health insurance or groceries? health care trends: analysis of real changes in u.s. health care and...

Abstract: The purpose of this report is to assess real changes in the costs of health care and health insurance in the U.S. and in 18 major metropolitan areas in the U.S. from 1998 to 2008. Additionally, this report identifies age groups that have experienced the largest increases in their health care costs and health insurance costs during this time period. Published: January 2010

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Health Care Trends Analysis of Real Changes in U.S. Health Care and Health Insurance Costs from 1998 to 2008

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Table of Contents Summary of Key Findings ............................................................................................................................................................................................................................... 2 U.S. Health Care Costs .................................................................................................................................................................................................................................... 5 U.S. Health Care Costs by Age ..................................................................................................................................................................................................................... 6 U.S. Health Insurance Costs by Age .............................................................................................................................................................................................................. 7 Health Insurance as a Percent of Total Health Care Costs ....................................................................................................................................................................... 8 U.S. Changes in Income, Health Care, and Health Insurance Costs ........................................................................................................................................................ 9 U.S. Health Care Costs as a Percent of Income ........................................................................................................................................................................................ 10 Western Metro Areas .................................................................................................................................................................................................................................... 11 Northeastern Metro Areas ............................................................................................................................................................................................................................ 12 Southern Metro Areas ................................................................................................................................................................................................................................... 13 Midwestern Metro Areas .............................................................................................................................................................................................................................. 14 U.S. Metro Area Income Changes ............................................................................................................................................................................................................... 15 U.S. Metro Area Health Care Cost Changes ............................................................................................................................................................................................ 16 Differences Between Health Care Cost and Income Changes ............................................................................................................................................................... 17 Health Care Costs as a Percent of Income by Metro Area .................................................................................................................................................................... 18 U.S. Metro Area Health Care Costs ............................................................................................................................................................................................................ 19

Disclaimer These materials and the information contained herein are provided by Zpryme Research & Consulting, LLC and are intended to provide general information on a particular subject or subjects and is not an exhaustive treatment of such subject(s). Accordingly, the information in these materials is not intended to constitute accounting, tax, legal, investment, consulting or other professional advice or services. The information is not intended to be relied upon as the sole basis for any decision which may affect you or your business. Before making any decision or taking any action that might affect your personal finances or business, you should consult a qualified professional adviser. These materials and the information contained herein is provided as is, and Zpryme Research & Consulting, LLC makes no express or implied representations or warranties regarding these materials and the information herein. Without limiting the foregoing, Zpryme Research & Consulting, LLC does not warrant that the materials or information contained herein will be error-free or will meet any particular criteria of performance or quality. Zpryme Research & Consulting, LLC expressly disclaims all implied warranties, including, without limitation, warranties of merchantability, title, fitness for a particular purpose, noninfringement, compatibility, security, and accuracy. Prediction of future events is inherently subject to both known and unknown risks, uncertainties and other factors that may cause actual results to vary materially. Your use of these and the information contained herein is at your own risk and you assume full responsibility and risk of loss resulting from the use thereof. Zpryme Research & Consulting, LLC will not be liable for any special, indirect, incidental, consequential, or punitive damages or any other damages whatsoever, whether in an action of contract, statute, tort (including, without limitation, negligence), or otherwise, relating to the use of these materials and the information contained herein.

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“ Health Care Insight

Clearly, getting spiraling health insurance costs under control is the key to stabilizing health care costs for all Americans.

Some Americans have seen their incomes grow just as fast as or faster than their health care costs. Thus the financial adversity caused by increasing health care costs is not equally shared among all Americans.

Americans now have to make more incremental economic choices such as paying their insurance co-payment to see a doctor or to purchase a day’s worth of groceries for their family. In fact, Americans age 65 and above are most likely to face such economic choices as their health care costs as a percent of their income are almost three times higher than other Americans.

