An Overview of the U.S. Healthcare System:
Two Decades of Change, 1980-2000
Table 1.1
National Health Expenditures and Their
Share of Gross Domestic Product (GDP), 1960-2010
National health spending growth is projected to significantly increase as a
share of GDP over the next decade.
NHE
Projected NHE
GDP Share
Projected GDP Share
$3,000
Projected
Actual
18%
16%
$2,500
14%
12%
10%
$1,500
8%
$1,000
6%
4%
$500
2%
$0
0%
1960 1970 1980 1985 1990 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Calendar Year
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
GDP Share
Billions
$2,000
Table 1.2
National Health Expenditures Per Capita, 1986-2010
National health spending per capita is projected to increase rapidly over the next decade.
$10,000
Actual
Projected
$9,000
$9,216
$8,228
$8,000
$7,000
$6,926
$6,000
$5,757
$5,000
$5,039
$4,000
$4,177
$3,698
$3,000
$3,183
$2,000
$1,000
$2,477
$1,872
$0
1986
1988
1990
1992
1994
1996
1998
2000
Calendar Year
2002
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
2004
2006
2008
2010
Table 1.3
Personal Health Care Expenditures by Source of Funds:
Selected Years 1960-2000
Over the last several decades, the public sector share of health spending has increased,
while the share from out-of-pocket spending has declined.
100
55.2%
2.8%
22.3%
2.0%
40
21.4%
5.0%
5.0%
28.3%
33.4%
11.9%
10.0%
34.6%
7.3%
15.7%
19.2%
20
16.9%
11.5%
8.0%
21.4%
0
1960
17.2%
22.5%
4.3%
60
$1,130.4
$609.3
27.1%
39.7%
80
Percent
$63.1
$23.3
Dollars in Billions
$214.5
1970
17.6%
11.5%
1980
16.8%
11.4%
1990
2000
Calendar Year
Total
Public
Other Public
Medicare
Total Medicaid, SCHIP expansion and SCHIP
Total
Private
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
Out-of-Pocket
Other Private
Private Health Insurance
Table 1.4
Sources of Health Insurance Coverage for the
Under 65 Population, 1980-2000
Over the last two decades, private coverage has declined, public coverage has stayed
about the same, and the uninsured have grown.
90
83%
80
Any Private
74%
74%
70
ESI
60
69%
50
40
30
20
10
15%
10%
Uninsured
Any Government
Medicaid
8%
16%
14%
9%
0
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
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.
Centers for Medicare & Medicaid Services
Table 1.5
Distribution of Personal Health Care Expenditures
by Type of Service, 1960-2000
The 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.
50
47.3%
41.7%
40
39.3%
30
25.9% 25.3%
22.9% 21.9%
Service
Percent
36.5%
22.5%
20
15.8%
16.4%
15.2%
11.4%
10.8%
10
5.6%
0.2%
0
Hospital
Physician
1.1%
2.1%
1960
3.6%
2.9%
Home Health
1980
8.2% 8.6% 8.2%
6.6%
Prescriptions Nursing Home
Percent
1990
2000
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
Other
Table 1.6
Percent Change in Personal Health Care Expenditures for
Medicare, Medicaid and Total: 1971-2010
While the actual percent changes vary, spending overall and for Medicare and
for Medicaid tend to rise and fall together.
PHCE
Projected PHCE
40
Medicare
Projected Medicare
Actual
Projected
35
Percent
30
Medicaid
Projected Medicaid
Medicare Extended to
Disabled & ESRD
(1973)
Medicare
Catastrophic
Coverage
Act of 1988
Medicaid Taxes
& Donations
(1991)
25
Balanced
Budget
Refinement
Act (1999)
20
15
10
5
Medicare Prospective
Payment System (1983)
Balanced Budget Act
(1997)
0
1971 1974 1977 1980 1983
1986 1989 1992 1995
Calendar Year
1998 2001 2004 2007 2010
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
Table 1.7
Average 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.
