Out-of-pocket health care expenditures, by insurance status, 2007-10.

Out-of-pocket health care spending in the United States totaled $306.2 billion in 2010 and represented 11.8 percent of total national health expenditures, according to the Centers for Medicare and Medicaid Services' National Health Expenditure Accounts. Spending by people with employer-sponsored health insurance and those covered by Medicare accounted for over 80 percent of total out-of-pocket spending. People without comprehensive medical coverage accounted for less than 8 percent of all out-of-pocket expenditures in 2010. Between 2007 and 2010 per person out-of-pocket spending grew most rapidly for people primarily covered by employer-sponsored insurance and declined for people primarily covered by Medicare and those without coverage.

Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.

OBJECTIVE: Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. DATA SOURCES: The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. RESULTS: In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.

Health spending projections through 2017: the baby-boom generation is coming to Medicare.

The outlook for national health spending calls for continued steady growth. Spending growth is projected to be 6.7 percent in 2007, similar to its rate in 2006. Average annual growth over the projection period is expected to be 6.7 percent. Slower growth in private spending toward the end of the period is expected to be offset by stronger growth in public spending. The health share of gross domestic product (GDP) is expected to increase to 16.3 percent in 2007 and then rise throughout the projection period, reaching 19.5 percent of GDP by 2017.

National health spending in 2006: a year of change for prescription drugs.

In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years. The implementation of Medicare Part D caused a major shift in the distribution of payers for prescription drugs, as Medicare played a larger role in drug purchases than it had before.

Health spending projections through 2016: modest changes obscure part D's impact.

Growth in national health spending is projected to slow slightly from 6.9 percent in 2005 to 6.8 percent in 2006, marking the fourth consecutive year of a slowing trend. The health share of gross domestic product (GDP) is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19.6 percent of GDP by 2016. Prescription drug spending growth is expected to accelerate to 6.5 percent in 2006. Medicare prescription drug coverage has dramatically changed the distribution of drug spending among payers, but the net effect on aggregate spending is anticipated to be small.

National health spending in 2005: the slowdown continues.

In 2005, U.S. health care spending increased 6.9 percent to almost 2.0 trillion dollars, or 6,697 dollars per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than the 15.9 percent share in 2004. This third consecutive year of slower health spending growth was largely driven by prescription drug expenditures. Spending for hospital and physician and clinical services grew at similar rates as they did in 2004.

National health spending in 2004: recent slowdown led by prescription drug spending.

U.S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. Health spending accounted for 16 percent of gross domestic product (GDP), nearly the same as in 2003. The pace of health spending growth has slowed, compared with the 2000-2002 period, for both public and private payers. Hospital spending accounted for 30 percent of the aggregate increase between 2002 and 2004, and prescription drugs accounted for an 11 percent share-smaller than its share of the increase in recent years and much slower in absolute terms.

Reconciling medical expenditure estimates from the MEPS and NHEA, 2002.

The Medical Expenditure Panel Survey (MEPS) and National Health Expenditure Accounts (NHEA) are often used for health care policy analysis and simulations because they contain comprehensive estimates of national health care expenditures. The NHEA are primarily based on aggregate provider revenue data, while MEPS is based on person-level data on health care expenditures. This article compares MEPS and NHEA expenditure estimates for 2002 and discusses the differences. When MEPS and the NHEA are adjusted to be on a consistent basis, their expenditure estimates differ by 13.8 percent.

Health spending growth slows in 2003.

The pace of health spending growth slowed in 2003 for the first time in seven years, driven in part by a slowdown in public spending growth. U.S. health care spending rose 7.7 percent in 2003, much slower than the 9.3 percent growth in 2002. Financial constraints on the Medicaid program and the expiration of supplemental funding provisions for Medicare services drove the deceleration. U.S. health spending accounted for 15.3 percent of U.S. gross domestic product in 2003, an increase of 0.4 percentage points from 2002.

Financing Health Care: Businesses, Households, and Governments, 1987-2003.