—Jason S. Rodriguez, Zpryme CEO & Director of Research

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Purpose

The purpose of this report is to assess real changes in the costs of health care and health insurance in the U.S. and in 18 major metropolitan areas in the U.S. from 1998 to 2008. Additionally, this report analyzes the change in average annual income for U.S. consumers. Last, this report identifies age groups that have experienced the largest increases in their health care costs and health insurance costs from 1998 to 2008. Inflation Adjustment and Data Sources In this analysis Zpryme standardized U.S. historical annual average income, health care costs, and health insurance costs from 1998 to 2008 using the Consumer Price Index (CPI) for urban consumers. In this analysis all values are converted to 2008 constant dollars. Due to inflation, the purchasing power of the dollar changes over time, so in order to compare dollar values from one year to another they need to be converted to constant dollar values. By adjusting for inflation, we can uncover the real growth in annual average health care costs and health insurance costs from 1998 to 2008. Data for this analysis was obtained from the U.S Bureau of Labor Statistics Consumer Expenditure Survey and Consumer Price Index.

Summary of Key Findings

In 2008, health insurance costs accounted for 56.0% of total health care costs versus 48.0% of total health care costs in 1998.

From 1998 to 2008, inflation adjusted health care costs for consumers age 55-64, 65-74, and 75 and up increased by $975, $905, and $532, respectively.

From 1998 to 2008, inflation adjusted health insurance costs for consumers age 65-74 and 75 and up increased by $855 and $798, respectively.

From 1998 to 2008, health insurance costs as a percent of total health care costs increased across all age groups in this analysis.

From 1998 to 2008, among all U.S. consumers, inflation adjusted income, health care, and health insurance costs increased by 16.0%, 18.0%, and 37.0%, respectively. Health care and health insurance costs increased the most among 55-64 year-olds.

In 2008, health care costs as a percent of total income were highest among consumers age 65 and up.

From 1998 to 2008, Cleveland, Seattle, San Francisco, Boston, Phoenix, and Minneapolis-St. Paul experienced the greatest increase in their health care costs relative to their increase in income.

After adjusting for inflation, 16 out of the 18 U.S. metro areas in this analysis experienced an increase in their health care costs from 1998 to 2008.

All 18 U.S. metro areas in this analysis experienced an increase in their average annual income from 1998 to 2008.

From 1998 to 2008, health care costs as a percent of total income increased for 10 of the metro areas in this analysis and decreased for 8 of the metro areas in this analysis.

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U.S. Health Care Costs From 1998 to 2008, U.S. inflation adjusted health care costs increased from $2,514 to $2,976. During this time period, inflation adjusted health insurance costs increased from $1,206 to $1,653. In 2008, health insurance costs accounted for 56.0% of total health care costs versus 48.0% of total health care costs in 1998.

Data: U.S Bureau of Labor Statistics: Consumer Expenditure Survey and Consumer Price Index (1998 – 2008)

$2,514 $2,532$2,583

$2,653

$2,813 $2,828

$2,934 $2,937 $2,954 $2,963 $2,976

$1,206 $1,193 $1,229$1,290

$1,398$1,465

$1,518 $1,500$1,565

$1,604$1,653

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average U.S. Health Care and Health Insurance Costs, 1998 – 2008(inflation adjusted to 2008 constant dollars)

Health care Health insurance

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U.S. Health Care Costs by Age As expected, higher inflation adjusted health care costs are strongly related to the age of consumers. From 1998 to 2008, inflation adjusted health care costs for consumers age 55-64, 65-74, and 75 and up increased by $975, $905, and $532, respectively. Consumers under 25 and 25-54 experienced the smallest increases in their health care costs when compared to the other age groups in this analysis.