Private Health Insurance
Medicare
16
14
12
Percent
10
Entire Period
Selected Calendar Year Periods
11.5
11.0
9.4
8
8.6
8.0
7.0
7.2
6
5.7
4.6
4.7
5.2
4
2
0
-0.1
Calendar Years
-2
19692000
19851991
19911993
19931997
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
19971999
19992000
Table 1.8
Concentration of Health Spending, 1980-1996
Health spending remains highly concentrated on a small percentage of people. The top
1% of people account for more than a quarter of all health spending.
120
Percent of Expenditures
100
90
80
97
90
70
90
70
69
56
55
60
40
97
96
29
55
28
27
20
4
3
3
0
1980
1987
1996
Year
Top 1%
Top 5%
Top 10% Top 30%
Percent of People
Top 50%
Bottom 50%
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.
Centers for Medicare & Medicaid Services
Table 1.9
Factors Accounting for Growth in Prescription Drug Spending
per Capita, 1980-2011
Growth in spending is projected to return to 1980-1993 levels.
Other
Drug Utilization (Number of Prescriptions)
Drug Prices (Consumer Price Index - Drugs)
Average Annual Percent Change
18
16.1
16
13.3
14
12
10
6.5
10.7
0.8
0.9
8
5.1
9.2
2.7
5
4.2
3.3
2.4
4.6
4.9
4.9
1997-2000
2000-2003
2003-2011
6
4
9
2
10.0
2.2
2.8
0
1980-1993
1993-1997
Calendar Years
Note: Data for 2000-2011 are projections.
”Other” includes quality and intensity of services, and age-gender effects.
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
Table 1.10
Spending for Prescription Drugs by Source of Funds,
1965-2000
The share of drug spending covered by public and private sources has grown significantly.
100%
4%
4%
14%
90%
22%
80%
24%
70%
60%
46%
50%
93%
40%
63%
30%
20%
32%
10%
0%
1965
1985
Out-of-Pocket
Private Health Insurance
Note: Percentages may not sum to 100 due to rounding.
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
2000
Public
Table 1.11
Sources 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
Medicare
8.0%
Out-of-Pocket
46.0%
Medicare
17.3%
Medicaid
41.0%
Out-of-Pocket
62.2%
Medicaid
15.3%
Private LTC Ins.
5.0%
Private LTC Ins.
5.0%
Total Long Term Care Spending in 2000 is $100 Billion
Source: CMS, Office of the Actuary, National Health Statistics Group.
Centers for Medicare & Medicaid Services
Table 1.12
Number of People Employed in Health Care, 1985-2001
Number of people employed in health is growing.
12
Employment in Millions
10
7.8
8
8.2
8.5
8.8
9
9.2
9.5
9.7
9.9
10
10.1
10.3
6.3
6
4
2
0
1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
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.
Centers for Medicare & Medicaid Services
Table 1.13
Health Care Employment by Occupation, 1983-2000
Health care employment growth exceeded that of the general economy.
Percent
Change
1990-02
32.0% . . . . . . . . . . . . . . . . . . . . . . . . . . Radiologic Technicians
-75.4% . . . . . . . Health Record Technologists & Technicians
1983
28.7% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dental Hygienists
1990
2000
1400
1600
14.8% . . Clinical Laboratory Technologists & Technicians
7.5% . . . . . . . . . . . . . . . . . . . . . . . . . Physicians' Assistants
39.4% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Speech Therapists
61.9% . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical Therapists
56.5% . . . . . . . . . . . . . . . . . . . . . . . . Occupational Therapists
48.6% . . . . . . . . . . . . . . . . . . . . . . . . . Respiratory Therapists
23.8% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Dietitians
16.9% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pharm acists
21.6% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Registered Nurses
26.6% . . . . . . . . . . . . . . . . . . . . . . . . Licensed Practial Nurses
-15.2% . . . . . . . . . . . . . . . . . . Health Diagnosing Practitioners
30.4% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Optom etrists
5.0% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dentists
24.6% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physicians
95.3% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Scientists
332.2% . . . . . . . . . . . . . . . . . . . Managers, Medicine & Health
13.8% Total Employment
0
200
400
600
800
1000
1200
Em ploym ent (Thousands)
Source: Dept. of Labor, Bureau of Labor Statistics. Current Population Survey.
