Research
Findings #21: Health Care Expenses in the United States, 2000
Trena M. Ezzati-Rice, M.S., David Kashihara,
M.S., and Steven R. Machlin, M.S.
The Medical Expenditure Panel Survey (MEPS)
collects detailed information on health care use, expenses,
sources of payment, and insurance coverage from a nationally
representative sample of the U.S. civilian noninstitutionalized
(community) population. The health care system in the United
States is continually changing in keeping with technological
advancements in medical care and other factors. As a result,
aggregate spending on health care, sources of payment for services
and care, and specific expenses such as prescription medicines
also change.
This report primarily provides estimates of expenses for health
care based on data from the 2000 MEPS, but it also includes
selected comparisons with 1996 MEPS estimates. The expense estimates
for 2000 and 1996 presented and/or cited in this report were
obtained from the compendia of tables available on the MEPS
Web site at http://www.meps.ahrq.gov/data_stats/quick_tables.jsp. Expenses
are defined as direct payments for health services and care
received during the year. Expenses include out-of-pocket payments
made by individuals and payments made by private insurance,
Medicare, Medicaid, and other sources. Payments for over-the-counter
drugs and some alternative care services are not included. Indirect
payments not related to specific medical events, such as Medicaid
Disproportionate Share and Medicare Direct Medical Education
subsidies, are also not included.
The report provides aggregate estimates of health care expenses,
as well as estimates for hospital inpatient services, hospital
outpatient services, emergency room services, office-based medical
provider services, prescription medicines, dental services,
home health services, and other medical equipment and services.
It also shows the proportion of people whose expenses were paid
by various sources, including out of pocket, private insurance,
Medicare, Medicaid, and other sources, for each type of service.
In addition, distributions of expenses and sources of payment
across the population are examined by selected demographic,
socioeconomic, and geographic characteristics and by health
status and health insurance status.
All differences between estimates discussed in the text are
statistically significant at the 0.05 level. Detailed information
on data sources and methods of estimation, along with definitions
of the variables and categories used in this report, are included
in the Technical Appendix.
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Total
Health Care Expenses
Type of Service
In 2000, the approximately 278.4 million people in the U.S.
community population had health care expenses of about $627.9
billion. Table 1 shows that hospital inpatient care accounted
for the largest share of total expenses (36.7 percent). The
next largest share was for ambulatory services (31.9 percent),
almost two-thirds of which were office-based medical services.
Prescription medicines accounted for about 16.4 percent of total
expenses. The remaining expenses were for dental care (8.8 percent),
home health services (4.1 percent), and other medical equipment
and services (2.1 percent).
Data on health expenses for 1996, shown on the MEPS Web site
at http://www.meps.ahrq.gov/, reveal some interesting
changes over the period 1996-2000. The percent of total health
care expenses accounted for by prescription medicines rose from
11.9 percent in 1996 to 16.4 percent in 2000. On the other hand,
the percent of total expenses going for home health services
decreased from 6.2 percent in 1996 to 4.1 percent in 2000.
Source of Payment
In 2000, 83.5 percent of the U.S.
community population had medical expenses (Table
2). The mean expense
among those with expenses was $2,700. The median expense was
much lower, $721. The large difference between the mean and
median expenses results from a very small proportion of the
population that accounts for a disproportionate share of the
overall health care expenses. For example, in 2000, the 1
percent of the population with the highest health care expenses
accounted for about one-quarter of the total health care expenses
for the community population, and this level of skewed concentration
of health care expenses has been fairly stable over time (Berk
and Monheit, 2001). Because of the large difference between
mean and median expenses, this report emphasizes medians rather
than means when comparing subgroups.
Nearly one-fifth (19.4 percent)
of total expenses were paid out of pocket, while the remainder
was paid by third parties. Private health insurance was the
largest third-party payer of medical expenses (40.5 percent),
followed by Medicare (20.9 percent) and Medicaid (9.8 percent).
Demographic, Geographic, and Health Status
Characteristics
In 2000, an estimated 95.5 percent
of the population 65 and over had medical expenses. This compares
to 81.8 percent of the population under 65 years old (Table
2). In addition to
being more likely to have medical expenses, the older population
also had much higher mean expenses than the younger population
group ($6,140 versus $2,127). The largest single payer of
medical expenses among the population 65 and over was Medicare
(54.7 percent), while private health insurance was the largest
source of payment (52.8 percent) for the under-65 population.
The median expense among those
with an expense was lower for children under 6 ($267) than
for children 6-17 years ($335). The proportion of expenses
paid out of pocket was lower for children under 6 (10.3 percent)
than for children 6-17 (27.7 percent).
A higher proportion of females
than males had medical expenses (88.4 percent versus 78.4
percent). The median expense per person among females with
an expense was $871, as opposed to $580 for males.
The proportion of people with medical
expenses was lower for Hispanics (70.3 percent) and blacks
(73.2 percent) than for whites/others (87.4 percent). (About
95 percent of the white/other category is white.) The median
expense for people with an expense was lower for Hispanics
($386) and blacks ($411) than for whites/others ($833).
A higher percentage of out-of-pocket
expenses were paid by whites/others (20.3 percent) and Hispanics
(18.9 percent) than by blacks (12.2 percent). The percent
of expenses paid by Medicaid was lower for whites (7.8 percent)
than for blacks (18.9 percent) and Hispanics (19.3 percent).
