Highlights #12: Per Capita Health Care Expenses, 1996
Estimates for the U.S. Civilian Noninstitutionalized Population
Introduction
The Medical Expenditure Panel Survey (MEPS) is the Nation's primary
source of detailed, nationally representative data on medical
care spending and sources of payment for the U.S. civilian noninstitutionalized
(community) population. MEPS provides researchers and policymakers
with data on how much is paid for various types of health care
services and who pays for them. This Highlights presents data
on the proportion of people with expenses, as well as average
and median expenses per person, by type of service. Detailed
information of this sort has not been available since data from
the 1987 National Medical Expenditure Survey (NMES) were released
in the early 1990s.
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Briefly Stated
- In 1996, 86 percent of the U.S. community
population had medical expenses. Nearly three-quarters of the
population had ambulatory care expenses, and nearly two-thirds
had expenses for prescribed medicines.
- The average expense per person with any
medical expense was about $2,400. However, half of all people
with medical expenses had expenses of less than $559 (the median
value). Only small proportions of the population had expenses
for inpatient hospital and home health services, but these
health services had the highest average annual expenses.
- Only small proportions of the population
had expenses for inpatient hospital and home health services,
but these health services had the highest average annual expenses.
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Definitions
Expenses in MEPS are defined as the
sum of direct payments for care provided during the year, including
out-of-pocket payments and payments by private insurance, Medicare,
Medicaid, and other sources. MEPS and the Health Care Financing
Administration's National Health Accounts (NHA) have substantial
differences in methodologies and objectives. In particular, the
NHA are based on a composite of data from multiple sources at
the aggregate national level and are used primarily to track
aggregate medical expenditures in the U.S. economy. In contrast,
MEPS collects survey data on individuals that can be used to
estimate direct payments made for medical care and services purchased
by the civilian noninstitutionalized population. Data from the
survey are widely used for behavioral and socioeconomic analyses
of the relationship between individual characteristics and health
care spending.
National health care expenditure estimates
from MEPS are lower than those estimated by the NHA for several
reasons. First, the NHA are more expansive in the scope of included
expenditures, including, for example, expenditures for over-the-counter
drugs, nursing home care, program administration, Government
public health activities, and construction, as well as some hospital
and physician revenues not associated with patient care. Second,
the NHA include health care expenditures for individuals who
are not members of the civilian noninstitutionalized population,
such as individuals in the military and those residing in nursing
homes, assisted living facilities, and prisons. Researchers at
the Agency for Healthcare Research and Quality (AHRQ) and the
Health Care Financing Administration estimate that adjustments
for differences in the scope of included expenditures and population
reduce the NHA's national estimate to $606 billion (versus the
corresponding MEPS national estimate of $554 billion). For the
most part, the remaining difference is likely to reflect some
combination of (a) irreconcilable definition and measurement
differences between NHA and MEPS and (b) statistical uncertainty
associated with sampling error (in both MEPS and the NHA).
Expenses are grouped into six broad types
of service: hospital inpatient, ambulatory, prescribed
medicines, dental, home health, and other medical. Ambulatory
services include office-based care as well as visits to hospital
outpatient departments and emergency rooms. The "other
medical" category includes glasses, ambulance services,
orthopedic items, hearing devices, prostheses, bathroom aids,
medical equipment, disposable supplies, and other miscellaneous
items or services.
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Findings
In 1996, 86 percent of the U.S. community population
had some medical expenses (Figure
1). Nearly three-quarters had ambulatory care expenses, and
nearly two-thirds had expenses for prescribed medicines. Overall,
about 4 in 10 people had medical expenses for dental care and
about 2 in 10 had expenses for other medical services. Only 7
percent had expenses for inpatient hospital care and 2 percent
for home health services.
The average total expense (including both out-of-pocket
and third-party payments) among people with any medical expenses
in 1996 was about $2,400 (Figure 2).
However, half of all people with medical expenses had expenses
of less than $559 (the median value). This large discrepancy
between the average and median values occurs because a small
proportion of people incurred a disproportionately large share
of medical expenses. Median expenses were substantially smaller
than average expenses across all categories of type of service.
Only small proportions of the population had
expenses for inpatient hospital and home health services, but
these health services had the highest average annual expenses-$11,492
and $5,191, respectively (Figure 2).
The average expenses for ambulatory services were $920. Although
average expenses for ambulatory services were substantially lower
than expenses for inpatient hospital or home health services,
they were more than twice as high as for the remaining service
categories (dental, prescription medicines, and other medical
services).
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About MEPS
MEPS collects nationally
representative data on health care use, expenses, sources of
payment, and insurance coverage for the U.S. civilian noninstitutionalized
population. It is co-sponsored by AHRQ and the National Center
for
Health Statistics (NCHS). This Highlights summarizes data concerning health
care expenses in the United States during 1996, as derived from the MEPS Household
Component, Rounds 1-3. For more information about MEPS, see the sources listed
on the back page.
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Figures
Figure 1.
Percent of population with health expense, by type of service:
1996
- Most people had expenses for ambulatory
care and prescribed medicines, while relatively few had expenses
for inpatient hospital stays or home health care.
DATA
SOURCE: 1996
Medical Expenditure Panel Survey Household Component.
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Figure 2. Median
and average expense per person with expense, by type of service:
1996
- Although only small proportions of people
had expenses for hospital inpatient and home health services,
average and median expenses were by far the highest for those
types of services.
DATA
SOURCE: 1996 Medical Expenditure Panel Survey Household Component.
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References
For more information
about MEPS, call the MEPS information coordinator at AHCPR
(301-594-1406) or visit the
MEPS section of the AHCPR Web site at: http://www.meps.ahrq.gov
For a detailed description of the MEPS survey
design, sample design, and methods used to minimize sources of
nonsampling error, see the following publications:
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 S. Sample design of the 1996 Medical
Expenditure Panel Survey Household Component. Rockville (MD):
Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 2. AHCPR Pub. No. 97-0027.
Machlin S, Taylor A. 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.
The estimates in this Highlights are
based on the MEPS Expenditure File (HC-011), which is available
on the MEPS Web site. More detailed information on national medical
expenses will be published in:
Cohen JW, Machlin SR, Zuvekas SH, et al. Health
care expenses in the United States, 1996. MEPS Research Findings.
Forthcoming.
MEPS publications are available from the AHRQ
Clearinghouse (800-358-9295) and on the MEPS Web site.
MEPS Highlights No. 12,
AHRQ Pub. No. 00-0026, May 2000.
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Suggested Citation:
Highlights #12: Per Capita Health Care Expenses, 1996. May 2000. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.meps.ahrq.gov
/data_files/publications/hl12/hl12.shtml
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