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State Health Care Expenditures: Experience from 2001 Maryland Health Care Commission Analysis and Data Systems Division 4201 Patterson Avenue, 5th Floor Baltimore, Maryland 21215 Phone: 410- 764- 3570 Fax: 410- 358- 1236 Website: www. mhcc. state. md. us MARYLAND HEALTH CARE COMMISSION Donald E. Wilson, M. D., MACP, Chairman Vice President for Medical Affairs Dean, School of Medicine University of Maryland Residence: Baltimore County George S. Malouf, M. D., Vice Chairman Ophthalmologist Residence: Prince George’s County Larry Ginsburg Service Employees International Union Residence: Baltimore County Lenys Alcoreza Vice President of Community Markets AMERIGROUP Corporation Residence: Howard County Allan Jensen, M. D. Ophthalmologist Residence: Baltimore City Evelyn T. Beasley Retired Elementary/ Middle School Principal & Associate Broker Residence: Baltimore City Walter E. Chase, Sr. Retired Police Chief of Easton Residence: Talbot County J. Dennis Murray President & CEO Bay Mills Construction Co., Inc. Residence: Calvert County Constance Row Partner, Row Associates Residence: Harford County Ernest B. Crofoot AFL/ CIO Residence: Anne Arundel County Lynn Etheredge Health Policy Research & Consulting Residence: Montgomery County Marc E. Zanger President & CEO CBIZ Benefits & Insurance Services of Maryland, Inc. Residence: Allegany County M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table of Contents STATE HEALTH CARE EXPENDITURES .............................................................................. 1 HOW MUCH DID MARYLAND SPEND FOR HEALTH CARE?............................................................ 2 WHERE WERE MARYLAND’S HEALTH CARE DOLLARS SPENT?.................................................... 3 WHO PAID FOR MARYLAND’S HEALTH CARE? ............................................................................. 4 HOW MUCH DID HEALTH CARE EXPENDITURES GROW IN MARYLAND? ...................................... 7 WHAT TYPES OF SERVICES ACCOUNTED FOR THE GROWTH IN EXPENDITURES? .......................... 8 WHAT PAYERS ACCOUNTED FOR MOST OF THE GROWTH IN EXPENDITURES? .............................. 9 DID HMOS HAVE A DIFFERENT COST EXPERIENCE? .................................................................. 11 WHERE IN MARYLAND DID HEALTH CARE EXPENDITURES GROW THE FASTEST?...................... 13 SUPPORTING TABLES.............................................................................................................. 18 HEALTH CARE EXPENDITURES IN MARYLAND............................................................................ 18 HEALTH CARE EXPENDITURES BY TYPE OF SERVICE .................................................................. 18 HEALTH CARE EXPENDITURES BY SOURCE OF PAYMENT ........................................................... 19 HMO ENROLLMENT AND COST EXPERIENCE.............................................................................. 22 HEALTH CARE EXPENDITURES BY REGION ................................................................................. 25 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N List of Figures and Tables Figure 1: Total Health Care Expenditures in Maryland, 2000 and 2001 ............................. 2 Figure 2: Per Capita Health Care Expenditures in Maryland and the U. S., 2000 and 2001 ............................................................................................................................... ................ 2 Figure 3: Total Spending in Maryland by Type of Service, 2001 ........................................... 3 Figure 4: Total Health Care Expenditures in Maryland by Source of Payment, 2001........ 4 Figure 5: Percent of Expenditures for Major Types of Services by Third- Party Source of Payment, 2001 ...................................................................................................................... 5 Figure 6: Percent of Expenditures Paid Out- of- Pocket by Type of Service, 2001 ............. 6 Figure 7: Out- of- Pocket Spending by Type of Service, 2001................................................. 6 Figure 8: Growth in Total and Per Capita Spending in Maryland and the U. S., 2000- 2001........................................................................................................................... ............ 7 Figure 9: Percent Change in Total Expenditures by Type of Service, 2000- 2001............... 8 Figure 10: Growth in Expenditures by Type of Service as a Percent of Total Growth, 2001........................................................................................................................... ............ 9 Figure 11: Percent Growth in Total Expenditures by Source of Payment, 2000- 2001.... 10 Figure 12: Growth in Expenditures by Source of Payment as a Percent of Total Growth, 2001...................................................................................................................... 10 Figure 13: Percent Distribution of Growth in Insurers' Total Expenditures by Type of Service, 2000- 2001 ............................................................................................................. 11 Figure 14: HMO Enrollment as a Percent of Total Enrollment by Insurer, 2000 and 2001........................................................................................................................... .......... 12 Figure 15: Total Expenditures and Rate of Growth for All Insurers by Delivery System, 2000- 2001........................................................................................................................... 12 Figure 16: Per Capita Expenditures and Rate of Growth for All Insurers by Delivery System, 2000- 2001 ............................................................................................................. 13 Figure 17: Per Capita Expenditures by Region, 2000 and 2001........................................... 14 Figure 18: Percent Growth in Total and Per Capita Expenditures by Region, 2000- 2001 ............................................................................................................................... .............. 14 Figure 19: Percent Growth in Per Capita Expenditures for Hospital Care by Region, 2000- 2001........................................................................................................................... 15 Figure 20: Percent Growth in Per Capita Expenditures for Physician and Other Professional Services by Region, 2000- 2001.................................................................. 16 Figure 21: Percent Growth in Per Capita Expenditures for Prescription Drugs and Other Services by Region, 2000- 2001 ........................................................................................ 16 Figure 22: Percent Growth in Per Capita Expenditures for Nursing Home and Home Health Care by Region, 2000- 2001 ................................................................................. 17 Table 1: Total and Per Capita Expenditures and Rate of Growth, 2000- 2001.................. 18 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 2: Total Expenditures and Rate of Growth by Type of Service, 2000- 2001 .......... 18 Table 3: Per Capita Expenditures and Rate of Growth by Type of Service, 2000- 2001 . 18 Table 4: Expenditures by Selected Source of Payment as a Percent of Total Expenditures, 2001............................................................................................................ 19 Table 5: Total and Per Capita Expenditures by Source of Payment, 2000 and 2001....... 19 Table 6: Rate of Growth in Total and Per Capita Expenditures by Source of Payment, 2000- 2001 ........................................................................................................................... 19 Table 7: Total Expenditures by Source of Payment and Type of Service, 2000 and 2001 ............................................................................................................................... .............. 20 Table 8: Rate of Growth in Total Expenditures by Source of Payment and Type of Service, 2000- 2001............................................................................................................. 20 Table 9: Expenditures by Type of Service as a Percent of Total Expenditures, 2001 ..... 21 Table 10: Percent of the Growth in Insurers’ Expenditures Associated with Different Types of Service, 2000- 2001............................................................................................ 21 Table 11: Percent of the Growth in Expenditures for Types of Service Associated with Different Sources of Payment, 2000- 2001 .................................................................... 22 Table 12: HMO Enrollment: Number and Share of Total Enrollment by Insurer, 2000 and 2001........................................................................................................................... .. 22 Table 13: Rate of Growth in HMO Enrollment by Insurer, 1995- 2001............................ 23 Table 14: Total and Per Capita Expenditures for Medicare and Medicaid Beneficiaries and All Insured Residents, 2000 and 2001 .................................................................... 23 Table 15: Rate of Growth in Total and Per Capita Expenditures for Medicare and Medicaid Beneficiaries and All Insured Residents, 2000 and 2001 ........................... 23 Table 16: Per Capita Expenditures for Medicare and Medicaid Beneficiaries by Delivery System and Type of Service, 2000 and 2001................................................................. 24 Table 17: Rate of Growth in Per Capita Expenditures for Medicare and Medicaid Beneficiaries by Delivery System and Type of Service, 2000 and 2001.................... 