congressional budget office
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Congressional Budget Office
Presentation to the Alliance for Health Reform
The Outlook for Health Care Spending
January 28, 2008
Federal Spending Under CBO’s AlternativeFiscal Scenario
Percentage of Gross Domestic Product
1962 1972 1982 1992 2002 2012 2022 2032 2042 2052 2062 2072 2082
0
10
20
30
40
Medicare and Medicaid
Actual Projected
Social Security
Other Spending (Excluding debt service)
Federal Debt Held by the Public as a Percentage of Gross Domestic Product Under CBO’s Long-Term Budget Scenarios
1962 1972 1982 1992 2002 2012 2022 2032 2042 2052 2062 2072 2082
0
100
200
300
400
Alternative Fiscal Scenario
Extended-BaselineScenario
Actual Projected
Federal Fiscal Imbalance Under CBO’s Long-Term Budget Scenarios
Projection Period Revenues Outlays Fiscal Gap
Extended-Baseline Scenario
25 Years (2008–2032) 20.2 19.5 -0.7
50 Years (2008–2057) 21.3 21.9 0.6
75 Years (2008–2082) 22.1 23.8 1.7
Alternative Fiscal Scenario
25 Years (2008–2032) 18.6 21.4 2.8
50 Years (2008–2057) 18.8 24.1 5.2
75 Years (2008–2082) 19.2 26.1 6.9
Percentage of Gross Domestic Product
Contribution of Aging to the Fiscal Gap Under CBO’s Alternative Fiscal Scenario
Percentage of Gross Domestic Product
2008–2032 2008–2057 2008–2082
0
1
2
3
4
5
6
7
8
Pure Effect of Aging Starting from Zero Excess Cost Growth
Additional Effect of Aging Within the Scenario
Portion of the Fiscal Gap Not Attributable to Aging
2.8
5.2
6.9
Spending on Health Care as a Percentage of Gross Domestic Product
Percent
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
0
2
4
6
8
10
12
14
16
18
Medicare
Medicaid
All Other Health Care
Excess Cost Growth in Medicare, Medicaid, and All Other Spending on Health Care
Medicare Medicaid All Other Total
1975 to 1990 2.9 2.9 2.4 2.6
1990 to 2005 1.8 1.3 1.4 1.5
1975 to 2005 2.4 2.2 2.0 2.1
Percentage Points
Projected Spending on Health Care as a Percentage of Gross Domestic Product
Percent
2007 2012 2017 2022 2027 2032 2037 2042 2047 2052 2057 2062 2067 2072 2077 2082
0
5
10
15
20
25
30
35
40
45
50
All Other Health Care
Medicaid
Medicare
Sources of Growth in Projected Federal Spending on Medicare and Medicaid
Percentage of GDP
2007 2012 2017 2022 2027 2032 2037 2042 2047 2052 2057 2062 2067 2072 2077 2082
0
5
10
15
20
Effect of Excess Cost Growth
Effect of the Aging of the Population
Medicare Spending per Capita in the United States, by Hospital Referral Region, 2003
Source: www.dartmouthatlas.org.
$7,200 to 11,600 (74)6,800 to < 7,200 (45)
6,300 to < 6,800 (55)5,800 to < 6,300 (60)
4,500 to < 5,800 (72)Not Populated
The Relationship Between Quality and Medicare Spending, by State, 2004
73
78
83
88
4,000 5,000 6,000 7,000 8,000
Spending (Dollars)
Composite Measure of Quality of Care
Source: Data from AHRQ and CMS.
What Additional Services Are Provided in High-Spending Regions?
Source: Elliot Fisher, Dartmouth Medical School.
Variations Among Academic Medical Centers
UCLA Medical Center
Massachusetts General Hospital
Mayo Clinic(St. Mary’s Hospital)
Biologically Targeted Interventions: Acute Inpatient Care
CMS composite quality score 81.5 85.9 90.4
Care Delivery―and Spending―Among Medicare Patients in Last Six Months of Life
Total Medicare spending 50,522 40,181 26,330
Hospital days 19.2 17.7 12.9
Physician visits 52.1 42.2 23.9
Ratio, medical specialist / primary care 2.9 1.0 1.1
Use of Biologically Targeted Interventions and Care-Delivery Methods Among Three of U.S. News and World Report’s “Honor Roll” AMCs
Source: Elliot Fisher, Dartmouth Medical School.
Share of Personal Health Care Expenditures Paid Out of Pocket
1975 1985 1995 2005 2015
0
5
10
15
20
25
30
35
33%
26%
17%15%
13%
Percent
Concentration of Total Annual Medicare Expenditures Among Beneficiaries, 2001
Percent
Beneficiaries Expenditures
0
10
20
30
40
50
60
70
80
90
100
3.8
11.2
23.5
18.4
43.1
55
15
25
50
Source: CBO based on data from CMS.
CBO Health Activities
New Hires and Expanded Staffing– New deputy assistant director (Keith Fontenot) in the Budget
Analysis Division– Health staff agency wide increase from 30 FTEs to 40 FTEs
(Plus 6 new hires)– FY 2009 Plans
Reports and Analysis in 2008– Critical Topics in Health Reform– Health Options
Difference in Life Expectancy Between Lowest and Highest Economic Status Decile
Source: Data from Singh and Siahpush 2006
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
At Birth At Age 65
Yea
rs 1980-1982
1998-2000
Increase in Life Expectancy and Increase in Difference in Life Expectancy by Economic Status
Source: Data from Singh and Siahpush 2006 and CDC
0
0.5
1
1.5
2
2.5
3
3.5
4
At Birth At Age 65
Yea
rs
Increase in Average LifeExpectancy, 1980-2000Increase in Average LifeExpectancy, 1980-2000
Increase in Average LifeExpectancy, 1980-2000Increase in Difference inAverage Life ExpectancyBetween Lowest andHighest Decile, 1980-2000
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