$588$712

$630 $644$766

$639$745 $776 $754

$831

$682

$1,565 $1,512 $1,570 $1,563$1,696 $1,718 $1,731 $1,678

$1,764 $1,807$1,737

$2,230$2,108

$2,218$2,284

$2,370$2,464

$2,579$2,505

$2,439 $2,404$2,499

$2,887

$2,821$2,751 $2,754

$3,052$2,901

$3,072$2,946 $2,944 $2,899 $2,930

$2,850

$3,166 $3,136$3,286

$3,599 $3,580$3,718 $3,759 $3,798

$3,609

$3,825$3,874 $3,865

$3,955

$4,356 $4,295

$4,244$4,330

$4,604

$4,677

$5,158

$4,779

$3,881$3,944

$4,173 $4,130 $4,290

$4,513 $4,553

$4,641

$4,573$4,439 $4,413

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

$5,500

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average U.S. Health Care Costs, 1998 – 2008by Age Group | (inflation adjusted to 2008 constant dollars)

Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up

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U.S. Health Insurance Costs by Age From 1998 to 2008, inflation adjusted health insurance costs for consumers age 65-74 and 75 and up increased by $855 and $798, respectively. Consumers age 25-54 experienced the smallest increases in their health insurance costs when compared to the other age groups in this analysis.


$272 $301 $264$305 $341 $329 $366

$416 $392$412

$389

$798 $772 $800$845

$912 $948 $960$906 $943 $953 $983

$1,043$964

$1,063$1,125

$1,224$1,298

$1,367$1,279 $1,296 $1,318 $1,341

$1,243 $1,217 $1,220$1,262

$1,412 $1,365$1,471

$1,414 $1,399$1,439

$1,523

$1,309 $1,374$1,415 $1,445

$1,623

$1,840$1,786 $1,747

$1,790 $1,818

$1,945

$2,046 $2,032$2,010

$2,138

$2,299 $2,310

$2,474

$2,593

$2,903 $2,929 $2,901

$1,985 $1,982

$2,039

$2,179 $2,213

$2,377 $2,411$2,491

$2,682

$2,820 $2,783

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average U.S. Health Insurance Costs, 1998 – 2008by Age Group | (inflation adjusted to 2008 constant dollars)

Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up

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Health Insurance as a Percent of Total Health Care Costs Across all age groups, from 1998 to 2008, health insurance costs accounted for a larger amount of total health care costs. As expected, health insurance costs as a percent of total health care costs were the greatest for consumers age 65 and up. Interestingly, consumers age 55-64 paid the least amount of health insurance costs as a percent of their total health care costs in 2008.


46% 42% 42% 47% 45% 51% 49% 54% 52% 50% 57%

51% 51% 51%54% 54%

55% 55% 54% 53% 53%57%

47% 46% 48%49% 52%

53% 53% 51% 53% 55%54%

43% 43% 44%46% 46%

47% 48% 48% 48% 50%52%

46%43% 45%

44% 45%

51% 48% 46% 47% 50%51%

53%53% 51%

49%54%

54% 57% 56% 62% 57%61%

51%50%

49%53% 52%

53%53% 54%

59% 64%

63%

0%

50%

100%

150%

200%

250%

300%

350%

400%

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

U.S. Health Insurance Costs as a Percent of Total Health Care Costs, 1998 – 2008by Age Group | (inflation adjusted to 2008 constant dollars)

75 and up

65 to 74

55 to 64

45 to 54

35 to 44

25 to 34

Under 25

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U.S. Changes in Income, Health Care, and Health Insurance Costs From 1998 to 2008, among all U.S. consumers, inflation adjusted income, health care, and health insurance costs increased by 16.0%, 18.0%, and 37.0%, respectively. Health care and health insurance costs increased the most among 55-64 year-olds. Consumers under 25, 65-74, and 75 and up also experienced a significant increase in health insurance costs.


16%

26%

8%

15%

6%

23%

27%

23%

18%

16%

11%12%

1%

34%

23%

14%

37%

43%

23%

29%

23%

49%

42%40%

0%

10%

20%

30%

40%

50%

60%

All U.S. Consumers Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up

Percent Change in Annual Average Income, Health Care Costs, and Health Insurance Costs,1998 - 2008by Age Group| (inflation adjusted to 2008 constant dollars)

Income Before Taxes Health Care Health Insurance

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U.S. Health Care Costs as a Percent of Income Among all U.S. consumers, health care costs as a percent of total income increased from 2.2% to 2.6% from 1998 to 2008. In 2008, health care costs as a percent of total income were highest among consumers age 65 and up.