24 Table 18: Total and Per Capita Expenditures and Rate of Growth by Region, 2000- 2001 ............................................................................................................................... .............. 25 Table 19: Total Expenditures by Type of Service and Region, 2000 and 2001 ................ 25 Table 20: Per Capita Expenditures by Type of Service and Region, 2000 and 2001 ....... 26 Table 21: Rate of Growth in Total and Per Capita Expenditures by Type of Service and Region, 2000- 2001............................................................................................................. 26 Table 22a: Total Expenditures by Type of Service, Source of Payment, and Region, 2000 ............................................................................................................................... .............. 27 Table 22b: Total Expenditures by Type of Service, Source of Payment, and Region, 2001 ............................................................................................................................... .............. 29 Table 23: Rate of Growth in Total Expenditures by Type of Service, Source of Payment, and Region, 2000- 2001 ..................................................................................................... 31 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 24: Expenditures as a Percent of Total Expenditures by Type of Service and Region, 2000 and 2001...................................................................................................... 33 Table 25: Expenditures as a Percent of Total Expenditures by Source of Payment and Region, 2000 and 2001...................................................................................................... 33 Table 26: Per Capita Medicare, Medicaid, and Total Expenditures by Type of Service and Region, 2000 and 2001...................................................................................................... 34 Table 27: Rate of Growth in Medicare, Medicaid, and Total Per Capita Expenditures by Type of Service and Region, 2000- 2001......................................................................... 35 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Acknowledgements This report required the assistance of many individuals and offices in state government, private industry, and federal government. In particular, the Commission wishes to note special contributions from the following individuals and organizations: Patricia Holcomb, Office of Planning, Development and Finance, Maryland Department of Health and Mental Hygiene ( DHMH) and Babi Lamba, Center for Health Program Development and Management, University of Maryland- Baltimore County provided Medicaid expenditure and enrollment information and were especially helpful in answering questions. Jim Johnson, Budget Management Office, DHMH, and Dr. Anthony Swetz, Maryland Department of Corrections, supplied information on government spending, while Estelle Apelberg, Vital Statistics, DHMH, provided population statistics. In constructing spending accounts of this complexity, the MHCC relied on significant estimates of private insurance expenditures supplied by Calvert Gorman and Robert Stolte, Maryland Insurance Administration. Jake Pyzik, Maryland Department of Budget Management, provided information on state health insurance expenditure patterns. As in previous years, Maribel Franey at Centers for Medicare and Medicaid Services ( CMS) assisted MHCC with the data use agreements that are necessary before Medicare information can be released. Robert Buddemeier and Russell Hindel at CMS conducted special analyses to provide accurate information on Medicare enrollment counts. Leroy McKnight in the federal government’s Office of Personnel Management supplied information on federal employees' insurance coverage. The development of the state health care expenditure analysis would not have been possible without the significant contributions of our consultants. This year was a particularly ambitious effort as the report was redesigned, methodologies were revised, and data sources were expanded to include more extensive use of the Medical Care Data Base. This project was under the direction of Dr. Deborah Chollet, Mathematica Policy Research, Dr. Dean Farley, Healthcare Software Synergies, Inc. and Sophie Nemirovsky, of Social and Scientific Systems ( SSS). Dr. Eric Schone of Mathematica Policy Research developed the estimation algorithms for private sector spending and Dr. Chris Hogan of Direct Research, LLP independently validated spending estimates for physician and other professional services. Nancy Allen, Thomas Bell, Chris Brady, Po- Lun Chou and Adrien Ndikumwami of SSS had responsibility for important analytic and technical activities during the SHEA development. Julie Kale- Jones and Lynn Clay of SSS managed the numerous documents associated with the project and assisted in the preparation of the report. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Summary This report, State Health Care Expenditures: Experience from 2001, contains information on total expenditures for the state by public and private sources, as well as more specific information on expenditures for the major regions of the state. In releasing this report, the Commission meets its mandate to report annually on the state’s total reimbursement for health care services in accordance with health care reform legislation passed in 1993. Total health care spending for Maryland residents increased to $ 21.0 billion from $ 18.8 billion in 2000. The 12 percent rate of growth in 2001 was the most rapid since MHCC began estimating expenditures in 1994. Over the past three years, rates of growth have accelerated from 5 percent in 1999 to 8 percent in 2000 to 12 percent in 2001.1 These growth rates parallel, but exceed, the national rates that grew from 6 percent in 1999, climbed to 7 percent in 2000 and jumped to 10 percent in 2001. Per capita in state spending, which measure spending change after absolute population increases have been removed, grew at a rate of 10 percent compared to the national increase of about 9 percent. The growth rate for health care spending in 2001, when viewed in conjunction with the increases MHCC reported the previous 2 years, confirms that the forces credited with slowing growth in the mid- 1990s have run out of steam. Hospital and professional services each account for about one third of total health care spending. Spending on hospital care, including inpatient and the rapidly growing outpatient service sector, totaled $ 7.2 billion in 2001 with outpatient hospital care absorbing $ 2.1 billion of that total. Spending on professional health cares services now totals $ 5.0 billion for physician care and $ 2.1 billion for other professional services. Prescription drugs and nursing home/ home health care each account for about 11 percent of health care spending. Third party payer expenses associated with plan administration and the net cost of insurance account for about 7 percent of health care spending. The overall increase in health care expenditure of $ 2.3 billion is the result of rapid increases in spending across all types of health care services. Hospital outpatient services ( 18 percent), non- physician professional services ( 15 percent), and prescription drugs ( 14 percent) had the most rapid growth in spending. These three sectors 1 Previous estimates are contained in State Health Care Expenditures: Experience from 2000 and State Health Care Expenditures: Experience from 1999. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N accounted for about 40 percent of the overall growth. The prescription drug increase is on top of a 22 percent jump in 1999 and an 11 percent rise in 2000. Because the size of service sectors varies greatly, rapid growth rates alone do not fully explain the overall spending increase in 2001. The important, but slower growing physician and hospital inpatient care sectors which increased at a rate of 10 percent, accounted for 40 percent of added health care spending in 2001. 10% 10% 18% 14% 15% 13% 14% 6% 0% 20% Physician Services Hospital Inpatient Hospital Outpatient Prescription Drugs Other Prof. Services Nursing Home & Home Health Other Services Administration 20% 20% 14% 13% 13% 12% 3% 6% 0% 20% Physician Services Hospital Inpatient Hospital Outpatient Prescription Drugs Other Prof. Services Nursing Home & Home Health Other Services Administration Percent Change from 2000 Contribution to Total Spending Growth The trend toward greater public financing of health care continued in 2001. Medicare and Medicaid expenditures grew faster than spending by either private insurers or consumers in Maryland. Medicare, the largest single insurer in the state, spent 13 percent more in 2001 than in 2000, as did Medicaid. These programs combined account for about the same share of total spending as all private third party coverage ( 39 percent) including commercial and non- profit insurers, health maintenance organizations ( HMOs) and self- insured employer plans. Expenditures covered by these private third party payers grew by 11 percent. Consumer spending out of pocket, consisting of copayments, deductibles and full direct payments, increased by 12 percent. Maryland private third party and consumer spending increases are significantly higher than the 8 percent rate of growth in private sector spending reported by CMS. More rapid growth in consumer out- of- pocket spending underscores employers and other purchasers cost containment strategies that aim to slow the rate of increase in premiums by shifting costs to consumers through higher copayments and deductibles. Out- of- pocket spending increases for prescription drugs ( 15 percent) and