Erscheint auch als Online-Ausgabe 978-0-8447-7203-5 http://www.loc.gov/catdir/enhancements/fy1302/2011020295-b.html Contributor biographical information http://www.loc.gov/catdir/enhancements/fy1302/2011020295-t.html Table of contents only Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025429103&sequence=000003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025429103&sequence=000004&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Conover, Christopher J. American health economy illustrated Medical care, Cost of United States Health insurance Economic aspects United States Delivery of Health Care economics United States Health Services economics United States Insurance, Health economics United States Gesundheitsökonomie (DE-588)4130935-2 gnd |
| subject_GND | (DE-588)4130935-2 (DE-588)4078704-7 |
| title | American health economy illustrated |
| title_auth | American health economy illustrated |
| title_exact_search | American health economy illustrated |
| title_full | American health economy illustrated Christopher J. Conover |
| title_fullStr | American health economy illustrated Christopher J. Conover |
| title_full_unstemmed | American health economy illustrated Christopher J. Conover |
| title_short | American health economy illustrated |
| title_sort | american health economy illustrated |
| topic | Medical care, Cost of United States Health insurance Economic aspects United States Delivery of Health Care economics United States Health Services economics United States Insurance, Health economics United States Gesundheitsökonomie (DE-588)4130935-2 gnd |
| topic_facet | Medical care, Cost of United States Health insurance Economic aspects United States Delivery of Health Care economics United States Health Services economics United States Insurance, Health economics United States Gesundheitsökonomie USA |
| url | http://www.loc.gov/catdir/enhancements/fy1302/2011020295-b.html http://www.loc.gov/catdir/enhancements/fy1302/2011020295-t.html http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025429103&sequence=000003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025429103&sequence=000004&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
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