ICS 614 MEDICAL INFORMATICS I
Dennis Streveler
September 14, 2004
FACTOIDS
I. HEALTH ECONOMICS
Health Spending per Capita in 1999(in U.S. dollars adjusted for purchasing power parity)
Total Physicians in the United States
Health care business trends
20% of the workforce uses 80% of the health care resources
2003-2007 Drug Cost Trend Forecast
Prescription Drugs for Seniors - Annual Cost for Most Expensive of Top 50 Popular Drugs
Administrative Expenses - California HMOs
Administrative Cost Per Member Per Month
Average 2001-2002 PMPM Rates: Nephrology
Average Annual Growth of Medicaid Expenditures for Selected Services, 1997-2000
Factors Contributing to 17.1% ($22.5 billion) Increase in Retail Prescription Drug Spending
Five-Year Summary of Prescription Drug Trends
Growth in Medicare Beneficiaries' Out-of-Pocket Prescription Drug Expenditures
High Spending Medicare Beneficiaries
Functional Area PMPM Costs
HMO Penetration Rates by Region, as of July 2002
Health Care Cost Drivers of Most Concern for 2004 and 2005
Hospital Expenses per Inpatient Stay, 1997-2001
Employees Paying on Average 35% of Premium for HMOs; PPO Family Contribution Rises to 58%
Employer Spending to Sponsor and Fund Employee Health Insurance Benefits Rises to $330.9 Billion in 2003
II. DISEASE STATE MANAGEMENT
Top 10 Leading Causes of Death in 2001
Cost Savings of Disease Management Programs for Lower Back Pain
Ovarian Cancer
Death from Lung Diseases, Percent by Subgroup, United States, 1999
Diabetes - Per Capita Medical Expenditures in 2002
Diabetes - Rising Hospital Charges, Lower Hospital Stays
Average Number of Unproductive Hours in a Typical Eight-Hour Work Day, by Condition*
Diabetes PMPY Cost Estimates: 2001-2002 Summary and 2003-2007 Forecast
Avoidable Sick Days Due to Suboptimal Care (U.S. Workforce)
Cardiovascular Disease Statistics
III. HEALTH INSURANCE
Percentage of Self-Funded Plans by Plan Type*
Percentage of Firms Offering Health Benefits, by Firm Size, 1996-2003
Average Annual Premium Costs for Covered Workers (Single), 2003
Average Employee Health Care Premium Contributions for 2004
Average employee premium contribution, single and family, July 2003
Average Health Benefit Costs, January 2003
Commercial Primary Care PMPM Rates, 2000-2002
Consumer Copayments by Drug Type, 2001-2002
Consumer out-of-pocket health care costs average $694 per capita.
IV. ADOPTION
Where Do HealthCare Professionals Go Online?
Physician's Use of the Internet
CIO Technology-Adoption Predictions, 2002-2003
What Are the Major Factors That Are Driving the Need for Electronic Health Record (EHR) Systems?