non- physician M A R Y L A N D H E A L T H C A R E C O M M I S S I O N professional services ( 14 percent) were above the rate of growth for total consumer spending and exceeded the rates of increase that private third party payers experienced in these sectors. These jumps occurred in sectors where consumer spending already accounts for one- third or more of payment. The steady retreat from HMOs continued in 2001; only about 35 percent of the insured population was enrolled in HMOs, down from 40 percent in 2000. Despite the recent rapid growth in spending, neither purchasers nor consumers appear ready to embrace the managed care solutions that slowed health care spending a decade ago. Medicare beneficiaries exited the Medicare+ Choice program in droves during 2001, after all but two managed care organizations ( MCOs) dropped participation. The 9 percent decline in private sector HMO enrollment in 2001 follows two years of smaller enrollment declines. Only the Medicaid’s HealthChoice program experienced a small jump in enrollment due to a modest expansion in the eligibility criteria. Although enrollment fell in 2001, HMO products saw costs grow rapidly for their remaining patients. Per capita spending in HMOs climbed by 11 percent across all government and private payers compared to the 3 percent increase for non- HMOs. All five Maryland regions ( National Capital Area, Baltimore Metro, Western Maryland, Southern Maryland, and the Eastern Shore) experienced significant increases in health care spending. Per capita spending grew fastest on the Eastern Shore ( 15 percent), closely followed by Southern Maryland ( 13 percent) and Western Maryland ( 12 percent). The rate of growth in per capita spending in the more urban National Capital Area and Baltimore Metro regions was around 10 percent. Despite experiencing the slowest growth in spending, the Baltimore Metro region continues to have the highest per capita spending ($ 4,252), about 9 percent above the state per capita of $ 3,908. The Eastern Shore is the only other region that had a per capita spending level ($ 3,972) above the state per capita. Demographics and health status, payer mix, input costs, provider practice patterns, and consumer preferences are important factors in determining the level of health care spending. Future MHCC studies will examine these regional variations in greater detail. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N State Health Care Expenditures This report provides information about the level and patterns of health care expenditures by Maryland residents in 2001 and how they differ from 2000. It was developed to meet the requirement under Health- General Article, § 19- 134( g), which directs the Maryland Health Care Commission ( MHCC) to report annually on total payments in the state for health care services. A basic mission of the Commission is disseminating information for monitoring how the health care market in Maryland functions; this information prominently includes the level and growth of health care spending. The estimates provided in this report will help users to understand not only how health care spending changed between 2000 and 2001, but how spending levels and rates of change differed among service categories and the various major payer groups in Maryland’s health care system. This year’s report begins a new look and a new way of presenting this information. Responding to comments that MHCC elicited from payers, policymakers, and providers, this report is intended to convey the State Health Expenditure Accounts ( SHEA) estimates in a highly accessible format and to facilitate its use as a reference document. During the year, MHCC intends to issue one or more additional SHEA Analysis reports that focus on the reasons for and implications of health spending patterns and changes in Maryland. By separating the presentation of the SHEA estimates (“ How much does Maryland spend for health care?”) from analysis (“ Why does it spend that amount?”) and providing more detailed analysis of major trends, MHCC hopes to address the information needs of the various stakeholders in Maryland’s health care system more clearly and effectively. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 1 HOW MUCH DID MARYLAND SPEND FOR HEALTH CARE? In 2001, Maryland residents spent $ 21.0 billion for health care services, approximately $ 3,908 per person. These estimates of spending in Maryland represent significant increases over 2000. Total health care spending increased 11.8 percent in 2001 while per capita health care spending increased 10.5 percent. Nevertheless, Maryland residents still spent about 3 percent less than the projected U. S. average of $ 4,045 in 2001.2 Figure 1: Total Health Care Expenditures in Maryland, 2000 and 2001 ($ millions) $ 21,009 $ 18,787 11.8% growth $ 0 $ 5,000 $ 10,000 $ 15,000 $ 20,000 $ 25,000 2000 2001 Figure 2: Per Capita Health Care Expenditures in Maryland and the U. S., 2000 and 2001 $ 4,045 $ 3,724 $ 3,537 $ 3,908 10.5% growth 8.6% growth $ 0 $ 1,000 $ 2,000 $ 3,000 $ 4,000 $ 5,000 2000 2001 U. S. Maryland 2 All national health expenditure estimates and projections referred to in this report are developed by the Centers for Medicare and Medicaid Services, Office of the Actuary ( http:// www. cmc. nhe/ projections- 2001/ t5. asp). To make the NHE figures comparable to the Maryland SHEA methodology, some payers and services are omitted from the NHE totals. ( Continued on next page) 2 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N WHERE WERE MARYLAND’S HEALTH CARE DOLLARS SPENT? Approximately one- third of Maryland’s health care dollars are spent on hospital care. In 2001, inpatient hospital care accounted for 24 percent of total health care spending; outpatient hospital care accounted for another 10 percent. Physician and other professional services accounted for 34 percent of the total. In total, Marylanders spent $ 7.2 billion for hospital care, $ 5.0 billion for physician services, and $ 2.1 billion for other professional services. Spending for prescription drugs in Maryland totaled nearly $ 2.4 billion in 2001, which represents approximately 11 percent of total health care spending and is equal to total spending for nursing home and home health care combined. Administrative costs, including the net cost of health insurance, accounted for 7 percent of total health care spending in 2001. Figure 3: Total Spending in Maryland by Type of Service, 2001 Other Services 2% Hospital Inpatient 24% Prescription Drugs 11% Admin. & Net Cost of Insurance 7% Nursing Home & Home Health Care 11% Physician and Other Professional Services 34% Hospital Outpatient 10% .. ( continued) Payers omitted from NHE: Private or federal “ Other payers” are omitted, and “ Other government” is limited to state & local government payors. Services omissions: “ Other personal health care,” “ government public health activities,” “ Research,” and “ Construction” are excluded entirely, and non- prescription drugs and medical sundries are omitted from the NHE category of “ Medical non- durables.” M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 3 In general, the distribution of spending by service category in Maryland mirrors the national distribution. In 2001, Marylanders’ relative spending among broad categories of hospital and professional care, long- term care, prescription drugs, and administration of insurance programs was nearly identical ( within one percentage point per category) to the national average. WHO PAID FOR MARYLAND’S HEALTH CARE? In 2001, government programs accounted for 45 percent of all health care expenditures in Maryland. Medicare – the federal program that finances care for the elderly and disabled – was the largest insurer of health care in Maryland, accounting for 22 percent of all health care expenditures. Medicaid – the state program that finances care for low-income Marylanders in certain eligibility categories – accounted for 17 percent of health care expenditures. Together, Medicare and Medicaid spent as much for health care as did all private coverage in Maryland combined, including commercial and nonprofit insurers, health maintenance organizations ( HMOs), and self- insured employer plans. Figure 4: Total Health Care Expenditures in Maryland by Source of Payment, 2001 Medicare 22% Private Coverage 39% Out- of- Pocket 16% Other Government 6% Medicaid 17% 4 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N The relative significance of different sources of payment in Maryland varies by type of service. Medicare is the state’s largest insurer for inpatient hospital care, accounting for 43 percent of all inpatient expenditures in 2001, compared to 34 percent paid by private coverage. Medicaid was the predominant source of payment for nursing home care, paying for nearly half of all nursing home care in 2001. Private coverage was the largest source of payment for hospital outpatient care, physician care, and prescription drugs, accounting for 47 to 55 percent of all expenditures for those services in 2001. Private coverage was also the largest source of payer administrative cost: 70 percent of all insurer administrative cost in Maryland was related to private coverage. Figure 5: Percent of Expenditures for Major Types of Services by Third- Party Source of Payment, 2001 10% 27% 19% 7% 28% 43% 11% 5% 49% 16% 17% 10% 13% 15% 70% 10% 5% 47% 16% 55% 49% 34% 20% 22% 17% 39% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Admin. & Net Cost of Insurance Other Services Nursing Home & Home Health Care Prescription Drugs Other Professional Services Physician Services Hospital Outpatient Hospital Inpatient Total Expenditures Medicare Medicaid Private Coverage Note: Other Government and Out- of- Pocket Expenditures are excluded. Reflecting broad participation in government programs and private insurance ( and possibly also hospitals’ propensity to forgive cost sharing as bad debt), Marylanders paid out- of- pocket just 2 percent of the costs of inpatient care and 7 percent of hospital outpatient care in 2001. However, for some types of services, Marylanders paid a much larger share of the cost out- of- pocket. Approximately 40 percent of expenditures for non- physician professional services ( including dental, vision, and other professional services) were paid out- of- pocket in 2001, as were nearly one- third of expenditures for prescription drugs ( 32 percent) and nursing home care ( 27 percent). Across all types of services, Marylanders paid 16 percent of all expenditures out of pocket in 2001. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 5 Figure 6: Percent of Expenditures Paid Out- of- Pocket by Type of Service, 2001 73% 68% 60% 87% 93% 98% 84% 27% 32% 40% 13% 7% 16% 2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Nursing Home & Home Health Care Prescription Drugs Other Professional Services Physician Services Hospital Outpatient Hospital Inpatient Total Expenditures Third Party Payments Out- of- Pocket Out- of- pocket spending is allocated differently than overall health care spending because of the benefit structure of health insurance. Approximately 84 percent of out- of- pocket expenditures were associated with four service areas: physician services ( 19 percent), other professional services ( 26 percent), prescription drugs ( 23 percent), and nursing home and home health care ( 17 percent). Figure 7: Out- of- Pocket Spending by Type of Service, 2001 Hospital Inpatient 3% Physician Services 19% Other Professional Services 26% Prescription Drugs 23% Nursing Home & Home Health Care 17% Other Services 8% Hospital Outpatient 4% 6 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N HOW MUCH DID HEALTH CARE EXPENDITURES GROW IN MARYLAND? Total health care spending in Maryland grew nearly 12 percent in 2001, from a total of $ 18.8 billion in 2000 to $ 21.0 billion in 2001. This rate of growth compares to 10 percent for the United States as a whole. Maryland’s faster growth of total health care expenditures was in part due to the state’s faster rate of population growth, which slightly exceeded the U. S. average. However, Maryland’s health care expenditures per capita also rose faster than the U. S. average – 10 percent in 2001, compared to the national average growth rate of 9 percent. This growth in expenditures for health care continues an acceleration of expenditures in recent years, in general tracking ( but exceeding) the acceleration of health care expenditures nationally. Maryland’s 11.8 percent increase in 2001 compares to 8.4 percent in 2000 and 4.6 percent in 1999. National increases in health care spending ( 9.8 percent in 2001) accelerated from 7.2 percent growth in 2000 and 5.5 percent growth in 1999. Figure 8: Growth in Total and Per Capita Spending in Maryland and the U. S., 2000- 2001 9% 10% 10% 12% 0% 2% 4% 6% 8% 10% 12% 14% Per Capita Growth Total Growth U. S. Maryland M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 7 WHAT TYPES OF SERVICES ACCOUNTED FOR THE GROWTH IN EXPENDITURES? While total expenditures in Maryland grew by 12 percent in 2001, expenditures for some types of services grew either much faster or more slowly. Expenditures for outpatient hospital care grew very quickly in 2001 ( by 18 percent), as did expenditures for non-physician professional services ( 15 percent), prescription drugs ( 14 percent), and nursing home care ( 14 percent). Expenditures for inpatient hospital care and physician care ( both services that entailed relatively little out- of- pocket spending in Maryland) grew more slowly ( by 10 percent), as did administrative costs for insurance ( 9 percent). Figure 9: Percent Change in Total Expenditures by Type of Service, 2000- 2001 9% 14% 12% 14% 14% 15% 10% 18% 10% 12% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% Admin. & Net Cost of Insurance Other Services Home Health Care Nursing Home Care Prescription Drugs Other Professional Services Physician Services Hospital Outpatient Hospital Inpatient Total Expenditures Despite the relatively slow growth of expenditures for hospital inpatient care and physician services, the importance of these service types in Maryland’s total spending for health care means that even relatively slow growth in these sectors contributes significantly to overall expenditure growth. Growth in spending for hospital and physician care accounted for 54 percent of total spending growth in Maryland in 2001. Greater spending for non- physician professional services and prescription drugs each accounted for 13 percent of the growth in total expenditures. Nursing home care and home health care, taken together, accounted for 12 percent of expenditure growth. 8 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Figure 10: Growth in Expenditures by Type of Service as a Percent of Total Growth, 2001 Nursing Home & Home Health Care 12% Admin. & Net Cost of Insurance 6% Hospital Inpatient 20% Other Professional Services 13% Other Services 3% Prescription Drugs 13% Physician Services 20% Hospital Outpatient 14% WHAT PAYERS ACCOUNTED FOR MOST OF THE GROWTH IN EXPENDITURES? In 2001, Medicare and Medicaid expenditures grew faster than the expenditures by either private insurers or consumers in Maryland. Medicare, the largest single insurer in the state, spent 13 percent more in 2001 than in 2000, as did Medicaid. Spending by other government payers ( including the Veterans Administration, the Department of Defense CHAMPUS program, and other state and local programs) increased even faster ( 15 percent). Expenditures covered by private insurance grew less than the overall average ( 11 percent), while growth in consumer spending out- of- pocket reflects the average increase ( 12 percent). These figures indicate a shift in the financing of health care spending from private insurers ( including self- insured employers) to public payers and individual Maryland residents. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 9 Figure 11: Percent Growth in Total Expenditures by Source of Payment, 2000- 2001 12% 11% 15% 13% 13% 12% 0% 2% 4% 6% 8% 10% 12% 14% 16% Out- of- Pocket Private Coverage Other Government Medicaid Medicare Total Expenditures While privately insured expenditures grew more slowly than expenditures associated with other payers in Maryland, they are the largest sector of expenditures in Maryland and, therefore, accounted for the largest share of expenditure growth in 2001 ( 35 percent of the total). Medicare accounted for nearly a quarter of expenditure growth ( 23 percent). While other government program spending grew very fast in 2001, it nevertheless accounted for just 7 percent of expenditure growth overall. Figure 12: Growth in Expenditures by Source of Payment as a Percent of Total Growth, 2001 Medicare 23% Private Coverage 35% Out- of- Pocket 16% Other Government 7% Medicaid 18% 10 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N The relative growth in expenditures for different service types affected Maryland’s third-party payers differently. Sixty percent of the growth in Medicare expenditures in Maryland in 2001 was associated with increased expenditures for inpatient and outpatient hospital care. In contrast, the increase in Medicaid spending was more evenly distributed among major types of services – with long- term care ( and nursing home care in particular) accounting for nearly one- third of the increase in spending ( 31 percent), and hospital care accounting for nearly as large a proportion ( 29 percent). Physician and other professional services contributed more than other types of services to the growth in private insurer spending, accounting for 38 percent of the growth in private insurer spending in 2001. Figure 13: Percent Distribution of Growth in Insurers' Total Expenditures by Type of Service, 2000- 2001 21% 22% 22% 48% 24% 12% 5% 7% 12% 10% 38% 46% 24% 25% 34% 10% 11% 11% 13% 11% 5% 10% 13% 1% 3% 31% 9% 3% 7% 3% 2% 1% 1% 2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Private Coverage Other Government Medicaid Medicare Total Expenditures Hospital Outpatient Prescription Drugs Nursing Home and Home Health Care Admin. & Net Cost of Insurance Hospital Inpatient Physician and Other Professional Services Other Services DID HMOS HAVE A DIFFERENT COST EXPERIENCE? HMO enrollment accounted for 35 percent of enrollment among all insurers in 2001, but just 28 percent of insured health expenditures. Medicare+ Choice enrollment among Medicare beneficiaries declined by 72 percent in 2001 ( from 69,000 to just 20,000), leaving less than 3 percent of Medicare beneficiaries enrolled in an HMO. Total spending associated with Marylanders in Medicare+ Choice plans dropped from $ 416 million to $ 126 million. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 11 In contrast, HMO enrollment continued to climb among Medicaid beneficiaries. Greater Maryland Children’s Health Insurance Program ( MCHIP) enrollment and enrollment by previously ineligible mothers and children raised participation in Medicaid’s HMO product, called HealthChoice. Figure 14: HMO Enrollment as a Percent of Total Enrollment by Insurer, 2000 and 2001 39% 79% 11% 40% 34% 80% 3% 35% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Private Coverage Medicaid Medicare All Insurers 2000 2001 Among insured Marylanders as a whole, total and per capita HMO expenditures were substantially lower than among enrollees in non- HMO health plans, although per capita expenditures among HMO enrollees rose much faster – by 11 percent in 2001, compared to just 3 percent among non- HMO enrollees. Figure 15: Total Expenditures ($ millions) and Rate of Growth for All Insurers by Delivery System, 2000- 2001 $ 11,236 $ 12,990 $ 4,924 $ 5,041 15.6% growth 2.4% growth $ 0 $ 2,000 $ 4,000 $ 6,000 $ 8,000 $ 10,000 $ 12,000 $ 14,000 2000 2001 Non- HMO HMO 12 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Figure 16: Per Capita Expenditures and Rate of Growth for All Insurers by Delivery System, 2000- 2001 $ 3,905 $ 4,029 $ 2,620 $ 2,912 3.2% growth 11.1% growth $ 0 $ 500 $ 1,000 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 3,500 $ 4,000 $ 4,500 2000 2001 Non- HMO HMO WHERE IN MARYLAND DID HEALTH CARE EXPENDITURES GROW THE FASTEST? Per capita health care spending in Maryland remained the highest in the Baltimore Metropolitan area, reaching $ 4,252 per resident in 2001, compared to $ 3,532 per resident in the National Capital Area, Maryland’s next most populous region but more extensively suburban and residential than in the metropolitan Baltimore area. 3 Per capita health care expenditures in Maryland’s Eastern Shore area, $ 3,972 per person, ranked second behind Baltimore Metro in 2001. 3 The National Capital Area includes Montgomery and Prince George's counties; Baltimore Metro includes Anne Arundel, Baltimore, Carroll, Harford, and Howard counties, and Baltimore City; the Eastern Shore includes Caroline, Cecil, Dorchester, Kent, Queen Anne's, Somerset, Talbot, Wicomico, and Worcester counties; Southern Maryland includes Calvert, Charles, and St. Mary's counties; and Western Maryland includes Allegany, Frederick, Garrett, and Washington counties. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 13 Figure 17: Per Capita Expenditures by Region, 2000 and 2001 $ 3,972 $ 3,489 $ 3,612 $ 4,252 $ 3,532 $ 3,908 $ 3,463 $ 3,096 $ 3,226 $ 3,890 $ 3,181 $ 3,537 $ 0 $ 500 $ 1,000 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 3,500 $ 4,000 $ 4,500 Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total 2001 2000 While Baltimore Metro remained the region with the highest expenditures, expenditure growth between 2000 and 2001 in the region was the lowest of any region in Maryland. Per capita expenditures rose 9 percent in 2001 in the Baltimore Metro area, contrasted with 15 percent on the Eastern Shore ( bringing the Eastern Shore most closely in line with Baltimore Metro’s relatively high level of per capita expenditures), and 13 percent in Southern Maryland. In 2001, total health care spending rose 17 percent on the Eastern Shore and 16 percent in Southern Maryland, compared to 10 percent growth in the Baltimore Metro area and 13 percent in the National Capital Area. Figure 18: Percent Growth in Total and Per Capita Expenditures by Region, 2000- 2001 12% 17% 16% 14% 10% 13% 12% 10% 11% 9% 13% 15% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total Per Capita Expenditures Total Expenditures 14 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N The principal sources of expenditure growth varied among regions of Maryland. In at least one region of the state, per capita expenditures increased 15 percent or more in any of six service categories: hospital outpatient care, physician services, other professional services, prescription drugs, nursing home care, and other services. On the Eastern Shore, per capita expenditures for prescription drugs grew 24 percent in 2001, approximately twice as fast as in any other region of the state and consistent with Eastern Shore residents’ higher growth of total expenditures per capita relative to other regions. 4 Spending for outpatient hospital care rose 20 percent there, and spending for other professional services rose 18 percent. Prescription drugs was also the fastest growing service category in Southern Maryland, where per capita spending for prescription drugs rose 17 percent. In Western Maryland and in the Baltimore Metro area, per capita expenditures for hospital outpatient care led the regions’ growth in expenditures. Expenditures per resident for outpatient hospital care rose 18 percent in Western Maryland and 17 percent in the Baltimore Metro area. In the National Capital Area per capita spending grew fastest for physician and other professional services, which increased by 16 percent. Figure 19: Percent Growth in Per Capita Expenditures for Hospital Care by Region, 2000- 2001 20% 16% 18% 17% 13% 16% 11% 10% 9% 9% 5% 9% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total Hosptial Outpatient Hospital Inpatient 4 The large cost increase observed on the Eastern Shore may be related to a substantial shift in private coverage from HMOs into non- HMO health plans. This shift is measured as the difference between the number of Eastern Shore residents who are estimated to be privately insured ( using the Behavioral Risk Factor Surveillance System ( BRFSS) count of non- elderly insured adults net administrative enrollment figures for public insurance programs), and the number enrolled in HMOs as reported by InterStudy. The estimate of privately insured, non- HMO residents on the Eastern Shore increased significantly between 2000 and 2001; some of this growth may M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 15 Figure 20: Percent Growth in Per Capita Expenditures for Physician and Other Professional Services by Region, 2000- 2001 18% 9% 13% 13% 16% 14% 14% 16% 10% 4% 13% 8% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total Other Professional Services Physician Services Figure 21: Percent Growth in Per Capita Expenditures for Prescription Drugs and Other Services by Region, 2000- 2001 15% 17% 9% 13% 10% 13% 24% 13% 13% 11% 13% 12% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 22% 24% 26% Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total Other Services Prescription Drugs ( continued) reflect survey or sampling error. 16 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Figure 22: Percent Growth in Per Capita Expenditures for Nursing Home and Home Health Care by Region, 2000- 2001 12% 12% 8% 11% 11% 11% 6% 13% 16% 13% 13% 12% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Eastern Shore Southern MD Western MD Baltimore Metro National Capital Maryland Total Home Health Care Nursing Home Care The balance of this report offers detailed tables of the information presented in the preceding sections and figures. These tables offer the reader additional information and context for the changes in health care expenditures that occurred in Maryland in 2001. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 17 Supporting Tables Health Care Expenditures in Maryland Table 1: Total and Per Capita Expenditures and Rate of Growth, 2000- 2001 EXPENDITURE COMPONENTS 2000 2001 PERCENT CHANGE Total Expenditures ($ millions) $ 18,786.6 $ 21,008.8 11.8% Per Capita Expenditures 3,537 3,908 10.5 Health Care Expenditures by Type of Service Table 2: Total Expenditures and Rate of Growth by Type of Service, 2000- 2001 ($ millions) EXPENDITURE COMPONENTS 2000 2001 PERCENT CHANGE Total Health Expenditures $ 18,786.6 $ 21,008.8 11.8% Hospital Services Inpatient 4,666.5 5,119.6 9.7 Outpatient 1,747.8 2,055.8 17.6 Physician Services 4,591.7 5,028.7 9.5 Other Professional Services 1,849.6 2,131.4 15.2 Prescription Drugs 2,072.0 2,354.2 13.6 Nursing Home Care 1,364.1 1,551.1 13.7 Home Health Care 621.5 697.8 12.3 Other Services 457.6 521.1 13.9 Administration and Net Cost of Insurance 1,415.7 1,549.1 9.4 Table 3: Per Capita Expenditures and Rate of Growth by Type of Service, 2000- 2001 EXPENDITURE COMPONENTS 2000 2001 PERCENT CHANGE Total Per Capita Expenditures $ 3,537 $ 3,908 10.5% Hospital Services Inpatient 879 953 8.4 Outpatient 329 382 16.2 Physician Services 865 936 8.2 Other Professional Services 348 397 13.9 Prescription Drugs 390 438 12.3 Nursing Home Care 257 289 12.3 Home Health Care 117 130 10.9 Other Services 86 97 12.5 Administration and Net Cost of Insurance 267 288 8.1 18 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 4: Expenditures by Selected Source of Payment as a Percent of Total Expenditures, 2001 EXPENDITURE COMPONENTS MEDICARE MEDICAID OTHER GOVERNMENT PRIVATE COVERAGE ALL PAYERS Total Health Expenditures 100% 100% 100% 100% 100% Hospital Services Inpatient 47.5 21.7 22.3 21.3 24.4 Outpatient 12.3 7.5 5.3 12.4 9.8 Physician Services 21.5 13.6 11.5 33.6 23.9 Other Professional Services 3.1 10.3 34.6 4.1 10.1 Prescription Drugs 0.1 10.3 9.9 13.4 11.2 Nursing Home Care 6.6 21.4 2.8 0.3 7.4 Home Health Care 2.7 9.6 0.4 1.1 3.3 Other Services 3.0 0.8 2.2 0.6 2.5 Administration and Net Cost of Insurance 3.3 4.8 11.2 13.3 7.4 Note: Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, Private Coverage includes Insurers & Self- Funded and HMO plans, and All Payers includes all of the above and out- of- pocket expenditures. Health Care Expenditures by Source of Payment Table 5: Total and Per Capita Expenditures by Source of Payment, 2000 and 2001 MEDICARE MEDICAID OTHER GOVERNMENT PRIVATE COVERAGE EXPENDITURE COMPONENTS 2000 2001 2000 2001 2000 2001 2000 2001 Total Expenditures ($ millions) $ 4,130.9 $ 4,651.2 $ 3,173.9 $ 3,578.7 $ 1,068.7 $ 1,232.9 $ 7,407.8 $ 8,189.8 Per Capita Expenditures 7,315 8,153 6,298 6,633 ----- ----- 2,264 2,390 Note: Unduplicated estimates of persons covered by other government programs are not available. Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. Note: A "-----" means not applicable. Table 6: Rate of Growth in Total and Per Capita Expenditures by Source of Payment, 2000- 2001 EXPENDITURE COMPONENTS MEDICARE MEDICAID OTHER GOVERNMENT PRIVATE COVERAGE Total Expenditures 12.6% 12.8% 15.4% 10.6% Per Capita Expenditures 11.5 5.3 ----- 5.6 Note: Unduplicated estimates of persons covered by other government programs are not available. Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. Note: A "-----" means not applicable. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 19 Table 7: Total Expenditures by Source of Payment and Type of Service, 2000 and 2001 ($ millions) MEDICARE MEDICAID OTHER GOVERNMENT PRIVATE EXPENDITURE COMPONENTS COVERAGE 2000 2001 2000 2001 2000 2001 2000 2001 Total Health Expenditures $ 4,130.9 $ 4,651.2 $ 3,173.9 $ 3,578.7 $ 1,068.7 $ 1,232.9 $ 7,407.8 $ 8,189.8 Hospital Services Inpatient 1,967.1 2,210.2 728.5 776.1 234.8 274.7 1,633.7 1,748.2 Outpatient 487.4 571.2 227.5 268.0 49.7 65.0 855.9 1,014.0 Physician Services 920.7 998.2 452.7 488.5 125.5 141.4 2,498.5 2,748.8 Other Professional Services 113.8 144.2 304.7 366.9 371.3 426.1 312.0 334.0 Prescription Drugs 15.5 4.4 310.2 368.7 98.8 121.9 979.8 1,100.1 Nursing Home Care 232.4 305.8 691.0 766.6 29.4 34.8 18.5 20.6 Home Health Care 109.3 124.1 300.8 344.4 4.1 4.8 79.1 87.8 Other Services 118.8 139.4 24.1 28.6 25.9 26.6 44.1 49.5 Administration and Net Cost of Insurance 165.9 153.7 134.5 171.0 129.2 137.6 986.2 1,086.8 Note: Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. Table 8: Rate of Growth in Total Expenditures by Source of Payment and Type of Service, 2000- 2001 EXPENDITURE COMPONENTS MEDICARE MEDICAID OTHER GOVERNMENT PRIVATE COVERAGE Total Health Expenditures 12.6% 12.8% 15.4% 10.6% Hospital Services Inpatient 12.4 6.5 17.0 7.0 Outpatient 17.2 17.8 30.8 18.5 Physician Services 8.4 7.9 12.6 10.0 Other Professional Services 26.8 20.4 14.7 7.0 Prescription Drugs - 71.7 18.8 23.5 12.3 Nursing Home Care 31.6 10.9 18.3 11.8 Home Health Care 13.5 14.5 18.4 11.1 Other Services 17.4 18.5 3.0 12.2 Administration and Net Cost of Insurance - 7.4 27.2 6.5 10.2 Note: Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. 20 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 9: Expenditures by Type of Service as a Percent of Total Expenditures, 2001 GOVERNMENT SECTOR PRIVATE SECTOR EXPENDITURE COMPONENTS Medicare Medicaid Other Government Total Government Private Coverage Out- of- Pocket Total Private TOTAL EXPENDITURES Total Health Expenditures 22.1% 17.0% 5.9% 45.0% 39.0% 16.0% 55.0% 100% Hospital Services Inpatient 43.2 15.2 5.4 63.7 34.1 2.2 36.3 100 Outpatient 27.8 13.0 3.2 44.0 49.3 6.7 56.0 100 Physician Services 19.8 9.7 2.8 32.4 54.7 13.0 67.6 100 Other Professional Services 6.8 17.2 20.0 44.0 15.7 40.4 56.0 100 Prescription Drugs 0.2 15.7 5.2 21.0 46.7 32.2 79.0 100 Nursing Home Care 19.7 49.3 2.2 71.4 1.3 27.3 28.6 100 Home Health Care 17.8 49.3 0.7 67.8 12.6 19.6 32.2 100 Other Services 26.8 5.5 5.1 37.4 9.5 53.1 62.6 100 Administration and Net Cost of Insurance 9.9 11.0 8.9 29.8 70.2 ----- 70.2 100 Note: Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. Note: A "-----" means not applicable. Table 10: Percent of the Growth in Insurers’ Expenditures Associated with Different Types of Service, 2000- 2001 EXPENDITURE COMPONENTS GOVERNMENT SECTOR PRIVATE SECTOR Medicare Medicaid Private Coverage Total Health Expenditures 100% 100% 100% Hospital Services Inpatient 46.7 11.8 14.6 Outpatient 16.1 10.0 20.2 Physician Services 14.9 8.8 32.0 Other Professional Services 5.9 15.4 2.8 Prescription Drugs - 2.1 14.4 15.4 Nursing Home Care 14.1 18.7 0.3 Home Health Care 2.8 10.8 1.1 Other Services 4.0 1.1 0.7 Administration and Net Cost of Insurance - 2.3 9.0 12.9 Note: Types of delivery system are combined within payer groups. Medicare includes Original Medicare and Medicare+ Choice, Medicaid includes Traditional Medicaid and HealthChoice, and Private Coverage includes Insurers & Self- Funded and HMO plans. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 21 Table 11: Percent of the Growth in Expenditures for Types of Service Associated with Different Sources of Payment, 2000- 2001 GOVERNMENT SECTOR PRIVATE SECTOR EXPENDITURE Medicare Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of- Pocket TOTAL EXPENDITURES Total Health Expenditures 36.3% - 12.9% 12.6% 5.6% 7.4% 27.2% 7.9% 15.8% 100% Hospital Services Inpatient 75.3 - 21.6 7.9 2.6 8.8 26.6 - 1.3 1.8 100 Outpatient 33.9 - 6.6 2.9 10.2 5.0 32.4 18.9 3.3 100 Physician Services 41.5 - 23.8 2.1 6.1 3.6 45.6 11.7 13.1 100 Other Professional Services 11.6 - 0.8 20.4 1.7 19.4 4.6 3.2 39.9 100 Prescription Drugs ----- - 3.9 14.9 5.9 8.2 30.5 12.1 32.4 100 Nursing Home Care 43.4 - 4.2 40.4 0.1 2.9 1.0 0.1 16.3 100 Home Health Care 24.5 - 5.2 56.1 1.1 1.0 9.6 1.9 11.0 100 Other Services 43.3 - 10.7 6.3 0.7 1.2 7.4 1.1 50.7 100 Administration and Net Cost of Insurance 15.6 - 24.8 3.4 24.0 6.3 54.5 20.9 ----- 100 Note: A "-----" means not applicable. HMO Enrollment and Cost Experience Table 12: HMO Enrollment: Number and Share of Total Enrollment by Insurer, 2000 and 2001 YEAR HMO ENROLLMENT NUMBER Medicare Medicaid Private Coverage All Insurers 2000 69,483 389,851 1,420,209 1,879,543 2001 19,703 422,905 1,288,722 1,731,331 YEAR PERCENT OF TOTAL ENROLLMENT Medicare Medicaid Private Coverage All Insurers 2000 10.5% 79.1% 39.4% 39.5% 2001 2.9 80.2 34.3 34.9 22 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 13: Rate of Growth in HMO Enrollment by Insurer, 1995- 2001 YEAR MEDICARE MEDICAID PRIVATE COVERAGE ALL INSURERS 2000- 01 - 71.6% 8.5% - 9.3% - 7.9% 1999- 00 - 19.5 10.0 - 2.0 - 0.6 1998- 99 - 3.1 11.4 - 1.6 0.3 1997- 98 5.3 79.4 - 0.4 7.1 1996- 97 125.0 30.4 5.6 10.1 1995- 96 131.8 - 0.1 6.6 7.3 Table 14: Total and Per Capita Expenditures for Medicare and Medicaid Beneficiaries and All Insured Residents, 2000 and 2001 TOTAL HEALTH EXPENDITURES ($ millions) Medicare Medicaid All Insurers YEAR Original + Choice Traditional HealthChoice Non- HMO HMO 2000 $ 4,412.6 $ 416.3 $ 1,678.7 $ 1,495.2 $ 11,235.9 $ 4,924.2 2001 5,347.2 125.9 1,828.8 1,749.9 12,989.6 5,041.0 PER CAPITA EXPENDITURES Medicare Medicaid All Insurers YEAR Original + Choice Traditional HealthChoice Non- HMO HMO 2000 $ 7,471 $ 5,991 $ 16,237 $ 3,835 $ 3,905 $ 2,620 2001 8,206 6,390 17,502 4,138 4,029 2,912 Note: Medicare includes out- of- pocket payments and payments by Medicare Supplement plans. HealthChoice “ Wrap Around” Services included in Medicaid HealthChoice. Table 15: Rate of Growth in Total and Per Capita Expenditures for Medicare and Medicaid Beneficiaries and All Insured Residents, 2000 and 2001 MEDICARE MEDICAID ALL INSURERS Original + Choice Traditional HealthChoice Non- HMO HMO Total Health Expenditures 21.2% - 69.8% 8.9% 17.0% 15.6% 2.4% Per Capita Expenditures 9.8 6.7 7.8 7.9 3.2 11.1 Note: Medicare includes out- of- pocket payments and payments by Medicare Supplement plans. HealthChoice “ Wrap Around” Services included in Medicaid HealthChoice. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 23 Table 16: Per Capita Expenditures for Medicare and Medicaid Beneficiaries by Delivery System and Type of Service, 2000 and 2001 MEDICARE MEDICAID Original + Choice Traditional HealthChoice 2000 2001 2000 2001 2000 2001 2000 2001 Total Health Expenditures $ 7,471 $ 8,206 $ 5,991 $ 6,390 $ 16,237 $ 17,502 $ 3,835 $ 4,138 Hospital Services Inpatient 3,310 3,552 2,039 2,151 3,210 3,152 1,017 1,056 Outpatient 982 1,083 452 529 271 238 512 575 Physician Services 1,716 1,911 2,229 2,324 150 159 1,121 1,116 Other Professional Services 228 267 52 56 775 848 576 658 Prescription Drugs ----- ----- 246 249 1,777 1,982 324 382 Nursing Home Care 437 535 169 198 6,666 7,320 5 4 Home Health Care 175 188 87 101 2,746 3,090 43 51 Other Services 310 338 144 152 174 207 16 16 Administration and Net Cost of Insurance 314 332 572 631 469 508 221 279 Note: Medicare includes out- of- pocket payments and payments by Medicare Supplement plans. HealthChoice “ Wrap Around” Services included in Medicaid HealthChoice. Note: A “-----“ means not applicable. Table 17: Rate of Growth in Per Capita Expenditures for Medicare and Medicaid Beneficiaries by Delivery System and Type of Service, 2000 and 2001 MEDICARE MEDICAID EXPENDITURE COMPONENTS Original + Choice Traditional HealthChoice Total Health Expenditures 9.8% 6.7% 7.8% 7.9% Hospital Services Inpatient 7.3 5.5 - 1.8 3.8 Outpatient 10.3 17.0 - 12.1 12.3 Physician Services 11.3 4.3 5.6 - 0.5 Other Professional Services 17.3 7.7 9.4 14.2 Prescription Drugs ---- 1.3 11.5 17.8 Nursing Home Care 22.5 16.9 9.8 - 15.4 Home Health Care 7.0 15.9 12.5 17.6 Other Services 9.0 5.0 19.1 4.2 Administration and Net Cost of Insurance 5.8 10.3 8.3 26.5 Note: Medicare includes out- of- pocket payments and payments by Medicare Supplement plans. HealthChoice “ Wrap Around” Services included in Medicaid HealthChoice. Note: A “-----“ means not applicable. 