While the percent of people with
medical expenses did not differ between people residing in
metropolitan statistical areas (MSAs) and those living in
non-MSAs, the median medical expense was lower for people
living in MSAs ($702, compared to $816 for people living in
non-MSAs). The percent of people with medical expenses was
lower in the South (81.6) and West (81.3) than in the Northeast
(86.5) or Midwest (86.2).
People with better perceived health
status were less likely to have an expense and had generally
lower expenses. For example, 79.3 percent of people with excellent
perceived health status had medical expenses in 2000, and
the median expense for those who had expenses was $416. In
contrast, 97.0 percent of people with poor perceived health
status had medical expenses, with a median expense of $5,129.
In the aggregate, higher proportions of expenses were paid
out of pocket or by private insurance for those with better
health status, whereas Medicare and Medicaid paid for larger
proportions of expenses incurred by those in poorer health.
Insurance and Income
Among people under 65 years of
age, 57.3 percent of the uninsured, 83.3 percent of those
with only public insurance, and 85.9 percent of those with
any private insurance had medical expenses. The median total
expense for uninsured people was $305, lower than the figure
for people with public insurance ($465) or any private insurance
($638). While out-of-pocket payments constituted a substantially
higher proportion of expenses for the uninsured (40.4 percent)
than for people with private insurance (21.0 percent) or public
insurance (9.7 percent), other sources such as the Department
of Veterans Affairs, public clinics, and other miscellaneous
public and private sources paid for a substantial portion
(59.6 percent) of medical expenses for the uninsured.
There was no statistically significant
difference between the percent of elderly people with medical
expenses by type of insurance coverage (ranging from 94.7
percent to 96.4 percent). The proportion of out-of-pocket
spending was about two times higher for those with Medicare
only (22.2 percent) than for those with Medicare and other
public coverage (10.4 percent).
In general, people with lower income
were less likely than people with higher income to incur medical
expenses and had lower median expenses. For example, 77.3
percent of poor people (those with incomes below the Federal
poverty level) had medical expenses, with a median expense
of $524, while 88.2 percent of high-income people (those with
incomes over 400 percent of the Federal poverty level) had
medical expenses and their median expense was $815. (The positive
relationship for median expenses did not hold for mean expenses,
however.) People with lower income paid a smaller percentage
of their health care expenses out of pocket and more of their
expenses were paid by Medicaid. For example, poor people paid
only 13.9 percent of their medical expenses out of pocket,
while Medicaid paid 34.3 percent. In contrast, 22.3 percent
of expenses for high-income people were paid out of pocket
and 55.6 percent by private insurance.
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Hospital
Inpatient Services
The expenditure estimates for
hospital inpatient services shown in Table
3 include room and
board and all hospital diagnostic and laboratory expenses
associated with the basic facility charge, payments for separately
billed physician inpatient services, and emergency room expenses
incurred immediately prior to inpatient stays.
In 2000, 7.6 percent of the U.S.
community population incurred hospital inpatient expenses
totaling approximately $230 billion. Like total health care
expenses, inpatient expenses are highly skewed, as evidenced
by the approximately twofold difference between the mean expense
per person with an expense ($10,917) and the median ($5,195).
Slightly more than three-quarters
of hospital inpatient expenses were paid by private insurance
and Medicare (40.7 and 35.9 percent, respectively), while
out-of-pocket payments accounted for only 2.2 percent.
Demographic, Geographic, and Health Status
Characteristics
People 65 years of age and over
were 3.2 times as likely to incur hospital inpatient expenses
as people under 65 (19.0 percent versus 5.9 percent). Also,
the median expense per person with an expense was higher for
the elderly than the non-elderly ($9,160 versus $4,372).
The largest source of payment for
the elderly was Medicare, which accounted for 75.7 percent
of the payments for inpatient services for this age group.
The largest source of payment for the non-elderly was private
insurance, which accounted for 59.4 percent of their expenses.
Females were more likely than males
to have had hospital inpatient expenses (9.2 percent and 5.9
percent, respectively). However, the median expense per person
with an expense was higher for males ($6,695) than for females
($4,556).
The proportion of the population
with a hospital inpatient expense was higher for blacks (7.7
percent) and whites/others (7.9 percent) than for Hispanics
(5.3 percent). There were no statistically significant differences
by race/ethnicity in the proportion of inpatient expenses
paid by Medicare or private insurance. However, the share
of expenses paid out of pocket was higher for Hispanics (4.5
percent) than for whites/others (2.1 percent) or blacks (1.7
percent; note: relative standard error equal to or greater
than 30 percent). Further, the percent of expenses paid by
Medicaid was higher for blacks (16.4 percent) and Hispanics
(18.4 percent) than for whites/others (7.9 percent).
The percent of people with hospital
inpatient expenses was higher in non-MSA areas (9.1 percent)
than in MSAs (7.2 percent). A higher percentage of people
in the South and Midwest Regions had hospital inpatient expenses
(8.3 and 8.1 percent, respectively) compared to people in
the West Region (6.2 percent).
The
more negative people’s perceived
health status was, the more likely they were to incur inpatient
expenses, and their mean and median expenses also increased.
For example, 3.7 percent of people with excellent perceived
health had hospital inpatient expenses and the median total
expense for those who had an expense was $4,185. In contrast,
36.4 percent of people with poor perceived health had hospital
inpatient expenses and their median expense of $8,876 was
about two times that of people with excellent health status.
Insurance and Income
Among people under 65 years of
age, hospital inpatient expenses were incurred by 3.5 percent
of uninsured people, 12.4 percent of those with public insurance
only, and 5.4 percent of those with any private insurance.