2.2%

1.2%

1.4%

1.6%

1.6%

2.2%

5.7%

7.4%

2.6%

1.4%

1.6%

1.7%

1.9%

2.7%

6.4%

8.5%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0%

All U.S. Consumers

Under 25

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 and up

Health Care Costs as a Percent of Income,1998 - 2008by Age Group| (inflation adjusted to 2008 constant dollars)

2008

1998

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Western Metro Areas Among the 5 Western metro areas in this analysis, Seattle had the highest health care costs in 2008 ($3,373) while San Diego had the lowest ($1,840). From 1998 to 2008, inflation adjusted health care costs in Los Angeles, San Francisco, Seattle, and Phoenix increased by 19.6%, 41.2%, 55.3%, and 39.3%, respectively. During this time period, health care costs in San Diego decreased by 22.2%.


$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

$2,500

$2,750

$3,000

$3,250

$3,500

$3,750

$4,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average Health Care Costs, 1998 – 2008Los Angeles, San Francisco, San Diego, Seattle, and Phoenix Metro Areas

(inflation adjusted to 2008 constant dollars)

Los Angeles San Francisco San Diego Seattle Phoenix

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Northeastern Metro Areas Among the 5 Northeastern metro areas in this analysis, Washington, D.C. had the highest health care costs in 2008 ($2,996) while Baltimore had the lowest ($2,571). From 1998 to 2008, inflation adjusted health care costs in Washington, D.C., Baltimore, New York, Philadelphia, and Boston increased by 1.3%, 21.7%, 14.4%, 20.7%, and 31.3%, respectively.


$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

$2,500

$2,750

$3,000

$3,250

$3,500

$3,750

$4,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average Health Care Costs, 1998 – 2008Washington, D.C., Baltimore, New York, Philidelphia, and Boston Metro Areas


Washington, D.C. Baltimore New York Philadelphia Boston

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Southern Metro Areas Among the 4 Southern metro areas in this analysis, Houston had the highest health care costs in 2008 ($3,002) while Miami had the lowest ($1,933). From 1998 to 2008, inflation adjusted health care costs in Miami, Dallas-Fort Worth, and Houston increased by 3.2%, 0.4%, and 17.5%, respectively. During this time period, health care costs in Atlanta decreased by 3.6%.


$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

$2,500

$2,750

$3,000

$3,250

$3,500

$3,750

$4,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average Health Care Costs, 1998 – 2008Atlanta, Miami, Dallas-Ft Worth, and Houston Metro Areas


Atlanta Miami Dallas- Fort Worth Houston

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Midwestern Metro Areas Among the 4 Midwestern metro areas in this analysis, Minneapolis-St. Paul had the highest health care costs in 2008 ($3,365) while Detroit had the lowest ($2,432). From 1998 to 2008, inflation adjusted health care costs in Chicago, Detroit, Minneapolis-St. Paul, and Cleveland increased by 27.1%, 14.8%, 16.6%, and 82.1%, respectively.


$0

$250

$500

$750

$1,000

$1,250

$1,500

$1,750

$2,000

$2,250

$2,500

$2,750

$3,000

$3,250

$3,500

$3,750

$4,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Annual Average Health Care Costs, 1998 – 2008Chicago, Detroit, Minneapolis-St.Paul, and Cleveland Metro Areas


Chicago Detroit Minneapolis-St.Paul Cleveland

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U.S. Metro Area Income Changes After adjusting for inflation, all 18 U.S. metro areas in this analysis experienced an increase in their average annual income before taxes from 1998 to 2008. During this time period, Chicago, Baltimore, Washington, D.C., and Houston experienced the greatest increase in income. Minneapolis-St. Paul, Miami, Dallas-Fort Worth, and Detroit incomes increased the least among the 18 metro areas.