Centers for Medicare & Medicaid Services
1800
2000
2200
Table 1.14
Health Care Employment Growth Projections, 2000-2010
Over the next decade, health care employment is expected to grow at a rapid rate.
General Health Care
Occupations
100%
Fastest Growing* Specific
Health Care Occupations
2000-2010 Employment Growth
90%
80%
70%
62%
60%
57%
53%
47%
50%
40%
33%
20%
26%
25%
30%
15%
19%
10%
3%
0%
To ta l
E m p lo ym e n t
G ro wt h
S e rv ic e
S e c to r
M a n u f a c t u rin g
S e c to r
H e a lt h C a re
P ra c t it io n e rs
& T e c h n ic a l
O c c u p a t io n s
H e a lt h C a re
S u p p o rt
O c c u p a t io n s
P e rs o n a l &
H o m e C a re
A id e s
M e d ic a l
A s s is t a n t s
*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.
Centers for Medicare & Medicaid Services
P h ys ic ia n
A s s is t a n t s
H o m e H e a lt h
A id e s
R .N .s
Table 1.15
Physician Income Compared to All Workers, Selected Years
Physician income continues to be much higher than that of all full-time workers.
$180,000
$166,000
$160,000
$150,000
$120,000
Median Physician Net Incom e
$94,000
$90,000
Median Full-Tim e Worker Incom e
$60,000
$30,000
$17,836
$25,480
$27,196
$0
1985
1996
1998
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/statisticalabstract-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.
Centers for Medicare & Medicaid Services
Table 1.16
HMO Enrollment by Ownership Status, 1981-2000
The proportion of HMO enrollees in for-profit plans grew over the past decade.
% Non-Profit
% For-Profit
100%
12.0%
26.0%
80%
46.2%
52.2%
63.3%
63.7%
64.0%
63.5%
36.7%
36.3%
36.0%
36.5%
1997
1998
1999
2000
80.81
79.66
60%
40%
88.0%
74.0%
53.8%
20%
47.8%
0%
1981
1985
1989
1993
Total Enrollment (in millions)
10.27
18.89
32.49
42.07
72.23
78.78
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.
Centers for Medicare & Medicaid Services
Table 1.17
Concentration of Managed Care Enrollment, 1988-2000
Two-thirds of managed care enrollees are enrolled in the nation’s 10 largest
managed care firms.
Percent Enrolled in 10 Largest Firms
80
70
65.0
60
50
54.6
56.2
1991
1994
64.1
65.2
1998
1999
66.5
45.8
40
30
20
10
0
1988
1997
2000
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.
Centers for Medicare & Medicaid Services
Table 1.18
Managed Care Enrollment by Type of Plan, 1984-2000
Mixed model HMO plans have shown rapid growth.
80
Staff
Enrollees (in millions)
70
Group
Network
IPA
80.1
Mixed
63.3
32.1
60
23.1
50
38.8
40
31.4
6.7
13.5
16.2
5.6
3.9
33.5
30
20
10
0
Mixed
IPA
Network
Group
Staff
15.1
2.9
3.5
6.6
2.1
8
9.7
4.3
2.4
1984
1988
1992
NA
19.5%
23.3%
43.6%
13.6%
NA
43.0%
18.0%
25.4%
13.6%
17.3%
41.7%
10.0%
24.8%
6.2%
27.5
3.3
8.7
7.1
0.8
1996
36.4%
43.4%
5.3%
13.7%
1.2%
Source: Trends & Indicators in the Changing Health Care Marketplace, 2002 – Chartbook.
Centers for Medicare & Medicaid Services
7
2000
40.0%
41.9%
8.9%
8.8%
0.4%
0.4
Table 1.19
Number of Dedicated Health Care Mutual Funds and
Amount of Fund Assets, 1992-2002
The number of dedicated health care funds has grown from 10 in 1992 to 190 today.
