HC Statistics

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Heroes without Health Insurance

May 25, 2012 in HC Statistics, Health Insurance | No comments

This weekend is Memorial Day Weekend.  It is a time to celebrate the service of current and former members of the military. Although military veterans garner a lot of attention around Memorial Day, some veterans are not having their needs met the rest of the year.

A recent study, for instance, finds that many veterans lack health insurance.  As summarized in the National Journal:

“About 10 percent of U.S. veterans under the age of 65 lack health insurance and are not being cared for by the Veterans Affairs Department, either, according to a study published on Thursday.

The study estimated that 1.3 million veterans and nearly 950,000 members of their families lack health insurance. These uninsured military families account for 4.8 percent of the 47.3 million uninsured Americans, the Urban Institute and Robert Wood Johnson Foundation reported.”

The share of veterans without health insurance varies widely across states.  According to the study,

“Just four states have uninsurance rates below six percent—Massachusetts, Hawaii,Vermont and North Dakota.  Meanwhile,four states—Louisiana,Oregon,Idaho, and Montana—have uninsurance rates above 14 percent.”

But doesn’t the Department of Veterans Affairs (VA) provide health insurance to all veterans?

It is true that the VA is “the nation’s largest health system and provides health care for many veterans through a system of medical centers, clinics, and other facilities…However, some veterans do not use VA health care services. Eligibility is based on veteran status, service-related disabilities, income level, and other factors, and even within the groups eligible for VA care, other factors, such as their proximity to VA facilities and the cost-sharing requirements, may affect the likelihood
that they seek care in the VA system.”

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Who are the 1%?

January 30, 2012 in Economics - General, HC Statistics | No comments

Although executives and managers lead the way, in large part, the answer is doctors.  See the chart below.


Sources:

  • John Bakija, Williams College ”Jobs and Income Growth of Top Earners and the Causes of Changing Income Inequality: Evidence from U.S. Tax Return Data.” November 2010, Working Paper.
  • Hat tip: Mother Jones.

 

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Employer Health Benefits in California in 2011

January 24, 2012 in HC Statistics, Health Insurance, Managed Care | No comments

Each year, the California Health Care Foundation (CHCF) examines trends in employer health benefits in the state of California.  Last year, I reported on the 2010 CHCF report and now I will examine the 2011 report.

Between 2010 and 2011, some things have remained the same.  Healthcare premiums are far outpacing inflation over the medium run and California premiums remain higher than average. Workers at small California firms have to cover a large share of premiums and receive less generous insurance coverage (i.e., deductibles more than $1000).

High-wage firms (66% vs. 42%), firms with few part-time workers (70% vs. 41%) and firms with at least some unionized staff (84% vs. 61%) are more likely to offer health insurance to their workers.

Growth in California health insurance premiums (9.1%) in 2011 fell below the growth rate of the U.S. overall (9.5%). In 2010, the opposite was true. California health insurance premiums rose by 7.5%, but overall U.S. premium growth rose by only 3.0%.

The stereotype that California is the land of managed care holds true. Whereas the national proportion of covered workers enrolled in an HMO declined from 20% to 17% between 2009 and 2011, in California the proportion of covered workers enrolled in an HMO held steady at 54%. Also, although the U.S. overall has seen significant growth in high-deductible health plans (HDHPs) so that 17% of covered workers are enrolled in these plans, in California, only 6% of workers have enrolled in this plan type.

Is the ACA working? The answer is probably no. “Just 32% of small California firms not currently offering health benefits were aware of the small firm tax credit that is part of the Affordable Care Act.”

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The Number of Uninsured Growing in California

January 11, 2012 in HC Statistics | 1 comment

Although Health Reform has passed, many of its mandates–such as Health Insurance Exchanges–have not yet been implemented.  As the cost of health care has been growing over time, the number of uninsured has also been growing.

The California Health Care Foundation examines the uninsured in California in more detail.  Although Texas has the highest share of individuals uninsured (27.3%), California has the largest number of uninsured individuals in the country (6.9 million) and one of the largest share of (21%).  One of the reasons for this decline is a decrease in the share of firms offering insurance.  The share of non-elderly Californians who obtain their insurance through their job has  declined from 65% in 1987 to 53% in 2010. Part of this decrease has been offset by a rise in the share of Californians covered by Medicaid.

Some other highlights from the CHCF report include:

  • Employees in businesses of all sizes are more likely to be uninsured in California than in the United States.
  • Nearly one-third of the uninsured in California and the nation have family incomes of $50,000 or more.
  • Fifty-three percent of California’s uninsured children are in families where the head of household worked full-time during calendar year 2010, down from 61% in 2008.
  • About 60% of the uninsured population are Latino.

Below are two charts displaying the insurance source for Californians in 2010 and 2000.

For more facts and figures, see the CHCF Snapshot, California’s Uninsured, Dec 2011.

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California Health Care Almanac

December 23, 2011 in HC Statistics, Quality | No comments

The California Health Care Foundation (CHCF)’s Health Care Almanac provides some unique insights on trends in health care quality in California and for the United States as a whole.  Many of the national figures for the Almanac come from the CDC (BRFSS and Vital Stats) and AHRQ’s National Healthcare Quality Report.  California quality figures come from the California Department of Public Health, the Office of Statewide Health Planning and Development and the California Health Interview Survey.

Although not discussed in this post, another portion of the Health Care Almanac looks at quality by site of service.  Much of this data comes from Hospital Compare, CMS OASIS data, AHRQ’s National Healthcare Quality Report, and the Dartmouth Atlas.

Today I highlight 3 topics related to clinical quality:

  • Cesarean Deliveries
  • Infant Mortality
  • Cancer Incidence.

More detail is below.

