1、Centers for Medicare & Medicaid Services,1,An Overview of the U.S. Health Care System Chart BookCenters for Medicare and Medicaid ServicesAndOffice of the Assistant Secretary for Planning and EvaluationJanuary 31, 2007,Centers for Medicare & Medicaid Services,2,Table of Contents - Section 1,Section
2、1: Overview of the U.S. Health Care System 8Table 1.1 National Health Expenditures and their share of GDP, 1980-2015 9 Table 1.2 National Health Expenditures per Capita, 1980-2015 10 Table 1.3 Personal Health Expenditures by Source of Funds, 1960-2004 11 Table 1.4 Health Insurance Coverage for the U
3、nder 65 Population, 1980-2004 12 Table 1.5 Personal Health Care Expenditures by Service, 1960-2003 13 Table 1.6 Annual Percent Change in Personal Health Care Expenditures for Medicare, Medicaid, and Total, 1971-2015 14 Table 1.7 Average Annual Growth in Medicare & Private Health Insurance Benefits P
4、er Enrollee, Selected Periods 15 Table 1.8 Concentration of Health Spending, 1987-2002 16 Table 1.9 Factors Accounting for Growth in Prescription Drug Spending per Capita, 1980-2011 17 Table 1.10 Prescription Drug Expenditures by Source of Funds, 1965-2004 18 Table 1.11 Sources of Payment for Nursin
5、g Home and Home Health Care, 2004 19 Table 1.12 Number of People Employed in Health Care, 1990-2005 20 Table 1.13 Health Care Employment by Occupation, 1983-2005 21 Table 1.14 Health Care Employment Growth Projections, 2000-2010 22 Table 1.15 Average Annual Salaries of Selected Groups of Workers, 20
6、05 23 Table 1.16 HMO Enrollment by Ownership Status, 1981-2004 24 Table 1.17 Concentration of Managed Care Enrollment, 1988-2003 25 Table 1.18 Managed Care Enrollment by Type of Plan, 1984-2004 26 Table 1.19 Health Care as a Percent of Income by Age, 2004 27 Table 1.20 Annual Growth Rates in the Ove
7、rall CPI and MCPI, 1993-2005 28,Centers for Medicare & Medicaid Services,3,Table of Contents - Section 2,Section 2: International Comparisons 29Table 2.1 Percent of GDP Spent on Health Care by OECD Country, 1960-2004 30 Table 2.2 Per Capita Spending on Medical Services by OECD Country, 1980-2004 31
8、Table 2.3 Average Annual Growth in Per Capita Spending by Decade by OECD Country, 1960-2003 32 Table 2.4 Per Capita Health Spending by Type of Service by OECD Country, 2003 33 Table 2.5 Share of Total Health Spending on Outpatient care by OECD Country, 1970-2003 34 Table 2.6 National Health Spending
9、 by Source of Funds by OECD Country, 2003 35 Table 2.7 Per Capita Spending on Drugs and other Non-durables by OECD Country, 1970-2003 36 Table 2.8 Drug Spending as a Percentage of Total Health Spending, 1980-2003 37 Table 2.9 Infant Mortality Rates per 1,000 Live Births by OECD Country, 1970-2004 38
10、 Table 2.10 Male and Female Life Expectancy at Birth by OECD Country, 1960-2004 39 Table 2.11 Male and Female Life Expectancy at Age 65 by OECD Country, 1960-2004 40 Table 2.12 Number of Inpatient Discharges and Total Beds per 1,000 persons, by OECD Country, 2004 41 Table 2.13 Average Length of Hosp
11、tial Stay for Selected OECD Countries, 2004 42 Table 2.14 Medical Technology and Use of High Technology Medical Procedures by OECD Country, 2004 43 Table 2.15 Selected Indicators of Mobidity by OECD Country, Selected Years 44 Table 2.16 Selected Indicators of Mortality by OECD Country, 2004 45,Cente
12、rs for Medicare & Medicaid Services,4,Table of Contents - Section 3,Section 3: Providers 46Table 3.1 Number of Hospitals by Type, 1980-2004 47 Table 3.2 Number of Hospital Beds and Occupancy Rates by Hospital Type, 1980-2004 48 Table 3.3 Number of Hospital Beds per 1,000 Persons by State, 2004 49 Ta