The median expense for people with any private insurance ($4,925)
was higher than the medians for public only insurance ($3,761)
and uninsured ($3,426).
Among the elderly, people with
Medicare and other public insurance were more likely to have
hospital inpatient expenses (25.9 percent) than those with
Medicare only (17.4 percent) or Medicare and private insurance
(18.8 percent).
In general, people with lower incomes
were more likely to have hospital inpatient expenses and lower
median expenses. For example, among poor people, 11.3 percent
had hospital inpatient expenses and the median expense for
those with an expense was $4,377. In contrast, among people
with high income, 5.7 percent had hospital inpatient expenses
and the median expense was $6,477.
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Office-Based
Medical Provider Services
Expenses for visits to medical
providers seen in office-based settings are shown in Table
4. In 2000, slightly
more than two-thirds (68.8 percent) of the U.S. community
population had office-based medical provider services and
the expenses for these services totaled about $126 billion
(Table 4). The mean expense for those
with an expense was $657 and the median expense was $243.
Private insurance was the single largest payer, accounting
for 48.5 percent of total expenses for office-based medical
care. The next two largest payer sources were out-of-pocket
payments (17.8 percent) and payments by Medicare (16.8 percent).
Demographic, Geographic, and Health Status
Characteristics
The proportion of people with office-based
medical provider expenses was higher among the elderly (87.6
percent) than the non-elderly (66.1 percent). There was a
generally positive relationship between age and median expenses
per person. For example, the median expense per person with
an expense was $490 for the elderly and $212 for the non-elderly.
Among the elderly, the largest single source of payment was
Medicare, which accounted for 59.0 percent of the payments
for office-based care. Private insurance paid for another
18.6 percent and out-of-pocket spending was 11.4 percent.
In this age group, Medicaid paid for only 3.3 percent of office-based
care. In comparison, for the non-elderly, private insurance
accounted for 58.1 percent of expenses for office-based care,
out-of-pocket spending 19.9 percent, and Medicaid 6.6 percent.
More than three-quarters (78.5
percent) of children under 6 had expenses for office-based
medical provider services, compared to 60.9 percent of children
6-17. The median expense per child was higher for children
under 6 ($160) than for children 6-17 ($127).
Females were more likely than males
to have expenses for office-based medical care (75.4 percent
versus 61.9 percent). Females also had a higher median total
expense per person than males ($278 versus $207). The proportion
of expenses paid out of pocket was higher for females (19.0
percent) than males (16.1 percent).
Whites/others were more likely
than blacks or Hispanics to have had expenses for office-based
medical care (73.2 percent versus 56.0 and 55.0 percent, respectively),
and they had higher median expenses ($268 versus $150 and
$165, respectively). The proportion of expenses paid out of
pocket was higher for Hispanics (19.4 percent) and whites/others
(18.2 percent) than for blacks (12.0 percent). With respect
to public coverage, Medicaid covered a higher proportion of
expenses for blacks (13.5 percent) and Hispanics (12.4 percent)
than for whites/others (4.6 percent), while Medicare covered
a higher proportion of expenses for blacks (18.6 percent)
and whites/others (17.1 percent) than for Hispanics (9.9 percent).
There were no statistically significant
differences by MSA status in the percent with office-based
expenses, the median expense, or the distribution of sources
of payment. With respect to Census region, people in the South
and West (66.8 and 65.2 percent) were less likely to have
expenses for office-based medical care than people in the
Northeast and Midwest (73.2 and 71.8 percent).
People with better perceived health
status were less likely to have expenses for office-based
care, and annual expenses for those receiving care tended
to be lower. For example, 61.1 percent of people with excellent
perceived health status had expenses for office-based medical
care and the median expense for those who had an expense was
$174. In contrast, 87.1 percent of people with poor perceived
health status had expenses for office-based medical care,
with a median expense of $676.
Insurance and Income
Among the non-elderly population,
the proportion with expenses for office-based medical care
was much lower for the uninsured (38.8 percent) than for those
who had public insurance only (68.0 percent) or any private
insurance (70.7 percent). The median expense of $137 for uninsured
people was lower than the median expense for those with public
only insurance ($163) or any private insurance ($226).
Among the elderly, the proportion
with expenses for office-based care was higher for those with
Medicare and private insurance (89.0 percent) than those with
Medicare only (85.6 percent). The median expense for those
with an expense was also higher for people with Medicare and
private insurance ($548) than the Medicare-only group ($393).
People with lower income were less
likely than those with higher income to incur expenses for
office-based medical provider services, and the median expense
was also lower. For example, 61.2 percent of poor people had
expenses for office-based care and their median expense was
$182. However, 73.9 percent of high-income people had these
expenses and their median expense was $270. As income increased,
the proportion of expenses paid out of pocket or by private
insurance increased. For example, 10.5 percent of expenses
among the poor were paid out of pocket and 18.9 percent were
paid by private insurance. In comparison, 21.7 percent of
the expenses for the high-income group were paid out of pocket
and 60.6 percent by private insurance. About one-third (33.9
percent) of expenses for poor people were paid by Medicaid.
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Hospital
Outpatient Services
The expenses for hospital outpatient
services shown in Table
5 comprise expenses
for visits to both physicians and other medical providers
seen in hospital outpatient departments, including payments
for services covered under the basic facility charge and those
for separately billed physician services. In 2000, 13.1 percent
of the U.S. community population incurred about $55 billion
in expenses for hospital outpatient services. The mean expense
per person among those with an expense was $1,501 and the
median expense was $555.