This article provides estimates of health care expenditures by businesses, households, and governments for 1987-2003. Sponsors that finance public and private health insurance programs and other payers face increasing challenges as health care cost rise. Their capacity to support rising costs was particularly strained during the recent economic recession, with the Federal Government's burden measured against revenue available for this purpose growing faster than for other sponsors.

National health expenditures, 2002.

National health expenditures (NHE) were $1.6 trillion in 2002, a 9.3-percent increase from 2001. For the fourth consecutive year health spending grew faster than the overall economy as measured by the GDP. Growth in U.S. health care spending rose for most health services in 2002, with hospital spending once again the primary driver

Health spending rebound continues in 2002.

U.S. health care spending climbed to dollars 1.6 trillion in 2002, or dollars 5,440 per person. Health spending rose 8.5 percent in 2001 and 9.3 percent in 2002, contributing to a spike of 1.6 percentage points in the health share of gross domestic product (GDP) since 2000. Hospital spending accounted for nearly a third of the aggregate increase. During the past three decades, per enrollee spending for a common benefit package has grown at a slightly slower average annual rate for Medicare than for private health insurance, with more pronounced growth differences recently reflecting legislated Medicare reimbursement changes and consumers' calls for more loosely managed care.

Trends in U.S. health care spending, 2001.

U.S. health care spending grew 8.7 percent to $5,035 per capita in 2001. Total public funding continued to accelerate, increasing 9.4 percent and exceeding private funding growth by 1.2 percentage points. This acceleration was due in part to increased Medicaid spending in the midst of a recession and payment increases for Medicare providers. Prompted by sluggish economic growth and by faster-paced health spending, health spending's share of GDP spiked 0.8 percentage points in 2001 to 14.1 percent.

Burden of health care costs: businesses, households, and governments, 1987-2000.

In this article, we estimate expenditures by businesses, households, and governments in providing financing for health care for 1987-2000 and track measures of burden that these costs impose. Although burden measures for businesses and the Federal Government have stabilized or improved since 1993, measures of burden for State and local governments are deteriorating slightly--a situation that is likely to worsen in the near future. As health care spending accelerates and an economy wide recession seems imminent, businesses, households, and governments that finance health care will face renewed health cost pressures on their revenue and income.

Health Care Indicators.

THIS REGULAR FEATURE OF THE JOURNAL INCLUDES A DISCUSSION OF EACH OF THE FOLLOWING FOUR TOPICS: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.

Health Care Indicators.

THIS REGULAR FEATURE OF THE JOURNAL INCLUDES A DISCUSSION OF EACH OF THE FOLLOWING FOUR TOPICS: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data.

Consequences of larval intraspecific competition to stonefly growth and fecundity.

We conducted experiments in replicated circular streams to measure the effect of intraspecific larval density on growth rates, size at emergence, timing of emergence, and fecundity of two species of predatory stoneflies (Megarcys signata and Kogotus modestus, Perlodidae). Early instars of both species showed no significant effect of intraspecific larval density on mean growth rates, despite the observation that in the absence of competitors stoneflies ate on average, significantly more prey (Baetis bicaudatus, Ephemeroptera, Baetidae) than in the presence of competitors. However, larval size of stoneflies held at higher densities (two per chamber) diverged over time, resulting in a greater size variability (coefficient of variation) among Kogotus than in treatments with low densities of stoneflies (one per chamber). The effect of doubling the density of early-instar Megarcys larvae was also asymmetrical, resulting in one larger and one smaller individual. In contrast, doubling the density of last-instar stoneflies whose feeding rates declined significantly prior to emergence had few measurable consequences, except that male Megarcys, which continued to feed throughout the last instar, had lower average feeding rates in high-density than in low-density chambers, and emerged at a significantly smaller mean size. We conclude that competition between early-instar stonefly larvae results in an asymmetry of body sizes, but that competitive effects are reduced as larvae slow or cease feeding before emergence. Since larger females of both stonefly species produced more eggs, the probable cost to females of early-instar larval competition was a reduction in their potential contribution of offspring to the next generation. The cost of attaining a smaller body size for male stoneflies is unknown; but if, as in many other insects, larger males have greater reproductive success, larval competition may increase the opportunity for sexual selection among males. This hypothesis remains to be tested experimentally.