$48,510
250
Fund Assets ($ in Millions)
$44,172
$42,387
190
$40,000
177
$30,000
200
150
$24,641
$20,270
107
$20,000
100
$11,641
55
$8,440
$10,000
$4,299
33
21
50
40
10
$0
1992
0
1996
1997
1998
Total Health Care Fund Assets
1999
2000
2001
April,
2002
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.
Centers for Medicare & Medicaid Services
# of Funds
$50,000
Table 1.20
Number of Mergers and Acquisitions Among
Health Services Companies and HMOs, 1990-2000
As stock prices took a downward turn and merged entities confronted management difficulties,
the number of health company mergers fell sharply in recent years.
Mergers and Acquisitions Among Health
Services Companies
600
HMO Mergers and Acquisitions
561
35
32
508
500
30
25
390
400
367
347
297
300
21
19
20
305
253
15
200
159
157
14
10
10
10
9
8
120
100
16
15
5
1
0
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
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.
Centers for Medicare & Medicaid Services
Table 1.21
Out-of-Pocket Spending for Health Care as a Percent of Income
by Age and Income Level, 2000
Those over 65 and those with incomes under $20,000 spend a higher percentage of their
income on health than other groups.
By Income Level
16
14
12.9%
12
10
8
6
4
5.2%
2.7%
3.3%
2
0
Under 35
35 to 54
55 to 64
Age Group
65 and
over
Percent of Income Spent on Health
Percent of Income Spent on Health
By Age Group
16
14
15.2%
12
10
8
6
4
6.2%
4.0%
2.6%
2
0
Less than $20,000 to $50,000 to $70,000
$20,000
$49,999
$69,999 and above
Income Level
Source: Dept. of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.
Centers for Medicare & Medicaid Services
Table 1.22
Growth in the Overall Consumer Price Index (CPI) and
Medical-Specific Consumer Price Index (MCPI), 1993-2001
Medical prices have risen faster than overall consumer prices.
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
1993
1994
1995
1996
1997
CPI
1998
1999
MCPI
Source: Dept. of Labor, the Bureau of Labor Statistics.
Centers for Medicare & Medicaid Services
2000
2001
Table 1.23
Health Care Spending Per Capita by OECD Country, 1960-1999
U.S. spending is significantly higher than other OECD countries.
$4,373
$4,500
$4,000
$3,500
$3,080
$3,000
$2,739
$2,058
$2,000
$972
$328
$658
$522
$270
$89
$144
$74
$83
$14
$1,058
$850
$444
$130
$26
$151
$48
$240
$87
$662
$159
$64
$1,600
$1,245
$1,206
$1,083
Ita
ly
**
$813
$1,300
$1,836
$1,676
$1,517
$1,321
Ja
pa
n
$1,000
$2,144
$2,061
$1,492
$1,469
$2,226
$1,882
$1,844
$1,748
$1,666
$1,500
$500
$2,451
$2,428
$2,500
$577
$130
$53
$701
$206
$72
$881
$824
$710
$260
$109
$349
$144
$288
$136
$223
$90
1960
Median: $64
1999
$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.
Centers for Medicare & Medicaid Services
ta
te
s
S
ni
te
d
U
itz
er
la
nd
Sw
an
y
$591
er
m
$146
G
1990
C
an
ad
a
1980
Fr
an
ce
el
gi
um
B
us
tr
al
ia
**
*
1970
A
ed
en
**
*
Sw
do
m
in
g
A
us
tr
ia
U
ni
te
d
K
Sp
ai
n
$0
Table 1.24
Average Annual Growth in Per Capita Spending by Decade
by OECD Country, 1960-1999
Health spending growth over the last decade is lower in OECD countries than in prior decades.