Approximately one-half of hospital
outpatient services were paid for by private insurance (52.9
percent). Medicare was the second largest payer for hospital
outpatient expenses (22.2 percent), while out-of-pocket payments
and payments by Medicaid accounted for lower proportions-7.5
and 5.0 percent, respectively.
Demographic, Geographic, and Health Status
Characteristics
Elderly people were 2.6 times as
likely as non-elderly people to incur hospital outpatient
expenses (28.3 percent versus 11.0 percent). The largest source
of payment for the elderly was Medicare, which accounted for
56.5 percent of their expenses for hospital outpatient services.
The largest source of payment for the non-elderly was private
insurance, which accounted for 68.0 percent of their expenses.
Females were more likely than males
to have hospital outpatient expenses (15.9 percent versus
10.2 percent). However, the median expense per person with
an expense was higher for males ($683) than for females ($462).
The proportion of the population
with any hospital outpatient expenses was lower for blacks
(8.9 percent) and Hispanics (7.4 percent) than for whites/others
(14.8 percent). The median expense was also lower for blacks
($383) than whites/others ($577).
A lower proportion of people incurred
hospital outpatient expenses in the South (11.5 percent) and
West (10.0 percent) than in the Northeast (16.4 percent) and
Midwest (16.0 percent).
People with better perceived health
status were less likely to incur expenses for hospital outpatient
services and tended to have lower expenses. For example, 7.4
percent of people with excellent perceived health had hospital
outpatient service expenses, and the median expense for those
who had expenses was $362. In contrast, 30.8 percent of people
with poor perceived health had these expenses, and their median
expense was $1,098.
Insurance and Income
Among the non-elderly population,
hospital outpatient expenses were incurred by a smaller proportion
of the uninsured (5.0 percent) than by people with any private
insurance (12.0 percent) or public insurance only (11.1 percent).
Among the elderly, those with Medicare and private insurance
were more likely to incur hospital outpatient expenses (32.5
percent) than either those with Medicare only (22.5 percent)
or those with Medicare and other public insurance (24.5 percent).
In general, people with lower income
were less likely to incur hospital outpatient expenses and
had lower median expenses. For example, 10.0 percent of poor
people had hospital outpatient expenses, with a median expense
for those who had expenses of $377. However, 14.5 percent
of people in the high-income category had these expenses,
with a median expense of $581.
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Emergency
Room Services
In 2000, 11.6 percent of the U.S.
community population incurred expenses of $19.2 billion for
hospital emergency room services (Table
6). These expenses
include payments for services covered under the basic facility
charge and those for separately billed physician services,
but exclude expenses for emergency room services followed
by a hospital admission. The mean expense per person with
an expense was $594 and the median was $315.
Private insurance paid for almost
one-half of emergency room expenses (46.1 percent). Medicare
was the second largest payer of emergency room expenses (17.9
percent), with lower shares for out-of-pocket (12.2 percent)
and Medicaid payments (8.4 percent).
Demographic, Geographic, and Health Status
Characteristics
The elderly were more likely to
incur emergency room expenses than the non-elderly (16.8 percent
versus 10.9 percent). The largest source of payment for emergency
room expenses for the elderly was Medicare, which paid for
67.3 percent of their expenses. The largest source of payment
for the non-elderly was private insurance, which paid for
55.1 percent of their expenses.
A slightly higher proportion of
females (12.3 percent) than males (10.9 percent) had emergency
room expenses.
The proportion of the population
with emergency room expenses was lower for Hispanics (9.7
percent) than for blacks (13.0 percent) or whites/others (11.7
percent). Hispanics had a lower median expense per person
with an expense ($260) than whites/others ($333).
The proportion of people with emergency
room expenses was lower in the West Region (9.7 percent) than
in the Northeast (12.2 percent), South (11.9 percent), or
Midwest (12.7 percent).
In general,
the better people’s
perceived health status was, the less likely they were to
incur emergency room expenses. For example, 8.9 percent of
people with excellent perceived health, compared to 34.4 percent
of people with poor perceived health, had emergency room expenses.
Insurance and Income
Among the non-elderly, the uninsured
were the least likely to have emergency room expenses: only
7.4 percent of this group had expenses, compared to 17.7 percent
of those with only public insurance and 10.4 percent of those
with any private insurance.
In general, people with lower income
were more likely to incur emergency room expenses. For example,
14.8 percent of poor people, but only 9.3 percent of people
with high incomes, had emergency room expenses.
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Prescription
Medicines
The expenditure estimates for
prescription medicines shown in Table
7 include expenses
for all prescribed medicines initially purchased or otherwise
obtained during 2000, including any refills.
In 2000, the U.S. community population
incurred about $103.0 billion in expenses for prescription
medicines. This figure represents an increase over the $65.3
billion (MEPS Web site) spent in 1996 ($71.7 billion when
inflated to 2000 dollars using the overall Consumer Price
Index). Despite this increase in total dollars spent, the
proportion of the population with prescription medicine expenses
decreased from 64.9 percent in 1996 to 62.3 percent in 2000.
The mean expense per person with
an expense was $594 and the median was $186. Nearly half (46.1
percent) of prescription medicine expenses were paid out of
pocket and about one-third (33.9 percent) of expenses were
paid by private insurance. The next two largest sources of
payment were Medicaid (11.2 percent) and Medicare (4.6 percent).