MCO Online capabilities
V. UTILIZATION MANAGEMENT
Number of Physicians per 1,000 Population
Ambulatory Care Visits per Capita by Age, 2000
Ambulatory Utilization Measures for Commercial Health Plans, U.S. 2002
Median Number of Ambulatory Encounters Per Physician, by Specialty
Average Length of Stay for Male and Nonobstetric Female Patients, by Age, 2000
Average Length of Stay in Community Hospitals, 1990-2000
Average Length of Stay in Days, 1995-2001
Days per 1,000 Members - All Providers - Medicare 2000-2002
Major Reason for Outpatient Visits - All US, 2000
Mean & Median Inpatient Length of Stay (LOS) by Payer, All Discharges in 2000
VI. SATISFACTION & CONSUMER DYNAMICS
Americans' Satisfaction with Choice of Primary Care Physicians Available in Health Plans
Nearly one quarter of medical residents indicate that they would select another field
Nursing Statistics Among Various States, 2003
VII. RESOURCE MANAGEMENT
Mean Waiting Time for Nonurgent Visits to the Emergency Room, 1997-2000
VIII. QUALITY MANAGEMENT
Commercial HEDIS 2003 Audit Means, Percentiles and Ratios for Breast Cancer Screening
Medicaid HEDIS 2003 Audit Means, Percentiles and Ratios for Breast Cancer Screening
Excess length of stay and charges associated with medical injuries that occur during hospitalization
Medicare Spending and Quality of Care
Patient Safety in American Hospitals - Medicare Patients
I. HEALTH ECONOMICS
DAILY FACTOIDHealth Spending per Capita in 1999(in U.S. dollars adjusted for purchasing power parity)
Country / Health Spending per CapitaUnited States / $4,358
Switzerland* / $2,853
Canada / $2,463
Norway / $2,388
Germany* / $2,361
Netherlands / $2,259
Japan* / $1,796
Sweden* / $1,732
United Kingdom / $1,569
*1998 or 1990-1998
Data Source:Organization for Economic Cooperation and Development (OECD), 2001, as reported by Reinhardt et al., 2002
Publication: Medical Cost Reference Guide, Revised June 2003, Blue Cross Blue Shield Association.
DAILY FACTOIDTotal Physicians in the United States & Selected States: 1975, 1985, 1995 and 2000
Physicians* per 10,000 civilian population
State|1975|1985|1995**|2000***
US|15.3|20.7|24.2|25.8
New York|22.7|29.0|35.3|36.2
Minnesota|14.9|20.5|23.4|24.9
Florida|15.2|20.2|22.9|24.1
Texas|12.5|16.8|19.4|20.3
*Includes active non-Federal doctors of medicine and active duty doctors of osteopathy.
**Data for doctors of osteopathy are as of July 1996.
***Data for doctors of osteopathy are as of January 2001.
Data Sources: American Medical Association (AMA). Physician distribution and medical licensure in the U.S., 1975; Physician characteristics and distribution in the U.S., 1986 edition; 1996-97 edition; 2002-2003 edition. Department of Data Suruvey and Data Resources, AMA (Copyrights 1976, 1986, 1997, 2002: Used with permission of the AMA); American Osteopathic Association:1975-76 Yearbook and Directory of Osteopathic Physicians, 1985-86 Yearbook and Directory of Osteopathic Physicians; Rockville, Md. American Association of Colleges of Osteopathic Medicine: Annual Statistical Report, 1996 and 2000.
Publication: Active non-Federal physicians and doctors of medicine in patient care, according to geographic division and State: Health, United States, 2002. For additional information, please visit
Health care business trends having the greatest overall impact in 2004
The following survey question was asked in the February 2004 issue of MCOL's Future Care E-Poll:
Which of the following health care business trends do you think will have the greatest overall impact in 2004? (2003 Last Year’s Survey) *
Trend / This Year / Last YearAdvances in health care technology / 11.9% / 10.8%
Consumer Driven and defined contribution health plans / 14.4% / 15.1%
HIPAA Compliance / 5.9% / 18.0%
Medicare Prescription Reform Act of 2003 / 4.3% / N/A
Increased consumer cost sharing / 35.6% / 38.8%
Disease Management initiatives / 23.7% / N/A
Nursing Shortage / N/A / 7.2%
Hospital Medicare Outlier Payment Reform / N/A / 6.5%
Other / 4.2% / 3.6%
Grand Total / 100.0% / 100.0%
* = 118
Source: MCOL's Future Care 2004 E-Poll, conducted for MCOL Members and Healthcare Web Summit Attendees. These results were featured in @E-Poll, February 2004, Vol 5, Issue 2. @E-Poll is a periodic e-newsletter with MCOL surveys and survey results. For additional information on MCOL surveys, please visit
DAILY FACTOID20% of the workforce uses 80% of the health care resources
According to data presented by Hewitt Associates at the 2003 Defined Care Healthcare Web Summit, when evaluating the distribution of health care costs via average covered charges, the lowest-cost group represents only 0.2% of total covered charges. The highest-cost group, with the same number of claimants, represent 65.4% of total covered charges.