13、ble 3.4 Number of Nursing Home Beds & Residents, 1985-2003 50 Table 3.5 Number of Physicians per 100,000 Persons by State, 2004 51 Table 3.6 Distribution of Active Physicians:1950-1998 52 Table 3.7 Percentage of Physicians in Differing Practice Arrangements, 1987-2001 53 Table 3.8 Physician Revenue
14、by Payer, 1986-2004 54 Table 3.9 Physician Participation in Managed Care, 1988-2001 55 Table 3.10 Physician Managed Care Payment Arrangements, 2001 56 Table 3.11 Hospital Participation in HMOs and PPOs, 1987-2004 57 Table 3.12 Hospital Managed Care Payment Arrangements, 2001 58 Table 3.13 Hospital P
15、rofit Margins for All Payers and Medicare, 1997-2004 59 Table 3.14 Hospital Payment to Cost Ratios for Medicare, Medicaid, and Private Payers, 1985-2002 60 Table 3.15 Change in Nursing Home Institutionalization Rate for Elderly, 1985-1999 61 Table 3.16 Nursing Home Resident Rate by State, 2003 62 Ta
16、ble 3.17 Number of Hospital Discharges and Average Length of Stay, 1980-2004 63 Table 3.18 Number of Physician Visits per 1,000 Persons, 1990-2000 64,Centers for Medicare & Medicaid Services,5,Table of Contents Section 4, Tables 4.1 to 4.20,Section 4: Public Programs 65Table 4.1 Public Payers Share
17、of National Health Spending, 1980-2010 66 Table 4.2 Personal Health Care Expenditures by Type of Service and Percent Medicare Paid, 2004 67 Table 4.3 Personal Health Care Expenditures by Type of Service and Percent Medicare Paid, 1980 68 Table 4.4 Where the Medicare Dollar Went, 1980 and 2005 69 Tab
18、le 4.5 Medicare Trustees Report: Part A Income and Expenses, 1970-2015 70 Table 4.6 Number of Medicare Beneficiaries, 1970-2040 71 Table 4.7 Medicare Beneficiaries as a Share of the US Population, 1970-2030 72 Table 4.8 Medicare Spending for Fee-For-Service Beneficiaries by Income, 2003 73 Table 4.9
19、 Living Arrangements of Medicare Beneficiaries, 2003 74 Table 4.10 Age and Gender of the Medicare Population, 2003 75 Table 4.11 Total Health Care Spending for Medicare Beneficiaries, 2003 76 Table 4.12 Sources of Payment for Medicare Beneficiaries Medical Services, 2003 77 Table 4.13 Sources of Pay
20、ment for Medicare Beneficiaries by Type of Service, 2003 78 Table 4.14 Types of Supplemental Health Insurance held by Fee-for-Service Medicare Beneficiaries, 2003 79 Table 4.15 Medicare Beneficiary Out-Of-Pocket Spending, 2003 80 Table 4.16 Per Capita Out-Of-Pocket Expenses for Medicare Beneficiarie
21、s by Type of Insurance Coverage, 1993 and 2003 81 Table 4.17 Distribution of Medicare Enrollees by Functional Status, 2003 82 Table 4.18 Beneficiaries with Poor Health or Functional Limitations by Insurance Status, 2003 83 Table 4.19 Medicare Managed Care Enrollment, 1990-2005 84 Table 4.20 Medicare
22、 Beneficiaries with Prescription Drug Coverage,1992-2003 85,Centers for Medicare & Medicaid Services,6,Table of Contents Section 4, Tables 4.21 to 4.40,Section 4: Public Programs 65Table 4.21 Total Spending for Prescription Drugs for all Medicare Beneficiaries, 1996-2003 86 Table 4.22 Medicare Benef
23、iciaries with Drug Coverage by Primary Source of Supplemental Coverage, 1995 and 2003 87 Table 4.23 Personal Health Expenditures by Type of Service and Percent Medicaid Paid, 2004 88 Table 4.24 Personal Health Expenditures by Type of Service and Percent Medicaid Paid, 1980 89 Table 4.25 Medicaid Enr
24、ollment by Eligibility Group, 2003 90 Table 4.26 Average Medicaid Payments Per Person Served by Eligibility Group, 1985-2003 91 Table 4.27 Medicaid Enrollees by Eligibility Group, 1975-2003 92 Table 4.28 Total Medicaid Expenditures by Type of Service, FY 2005 93 Table 4.29 Total State Spending and F