19.5
20
17.5
18
16.1
16
Percent
14.7
14.0
14
12
15.3
14.9
13.0
11.7 12.2
10.6
10
9.1
10.7 10.6
9.5
9.5
8.0
8
6
10.0
9.3
9.0
7.0
6.9
5.8
11.9
11.8
11.7
11.1
5.9
5.5
5.3
7.8
8.2
7.6
7.6
6.2
6.1
5.9
9.5
9.4
6.9
6.1
8.0
6.2
6.2
6.8
4.4
4.2
4
2
2.0
Median:
10.7%
13.3%
Sp
ai
n
el
gi
um
ni
te
d
B
do
m
K
in
g
A
us
tr
ia
Ja
pa
n
itz
er
la
nd
1970-1979
1980-1989
1990-1999
8.0%
6.1%
U
1960-1969
Sw
A
us
tr
al
ia
**
an
y
er
m
U
G
ni
te
d
S
ta
te
s
Fr
an
ce
C
an
ad
a
Sw
ed
en
**
0
*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 to
1999. The medians include all OECD countries.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
Table 1.25
Percent of GDP Spent on Health Care by OECD Country, 1960-1999
The U.S. has had a higher share of GDP spent on health than the OECD median for
the past four decades.
14
13
11.9
12
10.7
10.3
Percent
10
8
6
4
5.6
4.5
3.9
6.4
6
8 7.8
7.7
7.4
7.1
5.4
4.5
4.5
3.6
7.5
7
6.1
5.6
5.3
5.1
7.8
7.6
7.1
4.3
9 9.2
8.7
8.5
8.1
6.9
6.6
5.9
9.1
8.5
7.9
8.8 8.7
7.6
7 7.1
6.6
8.7
8.5
6.9
6.3
5.6
4.9
5.4
5.1
4.3
3.6
3
2
1.5
Median:
1970
1980
1990
1999
3.9%
5.1%
6.8%
7.5%
7.9%
*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.
Centers for Medicare & Medicaid Services
ta
te
s
S
itz
er
la
nd
U
ni
te
d
1960
Sw
G
er
m
an
y*
,**
an
ad
a
C
re
ec
e*
G
A
us
tr
al
ia
**
us
tr
ia
A
ed
en
**
Sw
Ita
ly
*
Sp
ai
n
Ja
pa
n
U
ni
te
d
K
in
g
do
m
0
Table 1.26
Per Capita Health Spending by Type of Service
by OECD Country, 1980-1999
Health spending is moving to outpatient settings.
$3,500
$119
$3,000
$2,500
$1,429
$63
$103
$50
$2,000
$84
$852
$852
$9
$79
$99
$27
$1,500
$5
$7
$580
$4
$12
$625
$1,000
$10
$288
$1,766
$1,229
$500
$525
$21
$279
$1,352
$879
$418
$161
$0
$697
$358
$1
$7
$275
$589
$507
$4
$57
$834 $176
$556
$971
$697
$15
$183
$824
$6
$124
$635
$437
$322
$1,270 $4
$5
$178
$504
$338
$274
$20
$18
$66
$358
$487
$475
$6
$233
$709
$46
$31
$75
$458
$289
$821
$382
$1,022 $11
$151
$604
$761
$340
1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999 1980 1990 1999
United States
Switzerland
Japan
Germany*
Inpatient
Outpatient
France**
Ancillary
Denmark
Hom e Health
*The data for 1999 was missing, so 1998 data was used.
**The data for 1980 came from the 2001 OECD Health Data.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
Canada
Australia*
Table 1.27
National Health Spending by Source of Funds by OECD Country, 2000
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.
100%
80%
10%
11%
1%
2%
13%
13%
11%
15%
15%
16%
16%
6%
2%
2%
6%
7%
6%
11%
10%
70%
17%
5%
21%
21%
23%
5%
2%
3%
3%
2%
1%
7%
1%
15%
26%
44%
3%
6%
Out-of-Pocket
Payments
35%
60%
5%
50%
40%
19%
43%
74%
69%
66%
30%
15%
82%
78%
7%
63%
69%
64%
60%
33%
20%
29%
27%
10%
13%
(1
99
Ko
9)
re
a
(1
99
9)
ai
n
Ita
ly
11%
Sp
ga
ry
Hu
n
nl
an
d
tri
a
8%
Au
s
6%
Fr
an
ce
G
er
m
an
y
Ire
la
Un
nd
ite
d
St
at
Ne
es
w
Ze
al
Ca
an
d
na
da
(1
99
9)
De
nm
ar
Ja
k
pa
n
(1
99
9)
0%
2%
Source: OECD Health Data 2002 2nd ed.