Percent of Claimants / Distribution of Costs (Average covered charges) / Distribution of Costs as a Percent of Total10% / $50 / 0.2%
10% / $110 / 0.4%
10% / $210 / 0.7%
10% / $380 / 1.3%
10% / $600 / 2.0%
10% / $950 / 3.2%
10% / $1,460 / 4.9%
10% / $2,360 / 8.0%
10% / $4,090 / 13.9%
10% / $19,260 / 65.4%
Total: 100% / Total: $29,470 / Total: 100%
Source: Taking Control of Health Care Costs: The Six Decisions Framework, Jack Bruner, Hewitt Associates, presented at the Defined Care 2003 Healthcare Web Summit, March 2003.
DAILY FACTOID2003-2007 Drug Cost Trend Forecast
The table below lists estimated drug cost increases between 2003 and 2007, as presented in Express Scripts' 2002 Drug Trend Report. According to findings presented in this report, these estimated growth rates translate into PMPY (per member per year) incredient costs growing by 107 percent over the next five years from $585.60 in 2002 to $1,212.45 in 2007.
Year / Cost Increase2003 / 15.5%
2004 / 16.0%
2005 / 16.0%
2006 / 15.6%
2007 / 15.2%
Source: 2002 Drug Trend Report, Express Scripts, Inc.
For additional information, please visit
DAILY FACTOIDPrescription Drugs for Seniors - Annual Cost for Most Expensive of Top 50 Popular Drugs
According to a new report released by Families USA on prescription drugs for seniors, of the 50 top prescribed drugs, the most expensive as of January 2003, were the following:
*Combivent, which treats asthma and other respiratory conditions, costs $10,868 per year.
*Miacalcin, an osteoporosis treatment, costs $7,132 per year.
*Celebrex, an anti-inflammatory/analgesic, costs $2,102 per year.
Source: Out-of-Bounds, Rising Prescription Drug Prices for Seniors, A Report by Families USA, July 2003
For additional information, please visit
DAILY FACTOIDAdministrative Expenses - California HMOs
In 2002, California HMOs reported spending $4.2 billion in administrative costs. On average, they spent 8.1% of their revenues on administration, and $15.38 per member per month.
Source: California Health Care Market Report 2004. For additional information, please visit
DAILY FACTOIDAdministrative Cost Per Member Per Month
By Product Line for Blue Cross Blue Shield Plans' Administrative Expenses: 2002
Costs Per Member Per Month - By Product Line
Low /
High /
Mean /
Range / Range /
Mean
Commercial HMO
Insured / $16.76 / $34.93 / $25.00 / $18.17 / 72.7%
ASO / $12.97 / $25.17 / $18.49 / $12.20 / 66.0%
Commercial POS
Insured / $15.73 / $43.61 / $26.80 / $27.88 / 104.1%
ASO / $12.94 / $28.48 / $18.57 / $15.55 / 83.7%
Indemnity & PPO
Insured / $11.28 / $30.98 / $22.62 / $19.70 / 87.1%
ASO / $10.12 / $19.55 / $14.86 / $9.43 / 63.5%
Medicare+Choice / $28.37 / $52.51 / $41.81 / $24.15 / 57.8%
Medicaid / $16.86 / $27.08 / $21.00 / $10.23 / 48.7%
Medicare Supplemental / $8.57 / $28.38 / $16.77 / $19.82 / 118.2%
Stand-alone Dental / $1.85 / $4.67 / $3.28 / $2.82 / 85.8%
Copyright Sherlock Company. All Rights Reserved.
Source: ADMINISTRATIVE EXPENSE BENCHMARKS FOR HEALTH PLANS, published in SEER - Sherlock Expense Evaluation Report - BCBS Plan and Public Companies Editions - 2002 Report.