25、ederal Funds Provided to States, 2004 94 Table 4.30 Medicaid Spending for Long-Term Care, 1999-2003 95 Table 4.31 Births Financed by Medicaid as Percent of Total Births by State, 2005 96 Table 4.32 Medicaid Enrollment by Age, Sex, and Ethnicity, 2003 97 Table 4.33 Medicaid Managed Care Enrollment, 1
26、996-2004 98 Table 4.34 Health Insurance Coverage of Children, 1988-2005 99 Table 4.35 State Childrens Health Insurance Program Spending and Enrollment, 1998-2004 100 Table 4.36 State Childrens Health Insurance Program Plan By State, 2006 101 Table 4.37 State Health Spending as a Percent of Gross Sta
27、te Product, 2004 102 Table 4.38 Share of State Health Spending Financed by Medicare and Medicaid, 2004 103 Table 4.39 Share of State Health Spending Financed by Medicare, 2004 104 Table 4.40 Share of State Health Spending Financed by Medicaid, 2004 105,Centers for Medicare & Medicaid Services,7,Tabl
28、e of Contents Sections 5 and 6,Section 5: Private Health Insurance 106Table 5.1 Health Spending From Out-of-Pocket and Private Health Insurance, 1980-2010 107 Table 5.2 Changes in Employer Health Insurance Premiums, Overall Inflation, and Workers Earnings, 1989-2005 108 Table 5.3 Change in Health In
29、surance Premiums by Firm Size, 1988-2005 109 Table 5.4 Employee Contributions to Health Insurance Premiums, 1988-2005 110 Table 5.5 Average Annual Premium Costs by Plan Type, 2005 111 Table 5.6 Changes in Employee Benefit Packages, 1980-2004 112 Table 5.7 Firms Offering Health Insurance Coverage by
30、Firm Size, 1996-2005 113 Table 5.8 Number of Health Plans Offered by Firm Size, 2005 114 Table 5.9 Private Health Insurance Enrollment by Plan Type, 1988-2005 115 Table 5.10 Employees With a Choice of Health Plans, 1988-2005 116 Table 5.11 Covered Employees in Firms that Offer Health Benefits, 2005
31、117Section 6: Uninsured 118Table 6.1 Out of Pocket Spending by the Under 65 Population by Insurance Status by Income, 2001 and 2003 119 Table 6.2 Out of Pocket Spending by the Under 65 Population by Insurance Status by Type of Service, 2001 and 2003 120 Table 6.3 Percent Uninsured within Age Categor
32、ies, 1987-2005 121 Table 6.4 Percent Uninsured within Income Categories, 1987-2005 122 Table 6.5 Percent Uninsured by Ethnicity, 1987-2005 123 Table 6.6 The Uninsured by Age, 1987-2005 124 Table 6.7 The Uninsured by Income, 1987-2005 125 Table 6.8 The Uninsured by Ethnicity, 1987-2005 126 Table 6.9
33、The Uninsured by State, 2005 127 Table 6.10 Impact on Non-Elderly Adults of Being Uninsured, 2006 128,Centers for Medicare & Medicaid Services,8,Section 1Overview of the U.S. Health Care System,Centers for Medicare & Medicaid Services,9,Table 1.1 National Health Expenditures and Their Share of Gross
34、 Domestic Product (GDP), 1980-2015,Source: CMS, Office of the Actuary, National Health Statistics Group.,Actual,Projected,National health spending is projected to continue to increase as a share of GDP over the next decade.,Centers for Medicare & Medicaid Services,10,Table 1.2 National Health Expend
35、itures Per Capita, 1980-2015,Calendar Year,Source: CMS, Office of the Actuary, National Health Statistics Group.,Actual,Projected,National health spending per capita is projected to increase rapidly over the next decade.,Centers for Medicare & Medicaid Services,11,Table 1.3 Personal Health Care Expe
36、nditures by Source of Funds: Selected Years 1960-2004,Source: CMS, Office of the Actuary, National Health Statistics Group.,Total Private,Total Public,$23.3,$63.1,$214.5,$609.3,$1,553,Over the last several decades, both the public and private sector share of health spending has increased, while the
37、share from out-of-pocket spending has declined.,55%,40%,27%,23%,14%,21%,16%,12%,10%,12%,21%,22%,28%,33%,35%,2%,3%,4%,5%,5%,12%,17%,18%,17%,8%,12%,11%,16%,Dollars in Billions,Other Public Medicare Total Medicaid, SCHIP expansion and SCHIP,Out-of-Pocket Other Private Private Health Insurance,13%,7%,35
