Photo by Piron Guillaume
A recent report released by the Centers for Disease Control and Prevention presents an interesting snapshot of long-term trends in health care in the United States.
It’s timely, considering the uproar over the potential repeal of Obamacare and its replacement with ... well, something. Maybe. I won’t get into that debate at this time, and instead will let the data speak for itself.
Let’s start with how much we’re spending for medical care.
Wade through the 488 pages of “Health, United States 2016,” and you’ll find this nugget: Per capita personal health care expenditures more than doubled from 2000 to 2015, from $4,121 to $8,468. That represents $1.2 trillion in spending in 2000, and $2.7 trillion in 2015.
That's a lot, of course, and it's quite an increase in a short time span, but we've been here before. Repeatedly.
From 1960 to 1970, personal health care costs increased nearly threefold, from $24.7 billion to $63.1 billion; then nearly doubled in five years to $113.2 billion in 1975; and again in 1980 to $217 billion; and again nearly tripled to $615.3 billion in 1990.
The report also takes a long-term look at how we're paying for health care.
In 1975, private insurance paid for 24.5 percent of personal health care expenditures, and accounted for 34.8 percent of payments in 2015. Medicaid and Medicare covered 25.1 percent of such expenditures in 1975 and for 40.6 percent of costs in 2015. We covered 32.9 percent of our costs out of pocket in 1975 and 12.4 percent on our own in 2015. Other funding sources were 17.5 percent of funding in 1975 and covered 12.2 percent of health costs in 2015.
Where’s the money going? Hospital expenditures were 45.3 percent of personal health care spending in 1975, and accounted for 38.1 percent of spending in 2015. Payments to doctors were at 22.4 percent of expenditures in 1975, and were 23.4 percent in 2015. Prescriptions accounted for 7.1 percent of 1975 health spending, and 11.9 percent in 2015. Dental expenditures decreased from 7.1 percent in 1975 to 4.3 percent in 2015, and nursing care and retirement facilities costs decreased from 7.1 percent to 5.8 percent. Home health care rose from .5 percent to 3.2 percent, and other expenditures increased from 10.6 percent in 1975 to 13.2 percent in 2015.
Overall, more Americans have health coverage. Since the turn of the century, the number of uninsured Americans 65 and younger declined from 17 percent of the population in 2000 to 10.6 percent in 2015, about a 37 percent increase on the rolls of the insured. The number of uninsured children younger than 18 dropped from 12.6 percent in 2000 to 4.5 percent in 2015, about a 66 percent increase in children with insurance.
People are more inclined to seek medical care, too, but stay out of the emergency room, and out of the hospital itself. The number of health care visits in most age groups increased between 2000 and 2015, but the number of emergency room visits decreased. The changes were most pronounced in children, with a 33 percent increase in health care visits and a 15 percent decline in ER trips for ages 17 and younger. The hospitalization rate decreased in all age groups. Also, the number of people who put off or declined needed medical care because of cost increased in Americans age 45 to 64, from 8.8 percent in 2000 to 10.3 percent in 2015, about a 17 percent increase. All other age groups reported they were less likely to delay treatment because of cost concerns.
As for a bottom line in measuring what we're getting for our money, let's start with this simple fact: We’re living significantly longer. Life expectancy from birth has increased from 72.6 in 1975 to 78.8 in 2015 (after a tenth of a percent decline from 2014).
One reason is because we’re better at keeping babies alive: Infant mortality decreased from 16.07 per 1,000 live births in 1975 to 5.9 in 2015, a 63 percent drop. Deaths of infants (younger than 1 year) decreased from 45,526 in 1980 to 23,455 in 2015.
The two leading causes of death have long been heart disease and cancer, and that’s reflected in the stats, but there’s also been a significant decline in their toll over the years.
In 1980, heart disease claimed 761,085 Americans, and cancer killed 416,509. In 2015, 633,842 deaths were attributed to heart disease and 595,930 were caused by cancers. Now, consider that the U.S. population increased in that time period from 226.5 million to 321.4 million.
We’re also gotten better at treating influenza and pneumonia (48.1 deaths per 100,000 in 1950 to 15.2 in 2015); colon, rectal and anus cancer (30.3 deaths per 100,000 in 1960 to 14.2 in 2015); HIV (10.2 deaths per 100,000 in 1990 to 1.9 in 2015); and cerebrovascular disease (180.7 deaths per 100,000 in 1950 to 37.6 in 2015).
We’re also doing better when it comes to treating people who are injured in accidents, at raising safety awareness, and in improving equipment and heading off injuries before they occur. That's evident in car crash data: In 1950, vehicle wrecks accounted for 24.6 deaths per 100,000 Americans. In 2015, it was 11.4 deaths per 100,000. Deaths from other accidental occurrences also have decreased, from 78 per 100,000 in 1950 to 43.2 in 2015.
Rates for suicide and homicide have remained about the same, though with some significant fluctuations in homicide rates over some decades. The suicide rate was 13.2 per 100,000 population in 1950 and was 13.3 in 2015; the homicide rate was 5.1 in 1950 and was 5.7 in 2015.
One good thing we’ve done for ourselves that is reflected in these numbers is to quit smoking.
In 1974, 36.9 percent of Americans smoked cigarettes (42.9 percent of men and 32 percent of women). In 2015, that was down to 15.6 percent (17.1 percent of men, 14.3 percent of women). In ages 12 to 17, use of any tobacco product decreased from 15.2 percent in 2002 to 6 percent in 2015.
HEALTHY DEVELOPMENTS
A roundup of the week’s health and medicine news
Dr. Bajaj
Dr. Jasmohan Bajaj
- A Richmond researcher and physician travels to London for induction on July 25 as a fellow in the Royal College of Physicians. Jasmohan Bajaj, a gastroenterologist and liver specialist with Hunter Holmes McGuire VA Medical Center and the VCU School of Medicine, was nominated for his research, according to a McGuire release.
- A symposium on breastfeeding is set for Aug. 4 at the Virginia Historical Society, 428 N. Boulevard. "First Food: The Intersection of Health, Race, Policy and Practice," is the focus of the event. The morning session is open to the public, but registration is required. The sponsor is #RVAbreastfeeds.
- A 5-kilometer road race and 1-mile fun run will be staged Aug. 12 in a benefit for the Colorado Fund for Muscular Dystrophy. The race begins and ends at the Filipino Festival at Our Lady of Lourdes Catholic Church, 8200 Woodman Road, Henrico. The fund is a legacy of the late Midlothian resident Aileen Colorado, who lived with muscular dystrophy from birth and made a career of advocating for employment for those with disabilities. Organizers seek to raise $10,000 through the race, with proceeds benefiting people with muscular dystrophy.
- Does a smart phone make you dumb? According to a study reported in Science Daily, even if the ringer is shut off on your phone, simply having it on your desk is linked with lower performance in an assessment of how much information your brain can hold and process.