For more information, please visit:
Reprinted with permission.
DAILY FACTOIDAverage 2001-2002 PMPM Rates: Nephrology
2002 PMPM / 2001 PMPMCommercial Average / $0.15 / $0.15
Medicare Average / $1.57 / $1.14
Source: Capitation Rates & Data, Volume IV. National Health Information.
Reprinted with permission.
For additional information, please visit
DAILY FACTOIDAverage Annual Growth of Medicaid Expenditures for Selected Services, 1997-2000
All Medical Services: 7.7%
InpatientHospital: 3.6%
Physician, Lab, X-Ray: -2.4%
OutpatientHospital, Clinic: 4.6%
Prescribed Drugs: 18.1%
Nursing Facilities: 6.9%
HCBS Waivers: 13.7%
Prepaid/Managed Care: 18.4%
Source: CMS, CMSO, Financial Management Reports (HCFA64 data)
All growth rates shown represent changes in total fee-for-service expenditures for the types of services listed, except prepaid/managed care. Prepaid/managed care expenditures cover a wide range of medical services. Data are for federal fiscal years (October-September)
Publication: Medicaid and the Prescription Drug Benefit, Kaiser Family Foundation, September 2002. For additional information, please visit
DAILY FACTOIDFactors Contributing to 17.1% ($22.5 billion) Increase in Retail Prescription Drug Spending, 2000-2001
Shift to higher-cost drugs: 24%
Increase in number of prescriptions: 39%
Price increase: 37%
Data Source: American Institutes for Research (AR) analysis of Scott-Levin and Bureau of Labor Statistics data.
Publication: Prescription Drug Expenditures in 2001: Another Year of Escalating Costs (March 29, 2002).
Data used with permission.
Five-Year Summary of Prescription Drug Trends for Actives & Retirees under Age 65*: 1999 - 2002 Actual** & 2003 Projected
YEAR / RETAIL / MAIL ORDER1999 / 14.2% / 14.2%
2000 / 16.3% / 16.3%
2001 / 16.9% / 16.9%
2002 / 16.8% / 16.8%
2003 / 19.5% / 18.9%
* Actual prescription drug trend was not captured separately for retirees under and over age 65.
** Composite of retail and mail order drugs.
Source: 2003 Segal Health Plan Cost Trend Survey.
Complete findings from this survey are available in the MCOL Paid member web site.
DAILY FACTOIDGrowth in Medicare Beneficiaries' Out-of-Pocket Prescription Drug Expenditures, 2000-2004
Year / Average Annual Out-of-Pocket Drug Costs2000 / $644
2001 / $753
2002 / $866
2003 / $996
2004 / $1,147
Source: Actuarial Research Corporation analysis for The Kaiser Family Foundation (using CBO's 2003 estimates of prescription drug spending, which reflects adjustments in historical spending and lower expected economic growth in the near term).
Publication: Medicare and Prescription Drugs, The Kaiser Family Foundation, February 2003. For additional information, please visit
DAILY FACTOIDHigh Spending Medicare Beneficiaries
According to a new report published in the December 10, 2003 issue of Health Affairs, Medicare spending is highly concentrated, with a small number of beneficiaries accounting for a large proportion of annual expenditures. During 1995–1999 the most costly 5 percent of beneficiaries in each year accounted for 47 percent of total Medicare spending, while the most costly 20 percent accounted for 84 percent of spending. By contrast, the least costly 40 percent of beneficiaries accounted for 1 percent of spending.