1.0%

1.6%

2.7%

3.7%

10.4%

11.7%

12.0%

12.8%

13.0%

13.5%

16.1%

21.7%

22.2%

22.4%

25.5%

27.5%

35.6%

35.7%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Minneapolis-St.Paul

Miami

Dallas- Fort Worth

Detroit

Atlanta

Philadelphia

San Diego

Los Angeles

Cleveland

Boston

Seattle

Phoenix

San Francisco

New York

Houston

Washington, D.C.

Baltimore

Chicago

Percent Change in Annual Average Income, 1998 - 2008by U.S. Metro Area | (inflation adjusted to 2008 constant dollars)

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U.S. Metro Area Health Care Cost Changes After adjusting for inflation, 16 out of the 18 U.S. metro areas in this analysis experienced an increase in their health care costs from 1998 to 2008. During this time period, Cleveland, Seattle, San Francisco, Phoenix, and Boston experienced the greatest increase in their health care costs. Only Atlanta and San Diego experienced a decrease in their health care costs during this time period.


-22.2%

-3.6%

0.4%

1.3%

3.2%

14.4%

14.8%

16.6%

17.5%

19.6%

20.7%

21.7%

27.4%

31.3%

39.3%

41.2%

55.3%

82.1%

-40% -20% 0% 20% 40% 60% 80% 100%

San Diego

Atlanta

Dallas- Fort Worth

Washington, D.C.

Miami

New York

Detroit

Minneapolis-St.Paul

Houston

Los Angeles

Philadelphia

Baltimore

Chicago

Boston

Phoenix

San Francisco

Seattle

Cleveland

Percent Change in Annual Average Health Care Costs, 1998 - 2008by U.S. Metro Area | (inflation adjusted to 2008 constant dollars)

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Differences Between Health Care Cost and Income Changes From 1998 to 2008, Cleveland, Seattle, San Francisco, Boston, Phoenix, and Minneapolis-St. Paul experienced the greatest increase in their health care costs relative to their increase in income. On the other hand, San Diego, Washington, D.C., Atlanta, and Baltimore experienced the greatest increase in their incomes relative to their increase in health care costs.


-34.3

-26.2

-14.0

-14.0

-8.3

-8.1

-8.0

-2.3

1.6

6.8

9.0

11.1

15.7

17.6

17.8

19.0

39.2

69.1

-40.0 -20.0 0.0 20.0 40.0 60.0 80.0

San Diego

Washington, D.C.

Atlanta

Baltimore

Chicago

New York

Houston

Dallas- Fort Worth

Miami

Los Angeles

Philadelphia

Detroit

Minneapolis-St.Paul

Phoenix

Boston

San Francisco

Seattle

Cleveland

Net Percentage Point Difference Between Change in Health Care Costs and Change in Income, 1998 - 2008by Metro Area | (infaltion adjusted to 2008 costant dollars)

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Health Care Costs as a Percent of Income by Metro Area From 1998 to 2008, health care costs as a percent of total income increased in 10 out of the 18 metro areas in this analysis. In 2008, health care costs as a percent of income were highest for consumers in Cleveland and Minneapolis-St. Paul and lowest for consumers in San Diego and Washington, D.C.


3.8%

3.6%

3.5%

3.2%

3.2%

3.9%

3.7%

3.4%

3.2%

3.4%

4.2%

3.7%

4.4%

4.6%

3.9%

3.4%

4.1%

3.6%

2.7%

2.9%

3.1%

3.3%

3.4%

3.4%

3.4%

3.6%

3.7%

3.9%

4.0%

4.1%

4.3%

4.3%

4.5%

4.5%

4.7%

5.8%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

San Diego

Washington, D.C.