Centers for Medicare & Medicaid Services
All Other Private
Funds
Private Insurance
Social Security
Schemes
74%
70%
Fi
Percent of Total Health Expenditure
90%
General Government,
Excl. Social Security
Table 1.28
Per Capita Spending on Pharmaceuticals and Other Non-Durables
by OECD Country, 1970-1999
Per capita drug spending varies significantly across countries.
$500
1970
1980
1990
$492
1999
$450
$388
$400
$344
$350
$312
$300
$280
$250
$218
$239
$236
$227
$191
$200
$150
$100
$50
$25
$131
$120
$104
$65
$252
$228
$55
$18
$57
$21
$117
$53
$31
$110
$96
$60
$29
$36
$63
$22
$43
$0
Greece
Sweden
(1997)
Drug Spending as
Percent of GDP** (1999): 0.7%
United
Australia
Germany
Kingdom (1998, 1969) (1998)
Canada
Italy
(1979)
United
States
1.7%
1.4%
(1997)
1.0%
1.0%
1.1%
1.3%
1.3%
Expenditures in U.S. dollars using purchasing power parity rates.
**Reinhart, et. Al., 2002.
Note: Data is arrayed by spending levels for 1999.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
Table 1.29
Medical Technology and Use of High-Technology Medical Procedures
by OECD Country, 1999
Japan has the highest rates of diagnostic high-tech procedures, the U.S. has the
highest rate of heart procedures.
MRIs per
Million People
CT Scanners per
Million People
Coronary Bypass
Procedures per
100,000 People
Coronary Angioplasty
Procedures per
100,000 People
Patients Undergoing
Dialysis per
100,000 People
Bone Marrow
Transplants per
100,000 People
Australia
4.5
20.8*
93*
97*
31.5
5.1
Austria
10.9
25.7
40*
53*
35.9
4.7
Canada
1.8*
8.2
65*
70*
42.2*
3.9*
Denmark
5.5
10.2
64
82
36.3
0.7*
France
2.5*
9.7*
35*
73*
37.0*
_
Germany
6.2*
17.1*
38*
86*
58.5*
_
Greece
1.2*
6.1*
61*
28*
48.2*
_
Hungary
1.5
5.2
68
27
12.5*
1.0
Italy
6.7
19.6
46
67
31.6*
6.8
Japan
23.2
84.4
_
_
155.7
_
Mexico
0.3
2.0
1
2
28.8
0.2
Netherlands
3.9*
9.0*
60*
72*
26.4
1.6*
Poland
0.4*
0.4*
17*
5*
119.7
_
Spain
4.6
11.6
15*
20*
43.7
5.8
Sweden
6.8*
13.8*
54*
_
25.4*
1.8
Switzerland
13.2*
19.0*
60*
65*
26.5*
1.0*
United Kingdom
4.5
6.1
41*
35*
27.0
_
United States
7.6*
13.2*
203*
339*
86.5*
3.1
Median
4.1
12.0
54
55
31.6
2.3
*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.
Centers for Medicare & Medicaid Services
Table 1.30
Selected 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.