Source: Reducing The Growth Of Medicare Spending: Geographic Versus Patient-Based Strategies, by Steven M. Lieberman, Julie Lee, Todd Anderson, and Dan L. Crippen. Health Affairs, Web Exclusive, December 10, 2003. For full-text article, visit:
DAILY FACTOIDFunctional Area PMPM Costs
Benchmark Metrics / 25th Percentile / Mean / 75th Percentile / # of MetricsGovernance and Corporate Management / $0.63 / $0.92 / $1.27 / 52
Sales and Marketing / $4.51 / $5.11 / $5.35 / 118
Claims / $1.51 / $1.88 / $2.00 / 87
Information Systems / $3.51 / $5.41 / $6.58 / 107
Source: Managed Care Measures: Results of the 2002 Managed Care Benchmarking Study, Capgemini. For additional information, please visit
DAILY FACTOIDBenchmarks for Blue Cross Blue Shield Plans' Administrative Expenses: 2002
Cost Per Member Per Month - By Function, All Products
25th Percentile / 75th Percentile /
Mean /
Range / Range /
Mean
Marketing / $3.01 / $5.92 / $4.64 / $6.65 / 143.5%
Medical and Prov. Mgmt. / $1.42 / $2.24 / $1.93 / $2.29 / 118.3%
Acct. & Member. Adm. / $6.79 / $10.26 / $8.69 / $8.12 / 93.5%
Corporate Services / $2.61 / $5.20 / $4.12 / $6.88 / 167.2%
Theoretical Total / $13.83 / $23.62 / $19.37 / $23.94 / 123.6%
Actual Total / $16.37 / $21.00 / $19.20 / $18.85 / 98.2%
Source: 2002 Sherlock Expense Evaluation Report.
Copyright Sherlock Company. All Rights Reserved.
Used with permission.
For additional information, please visit
DAILY FACTOIDHMO Penetration Rates by Region, as of July 2002
REGION / HMO Penetration Rate - July 2002Northeast (CT, ME, MA, NH, RI, VT) / 36.8%
Mid-Atlantic (NJ, NY, PA) / 32.1%
South Atlantic (DE, DC, GA, FL, MD, NC, SC, VA, WV) / 22.3%
East South Central (AL, KY, MS, TN) / 16.2%
West South Central (AR, LA, OK, TX) / 15.9%
East North Central (IL, IN, MI, OH, WI) / 24.3%
West North Central (IA, KS, MN, MO, NE, ND, SD) / 27.1%
Mountain (AZ, CO, ID, MT, NV, NM, UT,WY) / 29.2%
Pacific (CA, HI, OR, WA) / 45.3%
National / 28.8%
Source: The Competitive Edge 13.1 Regional Market Analysis. For additional information, please visit:
DAILY FACTOIDHealth Care Cost Drivers of Most Concern for 2004 and 2005
The following question was asked in a recent e-poll conducted by MCOL for Managing Health Care Cost Healthcare Web Summit Attendees and MCOL members:
Which of the following cost drivers are you most concerned about for 2004 and 2005?(2003 and 2004 for Last Year’s Survey)
This Year / Last Year
Administrative Costs / 9% / 3.5%
Changing Patient Demographics / 7% / 7.8%
Hospital Payment Rates / 20% / 27.8%
Hospital Utilization / 8% / 7.8%
Liability Issues / 5% / 5.2%
New Technology / 11% / 10.4%
Other / 7% / 1.7%
Physician Payment Rates / 3% / 4.3%
Prescription Payment Rates / 17% / 13.9%
Prescription Utilization / 13% / 13.9%
Grand Total / 100.0% / 100.0%
n=100 for This Year; n = 124 for last year
Source: @E-POLL, November 2003: Managing Health Care Costs. @E-POLL is a periodic e-newsletter with MCOL surveys and survey results. For additional information about @E-POLL, please contact MCOL at 209.577.4888 or .
DAILY FACTOIDHospital Expenses per Inpatient Stay, 1997-2001
Year / Hospital Expenses Per Inpatient Stay1997 / $6,266
1998 / $6,388
1999 / $6,512
2000 / $6,651
2001 / $6,979
Source: Adapted from AmericanHospital Association, 2003.
Publication: Medical Cost Reference Guide, Revised June 2003. BlueCross BlueShield Association.