Baltimore

Miami

Los Angeles

Atlanta

New York

Philadelphia

San Francisco

Boston

Houston

Detroit

Dallas- Fort Worth

Chicago

Phoenix

Seattle

Minneapolis-St.Paul

Cleveland

Health Care Costs as a Percent of Income,1998 - 2008by Metro Area| (inflation adjusted to 2008 constant dollars)

2008

1998

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U.S. Metro Area Health Care Costs Table 1. below shows that Cleveland and Seattle have experienced the largest net increases in their health care costs from 1998 to 2008. During this time period annual average health care costs in Cleveland increased from $2,005 to $3,651 and from $2,171 to $3,373 in Seattle. In 2008, Miami and San Diego paid the least in health care costs among the 18 metro areas in this analysis.

Table 1. Annual Average Health Care Costs, 1998 – 2008 by Metro Area (inflation adjusted to 2008 constant dollars)

Metro Area 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Net Change

1998 - 2008

% Change

1998 - 2008

Los Angeles $2,100 $2,271 $2,292 $2,316 $2,431 $2,570 $2,632 $2,508 $2,473 $2,413 $2,512 $412

19.6% San Francisco $2,352 $2,316 $2,538 $2,638 $2,812 $3,020 $3,163 $3,057 $3,012 $3,348 $3,321 $969

41.2%

San Diego $2,366 $2,391 $2,409 $2,153 $2,255 $2,663 $2,969 $3,349 $3,653 $2,713 $1,840 -$526

-22.2% Seattle $2,171 $2,495 $3,143 $3,014 $2,784 $3,195 $3,410 $3,208 $3,085 $3,247 $3,373 $1,202

55.3%

Phoenix $2,293 $2,594 $2,711 $2,493 $2,682 $2,986 $2,974 $3,186 $3,347 $3,175 $3,195 $902

39.3% Washington, D.C. $2,959 $2,846 $2,778 $2,778 $2,634 $2,679 $2,757 $2,767 $2,675 $2,742 $2,996 $37

1.3%

Baltimore $2,113 $2,043 $2,304 $2,292 $2,202 $2,467 $2,367 $2,442 $2,724 $2,524 $2,571 $458

21.7% New York $2,474 $2,408 $2,451 $2,587 $2,725 $2,616 $2,535 $2,659 $2,784 $2,777 $2,829 $355

14.4%

Philadelphia $2,222 $2,302 $2,224 $2,338 $2,475 $2,502 $2,423 $2,485 $2,337 $2,259 $2,682 $460

20.7% Boston $2,236 $2,179 $2,176 $2,411 $2,461 $2,349 $2,592 $2,893 $2,984 $2,917 $2,936 $700

31.3%

Atlanta $2,473 $2,371 $2,388 $2,362 $2,406 $2,227 $2,006 $2,025 $2,154 $2,445 $2,383 -$90

-3.6% Miami $1,873 $1,914 $2,183 $2,292 $2,357 $2,410 $2,193 $2,208 $2,339 $2,250 $1,933 $60

3.2%

Dallas- Fort Worth $2,776 $2,776 $2,454 $2,507 $2,911 $3,316 $3,491 $3,337 $3,284 $3,081 $2,787 $11

0.4% Houston $2,556 $2,480 $2,744 $2,985 $2,931 $2,919 $3,011 $3,243 $3,480 $3,419 $3,002 $446

17.5%

Chicago $2,610 $2,521 $2,542 $2,597 $2,699 $2,881 $3,082 $3,233 $3,074 $3,136 $3,324 $714

27.4% Detroit $2,119 $2,198 $2,048 $2,328 $2,579 $2,340 $2,285 $2,493 $2,509 $2,396 $2,432 $313

14.8%

Minneapolis-St.Paul $2,885 $2,923 $2,918 $2,740 $2,749 $3,015 $3,337 $3,417 $3,548 $3,847 $3,365 $480

16.6% Cleveland $2,005 $2,147 $2,213 $2,140 $2,309 $2,382 $2,463 $2,866 $3,241 $3,419 $3,651 $1,646

82.1%


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health insurance or groceries? health care trends: analysis of real changes in u.s. health care and...

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