1997
Incidence of Cancer
(All Types of
Malignant
Neoplasms)
per 100,000
2000
Incidence of AIDS
in Population,
per 1,000,000
1999
Total Surgeries on
an In-patient
Basis, per 1,000
2000
Percentage of
Population That is
Obese (BMI >30)
1998
Percentage of
Population That are
Daily Smokers
1999
Percentage of Total
Live Births That are
Low-birthweight
Births
Australia
302.3
13.0
51.2
20.8*
22.8
6.2
Austria
249.2
9.6
129.8
8.5*
29.3*
6.5
Canada
401.5*
20.9
45.6
14.6*
23.8
5.6
Denmark
319.4*
10.0
60.8
7.6*
31.0
5.5*
France
261.0*
27.9
_
9.6
27.0 (2001)
6.4
Germany
412.3
8.2
77.6
11.5*
24.7 (1999)
6.5
Greece
273.0*
11.9
41.1*
_
37.0*
8.1
Hungary
319.4*
2.7
140.4
19.4
30.1 (2000)
8.5
_
33.7
109.1
8.6
24.7
6.0*
Japan
205.4*
2.6
_
2.9
34.3
8.4
Mexico
92.0
46.2
_
_
25.1
9.4
Netherlands
417.8
6.0
39.1
9.4
35.0
4.7
Poland
268.1*
2.6
_
11.4*
29.6*
6.0
Spain
_
66.8
56.5*
12.9*
33.1*
6.2*
Sweden
_
6.1
51.5
9.3
19.1
4.3
Switzerland
_
25.3
_
6.8*
33.0*
6.3
United Kingdom
242.5
13.8
_
21.0
27.0
7.6
United States
403.8
144.0
87.4
22.6*
19.9
7.6
Median
293.1
9.1
60.0
11.4
27.0
6.3
Italy
*Earlier data used.
Median includes all OECD countries.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
Table 1.31
Selected 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.
HIV Mortality Rates for
Total Population Due to
HIV Infection,
per 100,000
Cancer Mortality Rates,
per 100,000
Suicide Rates for
Total Population,
per 100,000
Homicide Rates for
Total Population,
per 100,000
Australia
168.6
13.4
1.5
3.4 (1999)
0.7
Austria
168.6
16.5
1.1
1.0 (2000)
0.7
Canada
177.1*
11.4*
1.4*
3.6*
1.8*
Homicide Rates for
Young Males 20-29,
per 100,000
Denmark
211.9
12.1
0.9
0.8
0.6
France
180.0
15.4
0.7
1.0
1.5
Germany
179.2
11.7
0.9
1.5 (1999)
0.6
Greece
150.4
3.2
1.2
2.2
0.3
Hungary
264.1
27.3
2.9
1.7 (2000)
0.2
Italy
174.8
6.3
1.2
3.4
2.0
Japan
155.6
20.3
0.6
0.5 (1999)
0.0
Mexico
133.8*
3.8*
19.1*
Netherlands
192.4
8.5
1.1
2.7 (1999)
Poland
200.2*
13.3*
2.5*
3.4 (1999)
0.3 (1999)
Spain
165.7
6.9
0.8
1.7
4.2
Sweden
152.3
11.9
1.1
1.7
0.3
Switzerland
155.9*
16.3*
1.4*
3.0*
3.2*
United Kingdom
188.8
6.9
0.7
2.0 (1999)
0.3
United States
174.9
10.7
6.8
25.8
4.3
Median
177.1
12.3
1.2
2.3
0.6
*Earlier data used.
Median includes all OECD countries.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
55.2*
18.4*
0.7
Table 1.32
Infant Mortality Rates (per 1,000 Live Births) by OECD Country,
1960-2000
OECD
country infant mortality rates have declined significantly since 1960.
45
Median
40
Japan
35
Sw eden
30
France
25
Sw itzerland
20
Denm ark
Canada
15
Greece
10
United States
5
Slovak Republic
0
1960
Median
Australia
Austria
Canada
Czech Republic
Denmark
France
Germany
Greece
Hungary
Italy
Japan
Netherlands
Poland
Slovak Republic
Spain
Sweden
Switzerland
United Kingdom
United States
1970
1960
27.5
20.2
37.5
27.3
20.0
21.5
27.5
35.0
40.1
47.6
43.9
30.7
17.9
54.8
28.6
43.7
16.6
21.1
22.5
26.0
1980
1970
20.1
17.9
25.9
18.8
20.2
14.2
18.2
22.5
29.6
35.9
29.6
13.1
12.7
36.7
25.7
28.1
11.0
15.1
18.5
20.0
1990
1980
12.1
10.7
14.3
10.4
16.9
8.4
10.0
12.4
17.9
23.2
14.6
7.5
8.6
25.5
20.9
12.3
6.9
9.1
12.1
12.6
1990
7.9
8.2
7.8
6.8
10.8
7.5
7.3
7.0
9.7
14.8
8.2
4.6
7.1
19.3
12.0
7.6
6.0
6.8
7.9
9.2
2000
2000
5.0
5.2
4.8
5.3*
4.1
5.3
4.5
4.4
6.1
9.2
5.1
3.2
5.1
8.1
8.6
4.6
3.4
4.9
5.6
7.1*
Decrease in Infant
Mortality Rate
1960-2000
22.25
-15.0
-32.7
-22.0
-15.9
-16.2
-23.0
-30.6
-34.0
-38.4
-38.8
-27.5
-12.8
-46.7
-20.0
-39.1
-13.2
-16.2
-16.9
-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.
