Table Of Content

1991 HCFA Statistics U.S. DEPARTMENT OF \ HEALTH AND HUMAN SERVICES U.S. Department of Health and Human Services LouisW. Sullivan, M.D., Secretary Health Care Financing Administration Gail R. Wilensky, Ph.D.,Administrator Bureau ofData Management and Strategy ReginaMcPhillips, Dr.P.H.,Director Office ofStatistics and DataManagement RobertMoore,Director Decision Support Division Joseph Hladky,Director Forfurtherinformation contact: Information Analysis Branch FTS 987-3933 (301) 597-3933 m\ Preface Thisreferencebookletprovides significantsummaryinformationabout healthexpenditures andHealthCare Financing Administration (HCFA) programs. Theinformationpresented wasthemostcurrentavailable atthetime ofpublication. Significanttimelagsmay occurbetweentheendofadatayear and aggregationofdataforthatyear. Thedataareorganized as follows: Page Highlights - Growth in HCFA Programs and Health Expenditures 1 I. Populations 5 II. Providers/Suppliers 15 ni. Expenditures 23 IV. Utilization 31 V. Administrative/Operating 39 Reference 47 i Providers/Suppliers • During theearlyyears oftheMedicareprogram, thenumber ofhospitalsclassified as short-staywasrelatively stable, in therangeof6,100-6,200. However, during 1980, the numberdroppedbelow 6,100, andby January 1991, the numberdecreasedto 5,549. This change ispartiallydueto thereclassificationofsome short-stayhospitals to non-short-stayclassificationforMedicarereimbursement purposes. • Untilrecently, the totalnumberofMedicarecertifiedbeds inshort-stayhospitals showed asteady increasefromless than800,000 atthebeginning oftheprogram andpeaking at 1,025,000in 1984-86. Sincethattime, thenumberhas droppedto slightlymorethan970,000. • Thenumberofpsychiatrichospitals grewto about400by 1976, whereitremaineduntil the startoftheprospective paymentsystem(PPS) in 1983. Sincethattime, thenumber has grownto 674. • Attheendoffiscalyear 1990, PPS covered5,480or 84percentofallhospitals. • Thenumberofskillednursing facilities (SNFs) increased rapidly during the 1960s, decreasedduring the firsthalfof the 1970s, andhasbeenincreasing eversince,reaching about9,000by thebeginning of 1991. • Afterpeaking in 1970, thenumberofhomehealth agencies (HHAs)remainedstableduringmostofthedecade. The numberofHHAsbegantopeakin 1978 and accelerated withthepassageoftheOmnibusBudgetReconciliationAct of 1980, whichpermitted the certificationofproprietary HHAs inStatesnothaving licensurelaws. By 1986, there were almost6,000participating facilities. Since thattime, thenumberhas decreased to 5,730. • Independentlaboratories increased 107 percentfrom2,355 inJanuary 1968 to4,881 inJanuary 1991. Expenditures • Nationalhealthexpenditureswere$51 billionin 1967, 6.3percentofthegrossnationalproduct(GNP). By 1991, expenditures areprojectedtoreach$738billion, 13 percentofGNP. • Publicexpenditures onhealth amountedto $19billionin 1967, 37percentoftotalhealthexpenditures. Publichealth expenditures areprojectedtoreach$317billionin 1991, 43percentoftotalhealthexpenditures. • Federalhealthexpendituresincreasedfrom23percentofall healthexpenditures in 1967 ($12billion)to29percentin 1991 ($216 billion). • Nationalhealthexpendituresperpersonincreasedfrom $247 in 1967 to$2,817 in 1991. • Nationalhealthexpenditures areprojectedtoreach $1,616 billionintheyear2000,representing 16percentof theGNP. Utilization ofMedicare andMedicaidservices • Over49 millionpersonswillreceiveservicespaidby MedicareorMedicaidin fiscalyear 1991. • Oneoutoffive, ornearly 11 millionpersons,willuse inpatienthospital services coveredbyMedicareorMedicaid thisyear. • Over fouroutoffive, orabout40millionpersons,will receivereimbursablephysician servicesunderMedicareor Medicaidthisyear. • About26millionpersons willreceivereimbursable outpatienthospital servicesunderMedicareorMedicaid thisyear. 