38、%,13%,17%,16%,$1,877.6,Centers for Medicare & Medicaid Services,12,Table 1.4 Health Insurance Coverage for the Under 65 Population, 1980-2004,Notes: ESI - Employer Sponsored Insurance. Any Private includes ESI and individually purchased insurance. Any government includes Medicare for the disabled po
39、pulation.Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.,Over the last two decades, private coverage has declined, public coverage (mostly Medicaid) has increased a small amount, and the uninsured have gr
40、own.,ESI,Any Private,Medicaid,Any Government,Uninsured,Centers for Medicare & Medicaid Services,13,Table 1.5 Personal Health Care Expenditures by Type of Service, 1960-2003,Service,Percent,Source: CMS, Office of the Actuary, National Health Statistics Group.,39.3%,47.3%,41.7%,36.5%,22.9%,21.9%,25.9%
41、,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%,The share of health spending on prescription drugs has grown since 1980. Physician share has stayed about the same while the hospital share grew and then declined.,35.8%,25.7%,7.7%,12.4%,2.8%,15.6%,Centers f
42、or Medicare & Medicaid Services,14,Table 1.6 Annual Percent Change in Personal Health Care Expenditures for Medicare, Medicaid and Total: 1971-2015,Percent,Calendar Year,Source: CMS, Office of the Actuary, National Health Statistics Group.,Medicare Prospective Payment System (1983),Projected,Balance
43、d Budget Act (1997),Balanced Budget RefinementAct (1999),Actual,Medicare Catastrophic Coverage Act of 1988,While the actual percent changes vary, overall spending for Medicare and Medicaid tend to rise and fall together.,Medicare Extended to Disabled & ESRD (1973),Medicaid Taxes & Donations (1991),P
44、HCE,Medicare,Medicaid,PHCE (projected),Medicare (projected),Medicaid (projected),Centers for Medicare & Medicaid Services,15,Table 1.7 Average Annual Growth in Medicare and Private Health Insurance Benefits Per Enrollee : Selected Periods,Source: CMS, Office of the Actuary, National Health Statistic
45、s Group.,Entire Period,Selected Calendar Year Periods,Except for 1993-1997, Medicare has grown slightly more slowly than private health insurance.,Calendar Years,1970-2004,1970-1993,1993-1997,1997-1999,1999-2004,Centers for Medicare & Medicaid Services,16,Table 1.8 Concentration of Health Spending,
46、1987-2002,Source: Yu, William W. & Trena M.Ezzati-Rice, Medical Expenditure Panel Survey Statistical Brief #81, AHRQ, May 2005.,Health spending remains highly concentrated on a small percentage of people. The top 1% of people account about a quarter of all health spending,Population Ranked By Expend
47、itures,Percentage of Expenditures,Centers for Medicare & Medicaid Services,17,Table 1.9 Factors Accounting for Growth in Prescription Drug Spending per Capita, 1980-2011,Note: Utilization also includes the effects of intensity and population growth. Per capita drug spending in 1990 was $252 * Withou
48、t the effect of Part D, overall growth would be 8.1% (price: 3.8%, Utilization 4.3%) Source: CMS, Office of the Actuary, Health Affairs Web Exclusive, Exhibit 6, pp. W70,10.7%,12.3%,8.2%,8.0%,8.1%,7.7%,8.3%,*,Drug Prices and Utilization significantly affect prescription drug spending per capita.,Cen
49、ters for Medicare & Medicaid Services,18,Table 1.10 Prescription Drugs Expenditures by Source of Funds, 1965-2004,Note: Percentages may not sum to 100 due to rounding. Drug spending grew from $3.7 billion in 1965 to $188.5 billion in 2004Source: CMS, Office of the Actuary, National Health Statistics Group.,The share of drug spending covered by public and private sources has grown significantly.,