Demographic, Geographic, and Health Status
Characteristics
The elderly were 1.5 times more
likely than younger people to incur prescription medicine
expenses (88.3 percent versus 58.5 percent). The median expense
per person with an expense was $695 for the elderly, but only
$136 for the non-elderly. For elderly people, the largest
source of payment was out of pocket, which accounted for 56.6
percent of their expenses for prescribed medicines. For the
non-elderly, the largest payment sources were private insurance
(42.4 percent) and out of pocket (41.0 percent).
Females were more likely to incur
prescription medicine expenses than males (69.2 percent compared
to 54.9 percent). The median expense per person with an expense
was $219 for females and $146 for males.
Blacks (50.8 percent) and Hispanics
(47.2 percent) were less likely to incur prescription medicine
expenses than whites/others (66.6 percent). The median prescription
medicine expense per person with an expense was lower for
blacks ($125) and Hispanics ($92) than for whites/others ($214).
The median prescription medicine
expense per person with an expense was $174 for people living
in an MSA and $239 for people not living in an MSA. People
in the West Region were the least likely to have prescription
medicine expenses: 58.1 percent versus 62.6 percent in the
South, 64.1 percent in the Midwest, and 64.3 percent in the
Northeast. People in the West Region also had the lowest median
prescription medicine expenses: $135 versus $172 in the Northeast,
$204 in the Midwest, and $223 in the South.
People with better perceived health
status were less likely than people in poor health to incur
prescription medicine expenses and their total expenses were
also lower. For example, 49.0 percent of people with excellent
perceived health had prescription medicine expenses and their
median expense per person with an expense was $80. In contrast,
92.2 percent of people with poor perceived health had prescription
medicine expenses, with a median expense of $1,230.
Insurance and Income
Among the non-elderly, the percent
of people with prescription medicine expenses was smallest
for the uninsured: 37.6 percent, compared to 62.1 percent
for those with public only insurance and 61.7 percent for
those with any private insurance. The median expense for those
with an expense was also lowest for uninsured people: $89,
compared to $119 for those with public only insurance and
$144 for those with any private insurance.
Among the elderly, those with Medicare
and other public insurance had higher median expenses ($934)
than those with either Medicare only ($627) or Medicare and
private insurance ($708).
Poor people had a lower likelihood
of having prescription medicine expenses (58.6 percent) than
high-income people (64.8 percent), and the median expense
was less among poor people ($139) than for people with high
income ($205). (This positive relationship did not hold for
mean expenses.)
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Dental
Services
The expenditure estimates
for dental services shown in Table 8 include
expenses for any type of dental care provider. In 2000, 40.1
percent of the U.S. community population incurred a total
of about $55.6 billion in expenses for dental services, an
increase over the $43.1 billion (MEPS Web site) spent in 1996
($47.4 billion when inflated to 2000 dollars using the overall
Consumer Price Index).
The mean expense per
person with an expense increased from $384 in 1996 ($421 when
inflated to 2000 dollars using the overall Consumer Price
Index) to $498 in 2000. The median expense per person with
an expense increased from $137 in 1996 ($150 when inflated
to 2000 dollars using the overall Consumer Price Index) to
$168 in 2000. About half (49.3 percent) of the payments for
dental expenses were out of pocket and another 42.2 percent
of dental expense payments came from private insurance.
Demographic, Geographic,
and Health Status Characteristics
The
median total expense per person with a dental expense was
$196 for the elderly
and $164 for the non-elderly. For the elderly, the largest
source of payment for dental expenses (76.7 percent) was out
of pocket. For the non-elderly, the largest
source of payment was private insurance (46.3 percent), followed
closely by out-of-pocket payments (45.2 percent).
Females were more
likely than males to have dental expenses (43.2 percent versus
36.9 percent). Whites/others (45.0 percent) were much more
likely than blacks (26.0 percent) or Hispanics (24.4 percent)
to have dental expenses. Blacks ($107) and Hispanics ($128)
also had lower median dental expenses than whites/others ($178).
The proportion of
people using dental services was greater in the Northeast
(45.7 percent) and Midwest (45.0 percent) than in the South
(35.4 percent) and West (37.8 percent). The median total dental
expense per person with an expense also varied by region:
lower in the South ($154) and Midwest ($149) and higher in
the Northeast ($185) and West ($200). The median total dental
expense was $170 for people living in MSAs and $151 for people
not living in MSAs.
The proportion of
people with dental expenses was higher for people with excellent
(42.6 percent) or very good (42.8 percent) perceived health
than those in poor health (26.4 percent). However, there was
no statistically significant difference between the groups
in the median expense for those who had an expense.
Insurance and Income
Among the non-elderly,
17.5 percent of those who were uninsured, 27.9 percent of
those with only public insurance, and 46.1 percent of those
who had any private insurance had dental expenses. The median
expense among those who had an expense was $151 for people
who were uninsured. In comparison, the median expense was
$87 for those with public only insurance and $174 for those
with any private insurance. Among the elderly, 32.6 percent
of those with Medicare only, 47.9 percent of those with Medicare
and private insurance, and only 16.4 percent of those with
Medicare and other public insurance had dental expenses.
In
general, people with lower income were less likely than
higher income people to incur dental expenses, and their
median expenses were lower. For example, 24.8 percent of
poor people had dental expenses, and the median expense
was $105. However, 51.6 percent of people with high income
had dental expenses, and their median expense was $185.
