U.S. Health Care in the New Millennium

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1. What are future trends in health care and how they affect disease management, financial management, technology, and social aspect of health care delivery?

Trends and Indicators in the Changing Health Care Marketplace

- Increase in National Health Expenditures per Capita, 1990-2003 leaves more people uninsured and less safety net for disease management
Total health expenditures per capita were $5,670 in 2003, doubling (+107%) from $2,737 in 1990. The average annual increase in health expenditures per capita was 5.8% from 1990 to 2003.

- Increased Number of the Nonelderly Uninsured, 1994-2003
The number of the nonelderly (under age 65) uninsured in the United States increased in 2003 to 44.7 million, an increase of 1.4 million over 2002. Health insurance affects people’s access to health care, their health status, their job decisions, and their financial security. Health insurance makes a difference in whether people get necessary medical care, where they get their care, and, ultimately, how healthy they are. About two-thirds of the nonelderly uninsured are low income (see Exhibit 7.4), so medical bills can cause financial burdens for individuals and families. Uncompensated care to uninsured and underinsured individuals and the safety net of public hospitals and community clinics do not fully substitute for health insurance. With lower safety nets, there is less money for disease management, as well. http://www.kff.org/insurance/7031/print-sec7.cfm

- Declined Health Insurance Coverage Rates, Children and Nonelderly Adults, (Percentage Point Differences), 2002-2003
From 2002 to 2003, employer coverage of both children and adults declined, with a greater decline for children than for nonelderly adults. Increases in Medicaid coverage helped to offset the losses in employer coverage for children, but only partially offset such losses for nonelderly adults.
http://www.kff.org/insurance/7031/print-sec7.cfm

- Decline in Health Insurance Coverage of the Nonelderly by Poverty Level, 2003
As income decreases, the likelihood of being uninsured increases (17% of those with moderate incomes vs. 36% of the poor were uninsured in 2003) and the likelihood of having employer-sponsored coverage decreases (67% of those with moderate incomes vs. 15% of the poor had such coverage in 2003). Because the Near Poor are less likely to qualify for public insurance and have decreased access to employer-sponsored insurance, almost a third (30%) of this group was uninsured in 2003. This impacts disease control, because more people are less likely to have adequate health care. http://www.kff.org/insurance/7031/print-sec7.cfm

- Health Status Within Health Insurance Coverage Types, 2003
The uninsured are more likely than those with employer or other private coverage to be in fair or poor health (9% vs. 5% in 2003). The Medicaid population is the least healthy, with one in five (20%) being in fair or poor health.
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