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State Governments Providing Health Insurance to More Children

October 28, 2011 in CHIP, HC Statistics, Medicaid | No comments

Of the 6.6 million uninsured children in the nation, 4.3 million are eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Approximately 2.8 million children come from families at or near the federal poverty line (FPL).

Despite the fact that millions of children are uninsured, children’s participation rates in Medicaid/CHIP are increasing. Today I will review the results of an Urban Institute study examining trends in Medicaid participation rates for children.

Data

The authors use data from the 2008 and 2009 American Community Survey (ACS). This large survey data set has replaced the Census long form. The authors use the Integrated Public Use Microdata Series (IPUMS) version of the ACS.

Determining Eligibility

Three main characteristics determine a child’s eligibility: family composition, income, and immigration status.  Medicaid eligibility depends on the family’s income as a share of the federal poverty level (FPL).  The FPL threshold changes based on how many individuals are in the household.  Further, many States restrict Medicaid and CHIP access to citizens or legal residents.  Although survey data often indicate whether the individual is foreign born, the data do not contain information on whether the individual is a citizen, legal resident, temporary resident, or lives in the U.S. illegally.  This paper describes one methodology to impute immigration status from these survey data.

Results

  • The share of children without health insurance coverage fell between 2008 and 2009,despite the ongoing economic downturn;
  • Nationally, the rate of Medicaid/CHIP participation among children rose by 2.7 percentage points to 84.8 percent and cross-state variation in Medicaid/CHIP participation rates narrowed, as larger improvements occurred on average for states that had the lowest participation rates in 2008;
  • Six states (DC, Hawaii, Maine,Massachusetts, Michigan and Vermont) had participation at or above 90.0 percent in 2008 and 2009
  • Six states (Florida, Montana, Nevada, North Dakota, Texas and Utah) had participation rates below 80.0 percent in both 2008 and 2009
  • Participation gains occurred between 2008 and 2009 for children in each race/ethnicity, language, income and age group examined;

Source: Kenney GM, Lynch V, Haley J, Huntress M, Resnick D and Coyer C. “Coverage Gains for Children,” Urban Institute, RWJF Report, Aug 16, 2011.

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Health Insurance Snapshot for 2009

October 19, 2011 in HC Statistics, Health Insurance | No comments

There are approximately 265 million individuals in the United States under age 65 in 2009.  Using the 2010 March Current Population Survey (CPS) data, the employee benefits research institute provides the insurance coverage breakdowns.

  • Employer-sponsored group plan: 156.1 million (59.0 percent)
  • Insurance bought directly from insurer on individual market: 16.7 million (6.3 percent)
  • Medicaid: 44.1 million (16.7 percent)
  • Medicare: 7.3 million (2.8 percent)
  • Tricare/CHAMPVA: 8.3 million (3.1 percent)
  • No Health Insurance: 50.0 (18.9 percent)

Employer-based coverage has dropped from 65.9 percent in 2000 to 55.8 percent in 2009 for children and from 69.3 percent to 60.2 percent for adults under 65.  The advent of CHIP has meant that many more children are now covered by Medicaid (33.8 percent today versus 20.9 percent in 2000) and the uninsurance rate has dropped over the last 10 years from 11.3 percent to 10.0 percent. Medicaid enrollment for adults has also increased, from 6.4 percent of adults to 9.9 percent of adults today. Uninsurance rates, however, have also grown for adults: from 17.2 percent in 2000 to 22.4 in 2009.

 

Source:

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Medicare & Medicaid Statistical Supplement

October 7, 2011 in HC Statistics, Medicaid, Medicaid/Medicare, Medicare | 1 comment

CMS has a wealth of publicly available summary statistics regarding enrollment, spending, treatment patterns, cost sharing and other topics for both Medicare and Medicaid beneficiaries.  This information can be accessed through the Medicare & Medicaid Statistical Supplement website.  The site includes statistics on the following topics:

  • Personal Health Care Expenditures
  • Medicare Enrollment
  • Medicare Program Payments
  • Medicare Cost Sharing
  • Medicare Short Stay Hospitals
  • Medicare Skilled Nursing Facilities
  • Medicare Home Health Agencies
  • Medicare Hospices
  • Medicare Physician Services
  • Medicare Hospital Outpatient Services
  • End Stage Renal Disease
  • Medicare Managed Care
  • Medicaid
  • Medicare Part D

There is data available from 2001 to 2010.

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History says bending the health care expenditure curve may not be feasible

October 6, 2011 in HC Statistics | 1 comment

Many health policy researchers talk about bending the cost curve; this means reducing the rate of health care spending below GDP growth.  U.S. health spending, however, has consistently grown faster than GDP for nearly a century.  Woodward and Wang show that this relationship is surprisingly stable over time, even after the advent of large government entitlements.

“…simple extrapolations of trends observed in the years before Medicare and Medicaid are surprisingly accurate. For example, if one extrapolates the relationship between 1950 and 1960 to the per capita GDP in 2008, the error in predicted per capita NHE in 2008 is 8.6%. Or if one extrapolates the trends defined by the relationship between per capita NHE and per capita GDP in 1929 and 1965 to the per capita GDP in 2008, the error in predicted NHE in 2008 is 11.8%.”

Source:

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How Accurate is the Chronic Condition Data Warehouse?

August 29, 2011 in HC Statistics, Medicaid/Medicare | No comments

The CMS Chronic Condition Data Warehouse (CCW) provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across the continuum of care.  The files also use ICD-9 codes and other information to identify the chronic condition each beneficiary has.  The question is, how well does the CCW identify these chronic conditions?

According to Gorina and Kramarow (2011) the results are mixed.  The authors examine the strengths and limitations of using CMS’s CCW algorithm with Medicare claims data to identify chronic conditions in older persons.  Their methodology is as follows:

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