^top
Home
Health Services
The expenditure estimates for
home health services shown in Table
9 include expenses
for care provided by home health agencies and paid independent
home health providers. Even though a relatively small percentage
of the community population had home health expenses (1.8
percent), expenses for home health ranked second in terms
of mean and median expenses per person with an expense, with
a mean expense of $5,136 and a median of $1,710. Only hospital
inpatient services (Table 3) had higher
per-user expenses.
Medicaid paid for the highest proportion
of home health service expenses (48.2 percent), followed by
Medicare (25.6 percent) and out of pocket (12.4 percent).
The share of home health expenses covered by Medicaid tripled
from 1996 (16.2 percent) to 2000 (48.2 percent). The share
covered by Medicare decreased from 52.6 percent in 1996 (MEPS
Web site) to 25.6 percent in 2000, while the proportion paid
out of pocket was similar in 2000 and 1996, about 12 percent.
Demographic, Geographic, and Health Status
Characteristics
The elderly were more likely to
have home health expenses than the non-elderly (8.7 percent
versus 0.8 percent). A lower proportion of the elderly had
expenses in 2000 (8.7 percent) than in 1996 (13.2 percent).
The share of home health expenses among the elderly paid by
Medicare, the primary source of payment for home health services,
decreased significantly, from 58.9 percent in 1996 to 38.4
percent in 2000. In addition, Medicaid payments for home health
expenses for the elderly rose from 11.2 percent in 1996 to
28.1 percent in 2000. Another 21.2 percent of home health
expenses for the elderly were paid out of pocket.
Females (2.1 percent) were more
likely than males (1.5 percent) to have home health expenses;
however, the median expense per person did not differ for
females and males. Hispanics (1.0 percent) were less likely
than whites/others (1.9 percent) to incur home health expenses;
there were no statistically significant differences between
blacks and the whites/others group or blacks and Hispanics.
There was no statistically significant
difference in the proportion of people with home health expenses
in terms of place of residence-either MSA status or region.
Insurance and Income
Non-elderly people with public
only insurance were about seven times as likely as those with
private insurance to incur expenses for home health services-3.7
percent versus 0.5 percent. Among elderly people, those with
Medicare and other public coverage were about three times
as likely as those with Medicare and private coverage to have
expenses for home health services-22.2 percent versus 6.9
percent.
The proportion with home health
expenses was lower among high-income people (1.0 percent)
than among the poor (3.1 percent) or near-poor (3.7 percent).
^top
Other
Medical Equipment and Services
The expenditure estimates for
other medical equipment and services shown in Table
10 include expenses
for eyeglasses, contact lenses, ambulance services, orthopedic
items, hearing devices, prostheses, bathroom aids, medical
equipment, disposable supplies, alterations/modifications,
and other miscellaneous items or services that were obtained,
purchased, or rented during the year. About two-thirds of
the expenses in this category were for vision-related items.
In 2000, about 19 percent of the community population had
expenses for other medical equipment and services, totaling
about $13.4 billion. As with other health care expenses, the
median expense ($180) was less than the mean expense ($260).
Approximately 71 percent of the total expenses were paid out
of pocket, by far the most common source of payment.
Demographic,
Geographic, and Health Status Characteristics
Elderly people were more likely
than non-elderly people to have other medical expenses (26.7
percent versus 17.4 percent), and they had higher median expenses
for those with an expense ($200 versus $178). Other medical
expenses were more common for whites/others (20.6 percent)
than either blacks (12.9 percent) or Hispanics (11.8 percent).
They were also more common for people in fair health (24.1
percent) or poor health (31.9 percent) than for those in good,
very good, or excellent health (19.4, 19.0, and 15.1 percent,
respectively).
Insurance and Income
Among the non-elderly, the percent
with other medical expenses was higher for people with any
private insurance (19.2 percent) than those with public only
(14.7 percent) or the uninsured (9.8 percent). High-income
people were more likely than poor people to have other medical
expenses (22.9 percent versus 14.0 percent), and they paid
a higher percentage out of pocket (75.6 percent versus 52.4
percent).
^top
Summary
In 2000, about 84 percent of the
approximately 278.4 million people living in the U.S. civilian
noninstitutionalized population at any time during the year
had at least one health care expense. Aggregate health care
spending by this population was approximately $627.9 billion.
The mean expense per person with an expense was $2,700. The
median expense was much lower at $721, a differential primarily
caused by the highly skewed distribution of medical expenses
resulting from a small proportion of the population that accounts
for a disproportionate share of high health care expenses.
Hospital inpatient care accounted
for the largest share of total health care expenses (36.7
percent), and another 20.1 percent of the total was for office-based
medical provider services. The nearly $103 billion spent on
prescription medicines was the third largest share of total
expenses (16.4 percent).
Hospital inpatient services ranked
first in terms of mean and median expenses per person with
an expense ($10,917 and $5,195, respectively). Even though
home health services accounted for only 4.1 percent of total
expenses, this category of health care ranked the second highest
in terms of mean and median expenses per person with an expense,
with a mean expense of about $5,100 and a median of about
$1,700.
The largest source of payment for
health care expenses was third-party payers. Specifically,
private health insurance accounted for 40.5 percent of total
payments, followed by two public sources of payment: Medicare
(20.9 percent) and Medicaid (9.8 percent). Another 19.4 percent
of health care expenses were paid out of pocket by individuals
and/or family members.
