moral hazard
behaving differently when you know someone else
is taking the risk (Induced demand)
adverse selection
the sicker people likely want more insurance (the
pooling of risk
sharing risk proportionately among many is a basic insurance
concept
Non marketability of risks
inherent in medicine and medical practice
Health insurance
Asymmetries of information Healthcare
Physician vs. patient (vs. 3rd Party payer)
Uncertainty and Health Care
financing health care in the United States is a complex matter
•Workarounds
•Redundancies
•Contradictions
single national payment system
because the United States lacks a__________________________, for healthcare,
how the money is paid to the providers of health care has become very
complicated.
•Situation that to this point, health care reform policies have not reduced
National Health Expenditure Accounts (NHEA)
•Provide official estimates of health care spending in the United States
•Measures health care consumption and health care investment
Benefits of NHEA
,•Comprehensive—includes all major components of health care system in a
unified, mutually exclusive, and exhaustive structure
Health Care Financing
•Multidimensional—encompasses expenditures as well as payers
•Consistent—applies a common set of definitions that permits longitudinal
comparisons
Published by the U.S. Department of Health and Human Services (DHHS)
NHEA produce
National Health Expenditures (NHE)
Health Consumption Expenditures (HCE)
Personal Health Care (PHC)
NHE – HCE = Amount of investment in the Medical Sector of economy
National Health Expenditures (NHE)
•All health care consumption and investments in medical structures and
equipment and noncommercial health services and biomedical research
Health Consumption Expenditures (HCE)
•A subset of NHE
•Includes personal health care spending, government administration and net cost
of private health insurance, and public health activities
Personal Health Care (PHC)
•A subset of HCE
•Includes all medical goods and services that are used to diagnose, treat, and
prevent health problems in a specific person
Health care spending has
increased in the United States every year since 1960 except for slight dips in 2013
and 2017.
•Absolute amount
•Per capita amount
•Percentage of Gross Domestic Product (GDP)
In 2017, the National Health Expenditures (NHE) were
,•$3.49 trillion
•17.9% of GDP
•$10,739 per capita
per capita spending on health care
not adjusted for inflation—was $146 in 1960, compared to $10,739 in 2017
Buying power
of $146 in 1960 equates to about $1,207 when adjusted by the Consumer Price
Index (CPI)
direct and indirect health care spending
were it to be allocated evenly across the population—would be larger than any
other household expense
In 2017, median household income
was $57,652, and median rent or owner costs for housing was $11,784.
$29,000
50%
•With per household NHE at around ______, health care expenditures would be
more than _____of the median household income.
Between 1960 and 1990
the average annual percent changes were double-digit increases except in 1985–
1987
Beginning in 1991,
the annual rate of increase in health care spending began to decline to single
digits and continued in single digits through 2017.
From 2008 to 2017
the annual rate of increase each year was below 6%.
In 2017, spending grew
only 3.9% from the previous year.
Vast majority of expenditures
are in Health Consumption Expenditures (HCE).
Most of HCE
, are for Personal Health Care (PHC).
•Hospitalization
•Physician services
•Prescription drugs
•Other health care goods and services
small portion of expenditures
ranging between 5% and 10% over the decades—go toward investments,
comprised of:
•Buildings, equipment and research
Hospital care accounted for
the largest share of NHE.
• About 33%
•An amount that has remained relatively stable since at least 1960
remained relatively constant
Professional services
had the second highest share of the NHE.
• About 26%
•Most was for physician services—about 20% of NHE
remained relatively constant
Retail prescription drugs accounted for
the third highest share
•About 9.5% (10.5% in 2019)
•A relatively stable expenditure over the past 50+ years as percent
three categories of Personal Health Care
increased as a share of NHE since 1960.
1. Other Health, Residential, and Personal Care
2. Net Cost of Private Health Insurance
3.Home Health Care
reflect:
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