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
healthier, less)
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:
•Policy shift to lower costs by providing health care in facilities outside the
hospital
•Increasing use of private health insurance to pay for health care
consumption
Other Health, Residential, and Personal Care - ✔️ (1.6% to 5.2% of NHE)
•Ambulance providers
•Care delivered in residential care facilities
•Care in nontraditional settings such as community centers and schools
Net Cost of Private Health Insurance - ✔️ (3.7% to 6.6% of NHE)
•Administrative costs of running plans, dividends, and earnings from plan
profits/losses (ROI)
Home Health Care - ✔️ (0.2% to 2.8% of NHE)
Chronic diseases are defined - ✔️ broadly as conditions that last 1 year or
more and require ongoing medical attention or limit activities of daily
living or both.
as heart disease, cancer, and diabetes are the leading causes of death (2:3)
and disability in the United States.
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