The proportion of expenses paid
by different sources varied by type of service provided. For
example, 49.3 percent of dental expenses and 46.1 percent
of prescription medicine expenses were paid out of pocket,
while private insurance and Medicare were the largest sources
of payment for hospital inpatient services (40.7 and 35.9
percent, respectively) and hospital outpatient services (52.9
and 22.2 percent, respectively).
The percent of people with an expense,
as well as the mean and median level of spending, varied by
demographic characteristics, income, health status, and geographic
residence. Regardless of age, the majority of people had at
least one health care expense during 2000. Specifically, 95.5
percent of the population age 65 and over had medical expenses
and 81.8 percent of the under-65 population had expenses.
The mean expense for the elderly was $6,140, compared to $2,127
for the non-elderly. With respect to race/ethnicity, the proportion
of people with medical expenses was lower for Hispanics (70.3
percent) and blacks (73.2 percent) than for whites/others
(87.4 percent). Further, among those with expenses, the median
expenses of $386 for Hispanics and $411 for blacks were lower
than the $833 for whites/others. In the aggregate, people
with better perceived health status were less likely to have
health care expenses and they had generally lower expenses.
For example, the median expense for those with excellent perceived
health status was $416, compared to $5,129 for people with
poor perceived health status. People with lower incomes were
less likely to incur medical expenses and their median expenses
were also lower than those of high-income people. For example,
77.3 percent of poor people had medical expenses (median of
$524), while 88.2 percent of high-income people had expenses
(median of $815). Variations in these patterns were observed
across the various service types.
In summary, the health expenditure
data from the 2000 MEPS indicate that the levels of expenses,
proportions of people with expenses, and sources of payment
vary by type of service and by sociodemographic, geographic,
health insurance, and health status characteristics. These
estimates, along with estimates from past and future MEPS
surveys, provide researchers and health policymakers with
critical data to study trends in health care expenses and
the distribution of expenses and sources of payment in the
U.S. population.
^top
References
Berk M, Monheit A. The concentration
of health care expenditures revisited. Health Affairs 2001;
20(2):9-18.
Cohen J. Design and methods of
the Medical Expenditure Panel Survey Household Component.
Rockville (MD):Agency for Health Care Policy and Research;
1997. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026.
Cohen SB. Sample design of the
1997 Medical Expenditure Panel Survey Household Component.
Rockville (MD):Agency for Healthcare Research and Quality;
2000. MEPS Methodology Report No. 11. AHRQ Pub. No. 01-0001.
Cohen SB. Design strategies and
innovations in the Medical Expenditure Panel Survey. Medical
Care 2003; 41(7):5-12.
Machlin SR, Taylor AK. Design,
methods, and field results of the 1996 Medical Expenditure
Panel Survey Medical Provider Component. Rockville (MD):Agency
for Healthcare Research and Quality; 2000. MEPS Methodology
Report No. 9. AHRQ Pub. No. 00-0028.
Moeller JF, Stagnitti MN, Horan
E, et al. Outpatient prescription drugs: data collection and
editing in the 1996 Medical Expenditure Panel Survey (HC-010A).
Rockville (MD):Agency for Healthcare Research and Quality;
2001. MEPS Methodology Report No. 12. AHRQ Pub. No. 01-0002.
Selden TM, Levit KR, Cohen JW,
et al. Reconciling medical expenditure estimates from the
Medical Expenditure Panel Survey and the NHA, 1996. Health
Care Financing Review 2001 Fall; 23(1):161-78.
Zuvekas SH, Cohen JW. A guide to
comparing health care expenditures in the 1996 MEPS to the
1987 NMES. Inquiry 2002 Spring; 39(1):76-86.
^top
Tables
| Table
1. Expenses
by event type: United States, 2000
|
| |
Expenses
|
Payments
(in billions)
|
Percent
distribution
|
| Event
Type
| All
Expenses |
Ambulatory
Expenses |
All
Expenses |
Ambulatory
Expenses |
| Totala |
$627.9 |
NA |
100.0 |
NA |
| Hospital
inpatientb |
230.2 |
NA |
36.7 |
NA |
| Ambulatoryc |
200.1 |
NA |
31.9 |
100.0 |
| Office-based
visits |
NA |
$125.9 |
NA |
62.9 |
| Hospital
outpatient visits |
NA |
54.9 |
NA |
27.4 |
| Emergency
room visits |
NA |
19.2 |
NA |
9.6 |
| Prescription
medicinesd |
103.0 |
NA |
16.4 |
NA |
| Dentale |
55.6 |
NA |
8.8 |
NA |
| Home
healthf |
25.6 |
NA |
4.1 |
NA |
| Other
medicalg |
13.4 |
NA |
2.1 |
NA |
aTotal
includes inpatient hospital and physician services,
ambulatory physician and nonphysician services, prescribed
medicines, home health services, dental services, and
various other medical equipment, supplies, and services
that were purchased or rented during the year. Over-the-counter
medications, alternative care services, and telephone
contacts are excluded.
bHospital admissions that did not involve an overnight stay
are included. Expenses include room and board and all hospital diagnostic
and laboratory expenses associated with the basic facility charge, payments
for separately billed physician inpatient services, and emergency room
expenses incurred immediately prior to inpatient stays. Events for newborns
who left the hospital on the same day as the mother are treated as separate
events, but associated expenses are included in expense estimates.
cEvents and expenses for both physician and nonphysician
medical providers seen in office-based settings or clinics,
hospital outpatient departments, emergency rooms (except
visits resulting in an overnight hospital stay), and clinics
owned and operated by hospitals are included.
dAll prescribed medicines initially purchased
or otherwise obtained during 2000, as well as refills and
free samples, are included.
eServices provided by general dentists, dental
hygienists, dental technicians, dental surgeons, orthodontists,
endodontists, and periodontists are included.
fExpenses for care provided by home health agencies
and independent home health providers are included. Most
home health expenses (87.5 percent) were for agency providers.
gExpenses for eyeglasses, ambulance services,
orthopedic items, hearing devices, prostheses, bathroom aids,
medical equipment, disposable supplies, alterations/modifications,
and other miscellaneous items or services that were obtained,
purchased, or rented during the year are included.