Centers for Medicare & Medicaid Services
Table 1.33
Number of In-Patient Beds and Admissions per 1,000 Persons
by OECD Country, 2000
Admission rates generally track bed supply.
Austria
304
Finland
Austria
267
Hungary
Finland
243.2
Germany
9.1
France
Czech Repub
209
Czech Repub
Denmark
199.9
Denmark
180.4
8.2
8.8
4.5
Italy
160
Australia
8.2
Germany
230
Italy
7.5
Hungary
235.1
France
8.6
4.9
7.9
Australia
Poland
155.4
Poland
4.9
Greece
154
Greece
4.9
United Kingdom
United Kingdom
150.9
Ireland
147.6
New Zealand
Ireland
132
United States
50
3.9
Turkey
57.8
0
4.1
Canada
75.9
Mexico
3.9
Spain
101.8
Turkey
3.6
Portugal
115
Canada
6.2
United States
120
Spain
9.7
New Zealand
124
Portugal
4.1
2.6
Mexico
100
150
200
250
300
350
1.1
0
2
Admissions
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
4
6
Number of Beds
8
10
12
Table 1.34
Male and Female Life Expectancy at Birth by OECD Country,
1960-1999
Male
Female
77.1
73.4
Japan
Japan
70.2
65.3
France
Sweden
Australia
United States
Denmark
Czech Republic
Mexico
56.2
75
70.2
67
77
72.8
71.2
76.2
71
67.9
73.9
70
66.6
74.2
71.2
70.4
71.4
66.8
67.9
72.8
64
France
Sweden
Australia
United States
Denmark
Czech Republic
Mexico
66.3
65.5
65.9
Hungary
0
30
Year
1960
Median = 67.2
1980
70.0
60
1999
74.6
59.5
82.5
78.4
73.6
81.9
78.8
74.9
81.8
78.1
73.9
79.4
77.4
73.1
79
77.3
74.4
78.1
73.9
73.4
77.3
70
75.1
72.7
70.1
Hungary
90
84
78.8
0
30
1960
Median = 72.5
Year
1980
76.6
60
1999
80.6
Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
90
Table 1.35
Male and Female Life Expectancy at Age 65 by OECD Country,
1960-1999
Male
Female
Mexico
15.3
13.8
Japan
14.6
17.7
17
13.7
12.5
France
13.6
12.5
14.1
16.6
20.2
17.9
15.6
Australia
16.5
14.1
12.8
United States
21
France
0
10
Year
18.1
17.6
15.3
Denmark
16.9
14.3
14.5
Czech Republic
12.1
11.6
12.3
Hungary
19.1
18.3
15.8
United States
13.6
11.2
12.5
Czech Republic
18.2
15.6
16.1
14.9
13.6
13.7
Denmark
21.9
17.7
Japan
11.6
Australia
18.9
16.5
14.4
Mexico
15.8
14.6
13.8
Hungary
20
0
10
Year
20
1960
1980
1999
1960
1980
1999
Median = 12.6
13.2
15.4
Median = 14.8
16.8
19.2
Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.
Source: OECD Health Data 2002.
Centers for Medicare & Medicaid Services
30