3 About 1 millionpersons willreceivecareinSNFscovered byMedicareorMedicaidthisyear. Over 1 millionpersons willreceivecareinintermediatecare facilitiescoveredbyMedicaidthisyear. Over2.5millionpersons willreceivereimbursableHHA visitsunderMedicareorMedicaidthisyear. Over 18 millionpersonswillreceiveprescribeddrugsunder Medicaidthisyear. I Populations Information aboutpersonscovered byMedicareorMedicaid ForMedicare, statistics arebasedonpersonsenrolledfor coverage. ForMedicaid,recipientcounts areusedas a surrogateofpersonseligibleforcoverage, as well as for personsutilizing services. Statistics areavailablebymajor programcategories,bydemographic andgeographicvariables, and asproportionsoftheU.S.population. Utilizationdata organizedbypersons servedmaybefoundintheUtilization section. 5 Table 1 Medicare enrollment/trends Total Aged Disabled persons persons persons T±ini miiiiliiliiuojinis^ July 1966 19.1 19.1 1970 20.5 20.5 1975 25.0 22.8 2.2 1980 28.5 25.5 3.0 1985 31.1 28.2 2.9 1986 31.7 28.8 3.0 1987 32.4 29.4 3.0 1988 33.0 29.9 3.1 1989 33.6 30.4 3.2 1990 34.2 30.9 3.3 19911 35.0 31.6 3.4 19921 35.5 32.1 3.4 Estimated. SOURCE:HealthCareFinancingAdministration,BureauofDataManagement andStrategy:DatafromtheMedicare StatisticalSystemandtheOfficeofthe Actuary:DatafromtheOfficeofMedicareandMedicaidCostEstimates. Table2 Medicare enrollment/coverage HI HI and/or and HI SMI SMI HI SMI SMI only only Inmillions Allpersons 34.2 33.7 32.6 32.1 1.6 0.5 Agedpersons 30.9 30.5 29.7 29.2 1.3 0.5 Disabledpersons 3.3 3.3 2.9 2.9 0.3 C) dumberlessthan50,000. NOTES:DataasofJuly 1990. HIishospitalinsurance. SMIis supplementarymedicalinsurance. SOURCE: HealthCareFinancingAdministration,BureauofData ManagementandStrategy:DatafromtheMedicare StatisticalSystem. 6 Table3 Medicare enrollment/demographics Total Male Female Inthousands Allpersons 34,203 14,459 19,744 Aged 30,948 12,416 18,532 65-74years 17,647 7,758 9,888 75-84years 10,016 3,752 6,264 85years andover 3,286 906 2,380 Disabled 3,255 2,043 1,212 Under45years 1,138 733 405 45-54years 741 467 274 55-64years 1,376 842 533 White 29,336 12,376 16,960 Otherraces 3,826 1,662 2,165 Unknown 1,041 422 877 NOTES:DataasofJuly 1990.Numbersmaynotaddtototalsbecauseof rounding. SOURCE:HealthCareFinancingAdministration,BureauofDataManagement andStrategy:DatafromtheMedicareStatisticalSystem. Table4 Medicare enrollment/endstagerenal diseasetrends HIand/orSMI in SMI July 1980 66,741 66,254 64,896 1981 72,807 72,344 70,786 1982 76,117 75,707 73,705 1983 89,427 88,847 86,868 1984 97,780 97,080 94,620 1985 103,997 103,171 100,694 1986 120,060 118,946 116,093 1987 130,939 129,657 126,003 1988 141,300 139,958 135,687 1989 155,231 153,813 148,155 1990 172,078 170,629 163,708 NOTES:HIishospitalinsurance. SMIissupplementarymedicalinsurance. SOURCE:HealthCareFinancingAdministration,BureauofDataManagement andStrategy:DatafromtheMedicareStatisticalSystem. 7 Table5 Medicareenrollment/end stagerenal diseasedemographics Numberof enpolices Allpersons 172,078 Age Under25years 7,184 25-44years 43,028 45-64years 61,386 65yearsandover 60,480 Sex Male 93,475 Female 78,603 Race White 103,744 Other 62,397 Unknown 5,937 NOTE:DataasofJuly1990. SOURCE:HealthCareFinancingAdministration,BureauofDataManagement andStrategy:DatafromtheMedicareStatisticalSystem. Table6 Medicare/health maintenance organizations (HMOs) Pre-TEFRA HMOs1 Post-TEFRA HMOs2 Number Enrollees Number Enrollees ofplans in thousands ofplans inthousands Total prepaid 154 1,076 166 2,018 HCPPs3 46 612 40 596 Total HMOs 108 464 126 1,421 TEFRA risk 96 1,264 Oldrisk 4 37 0 0 Costbasis 65 117 26 141 Demonstrations 39 310 4 17 TaxEquityandFiscalResponsibilityAct(TEFRA)of1982;dataasof March1985. *DataasofDecember1990. 'Healthcareprepaymentplans. SOURCE:HealthCareFinancingAdministration,OfficeofPrepaidHealth Care:DatafromtheDivisionofContractAdministration. 8