NA—Not applicable.
Note: These estimates are for a target population of approximately 278.4
million persons who were in the civilian noninstitutionalized population
for all or part of 2000. Percents may not add to 100 because of rounding.
Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical Expenditure Panel Survey, 2000. |
Table
2. Total health servicesa - Median
and mean expenses per person with expenses and distribution
of expenses source of payment: United States, 2000 |
| |
|
|
Expense
per person with an expense
|
|
Percent
distribution of total
expenses by source of payment
|
|
Population
characteristic |
Population
(in thousands) |
Percent
with expense |
Median |
Mean |
Total
expenses (in millions) |
Out of pocket |
Private insuranceb |
Medicare |
Medicaid |
Otherc |
| Total |
278,406 |
83.5 |
$721 |
$2,700 |
$627,897 |
19.4 |
40.5 |
20.9 |
9.8 |
9.5 |
| |
| Age
in years |
| Under
65 |
243,624 |
81.8 |
586 |
2,127 |
423,933 |
20.3 |
52.8 |
4.6 |
12.3 |
10 |
| Under
6 |
24,126 |
86.7 |
267 |
1,124 |
23,497 |
10.3 |
51.3 |
*0.3 |
31.6 |
6.5 |
| 6-17 |
48,405 |
80 |
335 |
1,117 |
43,241 |
27.7 |
49.1 |
*0.1 |
16.4 |
6.7 |
| 18-44 |
109,021 |
77.7 |
575 |
1,905 |
161,419 |
19.9 |
51.6 |
*3.9 |
14.2 |
10.4 |
| 45-64 |
62,072 |
88.5 |
1,287 |
3,562 |
195,776 |
20.2 |
54.7 |
6.7 |
7.5 |
10.9 |
| 65
and over |
34,782 |
95.5 |
2,278 |
6,140 |
203,964 |
17.5 |
15 |
54.7 |
4.5 |
8.3 |
| Sex |
| Male |
135,882 |
78.4 |
580 |
2,633 |
280,592 |
16.8 |
40.7 |
21.4 |
8.5 |
12.6 |
| Female |
142,524 |
88.4 |
871 |
2,757 |
347,305 |
21.5 |
40.4 |
20.5 |
10.8 |
6.9 |
| Race/ethnicity |
| White
and other |
209,401 |
87.4 |
833 |
2,832 |
518,202 |
20.3 |
41.7 |
21.1 |
7.8 |
9 |
| Black |
35,049 |
73.2 |
411 |
2,647 |
67,926 |
12.2 |
33.3 |
22.1 |
18.9 |
13.5 |
| Hispanic |
33,955 |
70.3 |
386 |
1,749 |
41,770 |
18.9 |
37.4 |
16.1 |
19.3 |
8.3 |
| Health
insurance statusd |
| Under
age 65: |
| Any
private |
182,658 |
85.9 |
638 |
2,042 |
320,512 |
21 |
69.8 |
1.5 |
1.7 |
6 |
| Public
only |
28,622 |
83.3 |
465 |
3,170 |
75,629 |
9.7 |
*0.0 |
19.7 |
61.8 |
8.7 |
| Uninsured |
32,344 |
57.3 |
305 |
1,500 |
27,793 |
40.4 |
*0.0 |
*0.0 |
*0.0 |
59.6 |
| Age
65 and over: |
| Medicare
only |
11,515 |
94.7 |
2,033 |
5,206 |
56,798 |
22.2 |
*0.0 |
62.5 |
*0.0 |
15.3 |
| Medicare
and private |
19,570 |
95.9 |
2,362 |
6,276 |
117,811 |
17 |
25.9 |
51.7 |
*0.5 |
4.8 |
| Medicare
and other public |
3,568 |
96.4 |
3,094 |
8,324 |
28,624 |
10.4 |
*0.0 |
53.1 |
29.8 |
6.7 |
| Poverty
statuse |
| Poor |
32,053 |
77.3 |
524 |
3,173 |
78,641 |
13.9 |
13.2 |
26 |
34.3 |
12.6 |
| Near-poor |
12,196 |
78.1 |
729 |
2,967 |
28,263 |
17.3 |
11.3 |
35.2 |
27.2 |
9 |
| Low
income |
37,059 |
79.1 |
690 |
3,134 |
91,838 |
17.7 |
25.4 |
32.1 |
14.7 |
10.1 |
| Middle
income |
90,343 |
82.7 |
664 |
2,555 |
190,908 |
19 |
44.5 |
20.5 |
4.4 |
11.6 |
| High
income |
106,754 |
88.2 |
815 |
2,529 |
238,247 |
22.3 |
55.6 |
13.5 |
*2.1 |
6.5 |
| Metropolitan
statistical area (MSA) |
| MSA |
226,861 |
83.3 |
$702 |
$2,641 |
$498,915 |
|