DAILY FACTOIDEmployees Paying on Average 35% of Premium for HMOs; PPO Family Contribution Rises to 58%
According to Mercer's National Survey of Employer-Sponsored Health Plans, in 2003, the average employee-only contribution for HMOs rose from 31% of premium (or the premium equivalent) to 35%, and the family contribution rose from 50% to 57%. In PPOs, the family contribution jumped from 53% to 58%. With pay increasing by only about 3% on average, for some employees higher premium contributions wiped out increases in total compensation.
Source: Mercer Human Resource Consulting, National Survey of Employer-Sponsored Health Plans 2003. For additional information, please visit
Employer Spending to Sponsor and Fund Employee Health Insurance Benefits Rises to $330.9 Billion in 2003
In 2003, private employers in the U.S. spent an estimated $330.9 billion to sponsor and fund employee health insurance benefits. This amount represented an increase of 12.1 percent over 2002 and of 51.4 percent increase compared to 1998.
Source: Employment Trends, August 3, 2004, Employment Policy Foundation. For additional information, please visit
II. DISEASE STATE MANAGEMENT
DAILY FACTOIDTop 10 Leading Causes of Death in 2001
1. Disease of heart
2. Malignant neoplasms
3. Cerebrovascular diseases
4. Chronic lower respiratory diseases
5. Accidents (unintentional injuries)
6. Diabetes Mellitus
7. Influenza and pneumonia
8. Alzheimer's disease
9. Nephritis, nephrotic syndrome and nephrosis
10. Septicemia
Source: Centers for Disease Control and Prevention. National Vital Statistics Reports, Vol 51, No. 5, March 14, 2003.
DAILY FACTOIDCost Savings of Disease Management Programs for Lower Back Pain
According to a results published in a new study released this week by the American Association of Health Plans/Health Insurance Association of America (AAHP/HIAA), disease management programs for commercial HMO and commercial self-insured plan members with lower back pain found that for every dollar spent on the program, costs were reduced between $1.30 and $1.50.
Source: The Cost Savings of Disease Management Programs: Report on a Study of Health Plans, AAHP/HIAA, November 2003. For additional information, please visit:
DAILY FACTOIDOvarian Cancer
According to the American Cancer Society, ovarian cancer ranks as the fifth largest cause of death from cancer in women. It is estimated that over 23,000 women will develop ovarian cancer in the US each year.
Publication Source: PHARMA BUSINESS DAILY BULLETIN, August 27, 2002
For additional information, please visit
Death from Lung Diseases, Percent by Subgroup, United States, 1999
Subgroup / PercentCOPD (Chronic Obstructive Pulmonary Disease) / 50.7%
Influenza and Pneumonia / 27.3%
External Agents / 7.0%
Cardiopulmonary Diseases / 5.6%
Other / 4.9%
Neonatal Pulmonary Disorders / 2.5%
Asthma / 2.0%
Source: Morbidity & Mortality: 2002 Chart Book on Cardiovascular, Lung, and Blood Diseases. National Institute of Health, National Heart, Lung and Blood Institute. May 2002.
DAILY FACTOIDDiabetes - Per Capita Medical Expenditures in 2002
Per capita medical expenditures totaled $13,243 for people with diabetes and $2,560 for people without diabetes. When adjusting for differences in age, sex, and race/ethnicity between the population with and without diabetes, people with diabetes had medical expenditures that were 2.4 times higher than expenditures that would be incurred by the same group in the absence of diabetes.
Source: Economic Costs of Diabetes in the U.S. in 2002, Amercian Diabetes Association. Diabetes Care 26:917-932, 2003. For additional information, please visit
DAILY FACTOIDDiabetes - RisingHospital Charges, LowerHospital Stays
The total average hospital charge for treating patients with Diabetes rose from $11,021 in 1993 to $14,779 in 2000, while during this same time period the average number of days a patient spent in the hospital declined from 7.4 days to 5.6 days
Source: AHRQ Data Show Rising Hospital Charges, Falling Hospital Stays. Press Release, September 18, 2002. Agency for Healthcare Research and Quality, Rockville, MD.