24 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Health Care Expenditures by Region Table 18: Total and Per Capita Expenditures and Rate of Growth by Region, 2000- 2001 TOTAL EXPENDITURES ($ millions) REGION PER CAPITA EXPENDITURES 2000 2001 PERCENT CHANGE 2000 2001 PERCENT CHANGE Maryland Total $ 18,786.6 $ 21,008.8 11.8% $ 3,537 $ 3,908 10.5% National Capital 5,348.3 6,033.2 12.8 3,181 3,532 11.0 Baltimore Metro 9,788.5 10,762.8 10.0 3,890 4,252 9.3 Western MD 1,397.8 1,593.2 14.0 3,226 3,612 12.0 Southern MD 876.4 1,016.6 16.0 3,096 3,489 12.7 Eastern Shore 1,375.6 1,603.0 16.5 3,463 3,972 14.7 Table 19: Total Expenditures by Type of Service and Region, 2000 and 2001 ($ millions) EXPENDITURE COMPONENTS NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE 2000 2001 2000 2001 2000 2001 2000 2001 2000 2001 Total Health Expenditures $ 5,348.3 $ 6,033.2 $ 9,788.5 $ 10,762.8 $ 1,397.8 $ 1,593.2 $ 876.4 $ 1,016.6 $ 1,375.6 $ 1,603.0 Hospital Services Inpatient 1,225.5 1,311.4 2,547.9 2,804.1 330.8 368.2 215.5 243.7 346.9 392.3 Outpatient 485.8 559.8 873.8 1,028.5 140.1 168.3 84.2 100.2 163.8 198.9 Physician Services 1,468.8 1,682.2 2,320.6 2,420.9 314.1 352.3 216.3 257.8 271.9 315.6 Other Professional Services 515.3 607.9 972.8 1,103.5 139.3 160.7 83.1 92.9 139.1 166.4 Prescription Drugs 614.2 702.6 1,075.6 1,195.9 146.1 168.5 105.9 122.8 130.2 164.5 Nursing Home Care 333.2 381.7 695.6 788.5 139.2 164.5 52.5 61.3 143.7 155.1 Home Health Care 166.0 187.6 330.6 369.8 51.5 56.7 27.9 32.0 45.5 51.8 Other Services 104.5 116.9 250.9 286.2 38.8 43.1 20.2 24.4 43.2 50.5 Administration and Net Cost of Insurance 435.1 483.3 720.7 765.5 98.0 110.9 70.7 81.5 91.2 107.9 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 25 Table 20: Per Capita Expenditures by Type of Service and Region, 2000 and 2001 EXPENDITURE COMPONENTS NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE 2000 2001 2000 2001 2000 2001 2000 2001 2000 2001 Total Health Expenditures $ 3,181 $ 3,532 $ 3,890 $ 4,252 $ 3,226 $ 3,612 $ 3,096 $ 3,489 $ 3,463 $ 3,972 Hospital Services Inpatient 729 768 1,013 1,108 763 835 761 836 873 972 Outpatient 289 328 347 406 323 382 297 344 412 493 Physician Services 874 985 922 956 725 799 764 885 684 782 Other Professional Services 307 356 387 436 322 364 294 319 350 412 Prescription Drugs 365 411 427 472 337 382 374 421 328 408 Nursing Home Care 198 223 276 312 321 373 186 211 362 384 Home Health Care 99 110 131 146 119 129 98 110 115 128 Other Services 62 68 100 113 89 98 71 84 109 125 Administration and Net Cost of Insurance 259 283 286 302 226 252 250 280 230 268 Table 21: Rate of Growth in Total and Per Capita Expenditures by Type of Service and Region, 2000- 2001 NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE EXPENDITURE COMPONENTS % Change Total Expenditures % Change Per Capita Expenditures % Change Total Expenditures % Change Per Capita Expenditures % Change Total Expenditures % Change Per Capita Expenditures % Change Total Expenditures % Change Per Capita Expenditures % Change Total Expenditures % Change Per Capita Expenditures Total Health Expenditures 12.8% 11.0% 10.0% 9.3% 14.0% 12.0% 16.0% 12.7% 16.5% 14.7% Hospital Services Inpatient 7.0 5.3 10.1 9.4 11.3 9.3 13.1 9.8 13.1 11.3 Outpatient 15.2 13.4 17.7 17.0 20.1 18.0 19.0 15.6 21.4 19.5 Physician Services 14.5 12.7 4.3 3.7 12.2 10.2 19.2 15.8 16.1 14.3 Other Professional Services 18.0 16.1 13.4 12.8 15.3 13.3 11.9 8.7 19.6 17.7 Prescription Drugs 14.4 12.6 11.2 10.5 15.3 13.3 15.9 12.6 26.3 24.4 Nursing Home Care 14.6 12.7 13.4 12.7 18.2 16.1 16.8 13.5 8.0 6.3 Home Health Care 13.0 11.2 11.9 11.2 10.2 8.2 14.8 11.5 13.7 11.9 Other Services 11.8 10.1 14.0 13.4 11.3 9.3 20.6 17.1 16.9 15.1 Administration and Net Cost of Insurance 11.1 9.3 6.2 5.6 13.3 11.3 15.3 12.0 18.3 16.5 26 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 22a: Total Expenditures by Type of Service, Source of Payment, and Region, 2000 ($ millions) GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES National Capital Total Health Expenditures $ 902.4 $ 102.2 $ 446.3 $ 204.9 $ 261.2 $ 1,422.1 $ 1,114.0 $ 895.2 $ 5,348.3 Hospital Services Inpatient 416.8 34.9 103.5 47.3 60.2 290.0 244.8 27.9 Outpatient 98.5 7.6 7.9 25.8 14.2 160.7 133.3 37.9 485.8 Physician Services 223.4 36.8 11.5 27.7 450.4 437.4 197.1 1,468.8 Other Professional Services 27.9 0.8 42.4 8.4 93.7 73.8 43.4 224.8 515.3 Prescription Drugs ----- 3.9 44.0 18.7 19.0 223.0 96.7 209.0 614.2 Nursing Home Care 56.9 2.9 154.6 0.3 4.5 1.6 104.0 333.2 Home Health Care 25.5 1.5 68.0 2.1 1.3 18.7 10.7 38.4 166.0 24.2 2.4 4.3 1.0 5.2 6.5 5.0 56.0 104.5 Administration and Net Cost of Insurance 29.2 11.4 10.1 16.9 31.6 141.2 ----- 435.1 Baltimore Metro Total Health Expenditures $ 1,975.6 $ 297.1 $ 1,218.2 $ 644.2 $ 576.0 $ 2,348.2 $ 1,198.0 $ 1,531.1 $ 9,788.5 Hospital Services Inpatient 1,004.6 101.5 298.3 162.5 514.1 287.7 54.2 2,547.9 Outpatient 249.0 22.2 68.5 78.3 23.9 232.3 138.7 60.9 873.8 372.6 107.1 28.6 252.7 68.9 750.6 447.3 292.8 2,320.6 Other Professional Services 58.6 2.4 156.9 30.4 201.0 53.7 380.2 972.8 Prescription Drugs ----- 11.2 122.1 58.8 56.7 383.7 104.0 339.1 1,075.6 Nursing Home Care 1,225.5 84.5 8.4 Other Services 194.6 125.0 Physician Services 89.6 112.3 8.5 346.8 0.9 15.0 7.4 1.7 203.0 695.6 Home Health Care 158.1 4.3 2.0 31.2 7.6 67.2 330.6 Other Services 58.7 7.0 11.1 3.1 13.9 18.0 133.7 250.9 Administration and Net Cost of Insurance 63.9 33.0 27.7 53.2 69.6 321.4 151.9 ----- 720.7 Western MD $ 322.4 $ 3.1 $ 194.0 $ 71.6 $ 95.3 $ 317.0 $ 173.2 $ 221.3 $ 1,397.8 Hospital Services Inpatient 155.1 1.1 26.7 14.8 19.8 71.9 34.0 7.5 330.8 Outpatient 0.2 3.1 12.2 5.1 41.6 55.9 4.3 5.5 Total Health Expenditures 39.2 28.2 10.5 140.1 Physician Services 69.3 1.1 3.5 27.9 13.4 94.1 64.2 40.6 314.1 Other Professional Services 10.3 0.0 21.2 3.0 28.7 13.6 6.8 55.7 139.3 Prescription Drugs ----- 0.1 20.6 10.4 47.4 15.8 45.0 146.1 Nursing Home Care 19.7 0.1 83.1 0.1 2.3 1.0 0.2 32.7 139.2 Home Health Care 8.4 0.0 30.1 0.5 0.3 2.5 1.2 8.3 51.5 Other Services 10.1 0.1 1.2 0.4 3.7 1.5 0.8 21.0 38.8 Administration and Net Cost of Insurance 10.4 0.3 4.4 5.9 11.5 43.4 22.0 ----- 98.0 6.9 Note: A “-----“ means not applicable. Note: 0.0 means expenditures less than $ 50,000. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 27 Table 22a: Total Expenditures by Type of Service, Source of Payment, and Region, 2000 ($ millions) – ( continued) GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES Southern MD Total Health Expenditures $ 155.9 $ 5.7 $ 85.2 $ 40.7 $ 46.4 $ 295.4 $ 108.0 $ 139.1 $ 876.4 Hospital Services Inpatient 76.2 1.9 15.8 7.3 10.7 80.1 18.5 5.0 215.5 Outpatient 18.4 0.4 1.7 7.2 2.4 29.5 18.2 6.3 84.2 Physician Services 34.8 2.1 2.2 16.3 4.8 86.7 41.1 28.4 216.3 Other Professional Services 4.0 0.0 11.5 2.2 16.6 9.7 5.5 33.6 83.1 Prescription Drugs ----- 0.2 8.9 4.0 3.8 43.8 10.0 35.3 105.9 Nursing Home Care 7.6 0.2 27.7 0.1 1.4 0.9 0.2 14.4 52.5 Home Health Care 4.7 0.1 14.4 0.2 0.2 2.3 0.6 5.3 27.9 Other Services 5.1 0.1 1.0 0.1 0.9 1.9 0.3 10.8 20.2 Administration and Net Cost of Insurance 5.0 0.6 1.9 3.4 5.6 40.4 13.7 ----- 70.7 Eastern Shore Total Health Expenditures $ 365.5 $ 1.0 $ 188.2 $ 80.7 $ 89.8 $ 273.9 $ 158.0 $ 218.6 $ 1,375.6 Hospital Services Inpatient 174.8 0.3 29.8 22.5 19.2 50.7 42.0 7.6 346.9 Outpatient 51.7 0.1 4.3 18.4 4.1 39.1 34.3 11.8 163.8 Physician Services 73.3 0.3 4.1 21.4 10.6 86.9 39.9 35.4 271.9 Other Professional Services 9.7 0.0 25.4 3.4 31.3 9.6 6.4 53.4 139.1 Prescription Drugs ----- 0.0 19.4 7.0 9.0 42.5 13.0 39.4 130.2 Nursing Home Care 24.2 0.0 77.1 0.1 2.3 0.9 0.2 38.8 143.7 Home Health Care 8.9 0.0 22.2 0.9 0.3 2.6 1.6 9.0 45.5 Other Services 11.0 0.0 1.7 0.3 2.2 4.2 0.6 23.3 43.2 Administration and Net Cost of Insurance 11.8 0.1 4.3 6.7 10.9 37.5 20.0 ----- 91.2 No te: A “-----“ means not applicable. Note: 0.0 means expenditures less than $ 50,000. 28 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 22b: Total Expenditures by Type of Service, Source of Payment, and Region, 2001 ($ millions) GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES National Capital Total Health Expenditures $ 1,061.1 $ 62.2 $ 522.9 $ 231.7 $ 307.9 $ 1,589.5 $ 1,243.8 $ 1,014.0 $ 6,033.2 Hospital Services Inpatient 473.6 21.3 118.1 47.0 71.8 305.8 244.6 29.2 1,311.4 Outpatient 115.9 5.2 11.7 30.9 18.8 177.0 160.6 39.8 559.8 Physician Services 267.8 22.2 14.5 94.2 32.5 534.8 490.3 225.9 1,682.2 Other Professional Services 35.0 0.5 54.8 9.9 109.6 81.9 51.4 264.8 607.9 Prescription Drugs ----- 2.2 54.6 22.6 24.0 242.3 117.7 239.1 702.6 Nursing Home Care 76.4 2.0 174.9 0.3 10.0 5.0 1.7 111.4 381.7 Home Health Care 30.6 1.0 77.8 2.3 1.5 20.9 11.9 41.5 187.6 Other Services 28.8 1.5 5.2 1.1 5.4 7.3 5.5 62.2 116.9 Administration and Net Cost of Insurance 33.1 6.4 11.5 23.4 34.4 214.5 160.0 ----- 483.3 Baltimore Metro Total Health Expenditures $ 2,498.8 $ 55.7 $ 1,347.9 $ 709.3 $ 655.9 $ 2,605.9 $ 1,209.3 $ 1,680.0 $ 10,762.8 Hospital Services Inpatient 1,245.9 19.1 310.4 168.2 144.3 579.1 277.9 59.2 2,804.1 Outpatient 314.3 4.6 69.9 96.0 31.0 287.6 158.7 66.4 1,028.5 Physician Services 481.7 19.9 33.0 262.1 75.7 810.0 433.2 305.2 2,420.9 Other Professional Services 78.7 0.4 182.0 33.1 228.4 93.1 54.7 433.1 1,103.5 Prescription Drugs ----- 2.0 143.4 69.2 69.5 421.5 114.3 376.0 1,195.9 Nursing Home Care 157.2 1.8 382.6 1.0 17.6 8.2 1.7 218.5 788.5 Home Health Care 65.9 0.9 183.4 4.6 2.3 34.7 7.6 70.3 369.8 Other Services 77.1 1.3 13.5 3.3 13.9 20.0 5.5 151.4 286.2 Administration and Net Cost of Insurance 77.9 5.7 29.6 71.7 73.2 351.7 155.6 ----- 765.5 Western MD Total Health Expenditures $ 371.2 $ 0.8 $ 223.4 $ 82.6 $ 108.7 $ 376.8 $ 179.1 $ 250.7 $ 1,593.2 Hospital Services Inpatient 168.9 0.3 29.1 16.5 22.9 87.5 34.7 8.2 368.2 Outpatient 48.9 0.1 4.5 13.8 6.6 53.8 29.0 11.5 168.3 Physician Services 79.4 0.3 4.2 32.1 15.0 108.3 67.5 45.4 352.3 Other Professional Services 12.6 0.0 29.0 3.2 32.4 14.1 6.7 62.6 160.7 Prescription Drugs ----- 0.0 24.3 7.5 12.5 56.2 15.8 52.3 168.5 Nursing Home Care 28.5 0.0 93.4 0.1 2.7 1.2 0.2 38.3 164.5 Home Health Care 9.8 0.0 32.5 0.6 0.4 3.0 1.3 9.1 56.7 Other Services 11.5 0.0 1.5 0.4 4.0 1.8 0.8 23.2 43.1 Administration and Net Cost of Insurance 11.6 0.1 4.9 8.4 12.1 50.8 23.0 ----- 110.9 No te: A “-----“ means not applicable. Note: 0.0 means expenditures less than $ 50,000. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 29 Table 22b: Total Expenditures by Type of Service, Source of Payment, and Region, 2001 ($ millions) – ( continued) GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES Southern MD Total Health Expenditures $ 183.8 $ 2.5 $ 99.2 $ 48.2 $ 54.6 $ 326.5 $ 142.3 $ 159.5 $ 1,016.6 Hospital Services Inpatient 87.2 0.9 17.7 7.6 12.8 90.4 21.6 5.6 243.7 Outpatient 21.3 0.2 2.6 8.5 3.2 33.0 24.5 6.9 100.2 Physician Services 41.0 0.9 2.5 19.7 5.6 97.9 56.3 33.8 257.8 Other Professional Services 5.2 0.0 14.9 2.2 19.3 8.3 6.2 37.0 92.9 Prescription Drugs ----- 0.1 10.8 4.9 4.8 47.1 14.1 40.9 122.8 Nursing Home Care 11.1 0.1 30.6 0.1 1.7 1.0 0.2 16.6 61.3 Home Health Care 5.5 0.0 16.7 0.3 0.2 2.5 0.8 5.8 32.0 Other Services 6.7 0.1 1.1 0.1 0.9 2.1 0.4 13.0 24.4 Administration and Net Cost of Insurance 5.7 0.3 2.2 4.9 6.1 44.1 18.3 ----- 81.5 Eastern Shore Total Health Expenditures $ 414.5 $ 0.6 $ 218.7 $ 94.8 $ 105.7 $ 363.3 $ 153.5 $ 252.0 $ 1,603.0 Hospital Services Inpatient 192.9 0.2 34.7 26.8 22.8 64.5 42.0 8.4 392.3 Outpatient 60.7 0.0 5.8 24.2 5.4 51.8 38.0 13.0 198.9 Physician Services 84.7 0.2 4.7 21.4 12.5 116.9 33.6 41.6 315.6 Other Professional Services 11.8 0.0 34.1 3.8 36.4 11.7 5.9 62.6 166.4 Prescription Drugs ----- 0.0 23.9 7.5 11.2 59.2 11.8 50.9 164.5 Nursing Home Care 28.7 0.0 83.5 0.1 2.8 1.1 0.2 38.5 155.1 Home Health Care 10.3 0.0 25.2 1.0 0.4 3.5 1.6 9.9 51.8 Other Services 12.5 0.0 2.0 0.3 2.5 5.6 0.5 27.1 50.5 Administration and Net Cost of Insurance 12.9 0.1 4.8 9.6 11.8 49.0 19.7 ----- 107.9 Note: A “-----“ means not applicable. Note: 0.0 means expenditures less than $ 50,000. 30 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 23: Rate of Growth in Total Expenditures by Type of Service, Source of Payment, and Region, 2000- 2001 GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES National Capital Total Health Expenditures 17.6% - 39.1% 17.2% 13.1% 17.9% 11.8% 11.6% 13.3% 12.8% Hospital Services Inpatient 13.6 - 38.9 14.0 - 0.6 19.3 5.5 - 0.1 4.5 7.0 Outpatient 17.6 - 32.4 48.4 19.8 32.7 10.1 20.5 5.2 15.2 Physician Services 19.9 - 39.6 26.4 11.5 17.3 18.7 12.1 14.6 14.5 Other Professional Services 25.3 - 38.3 29.2 17.7 16.9 11.0 18.3 17.8 18.0 Prescription Drugs ----- - 42.2 24.1 21.2 26.3 8.7 21.8 14.4 14.4 Nursing Home Care 34.2 - 32.2 13.1 10.8 19.6 12.0 11.4 7.1 14.6 Home Health Care 19.8 - 33.4 14.5 10.8 18.8 12.0 11.4 8.2 13.0 Other Services 19.4 - 39.4 20.5 10.8 2.8 12.0 11.4 11.0 11.8 Administration and Net Cost of Insurance 13.3 - 44.1 13.4 38.6 8.9 10.2 13.3 ----- 11.1 Baltimore Metro Total Health Expenditures 26.5% - 81.2% 10.6% 10.1% 13.9% 11.0% 0.9% 9.7% 10.0% Hospital Services Inpatient 24.0 - 81.2 4.1 3.5 15.4 12.6 - 3.4 9.2 10.1 Outpatient 26.2 - 79.2 2.1 22.6 29.5 23.8 14.5 9.1 17.7 Physician Services 29.3 - 81.4 15.2 3.7 9.9 7.9 - 3.2 4.2 4.3 Other Professional Services 34.3 - 81.0 16.0 8.9 13.6 3.9 1.7 13.9 13.4 Prescription Drugs ----- - 82.2 17.4 17.7 22.7 9.9 9.9 10.9 11.2 Nursing Home Care 40.0 - 79.1 10.3 7.9 17.4 11.2 0.7 7.6 13.4 Home Health Care 18.0 - 79.5 16.0 7.9 17.6 11.2 0.7 4.5 11.9 Other Services 31.3 - 81.3 22.3 7.9 0.3 11.2 0.7 13.3 14.0 Administration and Net Cost of Insurance 21.9 - 82.8 7.0 34.9 5.1 9.4 2.4 ----- 6.2 Western MD Total Health Expenditures 15.1% - 75.8% 15.1% 15.4% 14.1% 18.9% 3.4% 13.3% 14.0% Hospital Services Inpatient 8.9 - 75.7 9.2 11.9 15.9 21.6 2.2 9.2 11.3 Outpatient 24.8 - 73.1 44.8 13.0 28.8 29.3 3.1 10.5 20.1 Physician Services 14.6 - 76.0 18.1 15.3 12.1 15.2 5.2 11.8 12.2 Other Professional Services 22.6 - 75.5 36.8 7.2 12.9 4.2 - 2.1 12.4 15.3 Prescription Drugs ----- - 77.0 17.9 9.2 20.4 18.6 - 0.3 16.2 15.3 Nursing Home Care 44.8 - 73.0 12.4 13.1 17.9 19.1 3.2 17.2 18.2 Home Health Care 17.1 - 73.5 7.9 13.1 19.5 19.1 3.2 9.6 10.2 Other Services 13.3 - 75.9 17.1 13.1 7.7 19.1 3.2 10.6 11.3 Administration and Net Cost of Insurance 10.9 - 77.7 11.4 41.4 5.4 17.2 4.9 ----- 13.3 No te: A “-----“ means not applicable. M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 31 Table 23: Rate of Growth in Total Expenditures by Type of Service, Source of Payment, and Region, 2000- 2001 – ( continued) GOVERNMENT SECTOR PRIVATE SECTOR Medicare EXPENDITURE Medicaid Private Coverage COMPONENTS Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES Southern MD Total Health Expenditures 17.9% - 56.0% 16.5% 18.5% 17.7% 10.5% 31.7% 14.7% 16.0% Hospital Services Inpatient 14.5 - 55.8 12.0 3.2 19.7 12.9 16.9 11.3 13.1 Outpatient 15.8 - 51.1 50.3 18.4 35.4 11.9 34.0 8.8 19.0 Physician Services 18.1 - 56.3 16.7 21.0 15.4 12.9 37.0 19.0 19.2 Other Professional Services 28.5 - 55.4 29.9 - 0.7 16.2 - 14.7 12.4 10.1 11.9 Prescription Drugs ----- - 58.2 21.5 24.5 26.3 7.6 41.0 16.0 15.9 Nursing Home Care 46.1 - 51.0 10.1 16.1 20.1 10.8 31.4 14.9 16.8 Home Health Care 17.2 - 51.8 16.1 16.1 20.9 10.8 31.4 9.6 14.8 Other Services 29.9 - 56.2 16.8 16.1 4.2 10.8 31.4 20.3 20.6 Administration and Net Cost of Insurance 13.6 - 59.5 12.7 45.2 8.7 9.0 33.7 ----- 15.3 Eastern Shore Total Health Expenditures 13.4% - 41.2% 16.2% 17.5% 17.7% 32.6% - 2.8% 15.3% 16.5% Hospital Services Inpatient 10.3 - 41.0 16.7 18.8 19.0 27.2 0.1 10.0 13.1 Outpatient 17.4 - 34.7 33.9 31.7 31.3 32.3 10.9 10.0 21.4 Physician Services 15.6 - 41.7 15.6 0.0 18.0 34.5 - 15.8 17.4 16.1 Other Professional Services 21.1 - 40.4 34.4 10.7 16.4 22.5 - 6.8 17.3 19.6 Prescription Drugs ----- - 44.2 23.3 7.8 24.8 39.3 - 9.2 29.2 26.3 Nursing Home Care 18.7 - 34.5 8.3 15.1 19.4 32.9 - 3.0 - 0.6 8.0 Home Health Care 15.2 - 35.7 13.5 15.1 19.1 32.9 - 3.0 10.2 13.7 Other Services 13.8 - 41.5 16.7 15.1 12.6 32.9 - 3.0 16.4 16.9 Administration and Net Cost of Insurance 9.3 - 46.0 12.4 44.0 8.7 30.8 - 1.4 ----- 18.3 No te: A “-----“ means not applicable. 32 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N Table 24: Expenditures as a Percent of Total Expenditures by Type of Service and Region, 2000 and 2001 EXPENDITURE NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE COMPONENTS 2000 2001 2000 2001 2000 2001 2000 2001 2000 2001 Total Health Expenditures 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Hospital Services Inpatient 22.9 21.7 26.0 26.1 23.7 23.1 24.6 24.0 25.2 24.5 Outpatient 9.1 9.3 8.9 9.6 10.0 10.6 9.6 9.9 11.9 12.4 Physician Services 27.5 27.9 23.7 22.5 22.5 22.1 24.7 25.4 19.8 19.7 Other Professional Services 9.6 10.1 9.9 10.3 10.0 10.1 9.5 9.1 10.1 10.4 Prescription Drugs 11.5 11.6 11.0 11.1 10.5 10.6 12.1 12.1 9.5 10.3 Nursing Home Care 6.2 6.3 7.1 7.3 10.0 10.3 6.0 6.0 10.4 9.7 Home Health Care 3.1 3.1 3.4 3.4 3.7 3.6 3.2 3.1 3.3 3.2 Other Services 2.0 1.9 2.6 2.7 2.8 2.7 2.3 2.4 3.1 3.2 Administration and Net Cost of Insurance 8.1 8.0 7.4 7.1 7.0 7.0 8.1 8.0 6.6 6.7 Table 25: Expenditures as a Percent of Total Expenditures by Source of Payment and Region, 2000 and 2001 GOVERNMENT SECTOR PRIVATE SECTOR REGION Medicare Medicaid Private Coverage Original + Choice Traditional HealthChoice Other Government Insurers & Self- Funded HMO Out- of-pocket TOTAL EXPENDITURES National Capital 2000 16.9% 1.9% 8.3% 3.8% 4.9% 26.6% 20.8% 16.7% 100% 2001 17.6 1.0 8.7 3.8 5.1 26.3 20.6 16.8 100 Baltimore Metro 2000 20.2% 3.0% 12.4% 6.6% 5.9% 24.0% 12.2% 15.6% 100% 2001 23.2 0.5 12.5 6.6 6.1 24.2 11.2 15.6 100 Western MD 2000 23.1% 0.2% 13.9% 5.1% 6.8% 22.7% 12.4% 15.8% 100% 2001 23.3 0.0 14.0 5.2 6.8 23.6 11.2 15.7 100 Southern MD 2000 17.8% 0.7% 9.7% 4.6% 5.3% 33.7% 12.3% 15.9% 100% 2001 18.1 0.2 9.8 4.7 5.4 32.1 14.0 15.7 100 Eastern Shore 2000 26.6% 0.1% 13.7% 5.9% 6.5% 19.9% 11.5% 15.9% 100% 2001 25.9 0.0 13.6 5.9 6.6 22.7 9.6 15.7 100 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 33 34 MARYLAND HEALTH CARE COMMISSION Table 26: Per Capita Medicare, Medicaid, and Total Expenditures by Type of Service and Region, 2000 and 2001 EXPENDITURE NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE COMPONENTS Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers 2000 Total Health Expenditures $ 7,006 $ 5,509 $ 3,181 $ 8,531 $ 6,809 $ 3,890 $ 6,388 $ 7,239 $ 3,226 $ 7,263 $ 5,905 $ 3,096 $ 6,831 $ 6,324 $ 3,463 Hospital Services Inpatient 2,843 1,276 729 3,815 1,685 1,013 2,770 1,129 763 3,177 1,085 761 2,950 1,230 873 Outpatient 817 284 289 1,087 537 347 819 419 323 912 420 297 1,013 534 412 Physician Services 1,956 812 874 1,951 1,029 922 1,529 856 725 1,799 865 764 1,511 600 684 Other Professional Services 204 430 307 239 685 387 207 659 322 186 639 294 194 677 350 Prescription Drugs 25 530 365 40 661 427 2 748 337 9 604 374 1 619 328 Nursing Home Care 405 1,311 198 454 1,271 276 384 2,267 321 341 1,304 186 453 1,817 362 Home Health Care 160 592 99 196 594 131 139 835 119 183 687 98 139 542 115 Other Services 267 44 62 343 52 100 263 43 89 338 50 71 279 47 109 Administration and Net Cost of Insurance 330 229 259 408 296 286 275 281 226 318 248 250 291 257 230 2001 Total Health Expenditures $ 7,627 $ 5,820 $ 3,532 $ 8,722 $ 7,115 $ 4,252 $ 7,163 $ 7,923 $ 3,612 $ 8,431 $ 6,381 $ 3,489 $ 7,429 $ 6,799 $ 3,972 Hospital Services Inpatient 3,030 1,273 768 3,927 1,655 1,108 2,946 1,182 835 3,609 1,094 836 3,120 1,334 972 Outpatient 890 328 328 1,157 574 406 995 475 382 1,042 483 344 1,145 651 493 Physician Services 2,137 838 985 1,895 1,021 956 1,693 940 799 2,068 962 885 1,668 567 782 Other Professional Services 244 499 356 280 744 436 249 834 364 240 738 319 226 821 412 Prescription Drugs 14 596 411 7 735 472 1 823 382 4 682 421 0 681 408 Nursing Home Care 512 1,351 223 536 1,327 312 539 2,421 373 491 1,326 211 502 1,815 384 Home Health Care 182 618 110 195 650 146 159 857 129 214 737 110 155 568 128 Other Services 286 48 68 366 58 113 286 48 98 415 54 84 293 51 125 Administration and Net Cost of Insurance 332 269 283 360 351 302 295 343 252 348 306 280 319 312 268 Note: Medicare includes out- of- pocket payments and payments by Medicare Supplement plans. Table 27: Rate of Growth in Medicare, Medicaid, and Total Per Capita Expenditures by Type of Service and Region, 2000- 2001 EXPENDITURE NATIONAL CAPITAL BALTIMORE METRO WESTERN MD SOUTHERN MD EASTERN SHORE COMPONENTS Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers Medicare Medicaid All Payers Total Health Expenditures 8.9% 5.6% 11.0% 2.2% 4.5% 9.3% 12.1% 9.5% 12.0% 16.1% 8.1% 12.7% 8.7% 7.5% 14.7% Hospital Services Inpatient 6.6 - 0.2 5.3 2.9 - 1.7 9.4 6.3 4.7 9.3 13.6 0.8 9.8 5.8 8.5 11.3 Outpatient 9.0 15.3 13.4 6.5 6.9 17.0 21.5 13.5 18.0 14.3 15.0 15.6 13.1 21.8 19.5 Physician Services 9.2 3.2 12.7 - 2.9 - 0.8 3.7 10.8 9.8 10.2 14.9 11.2 15.8 10.4 - 5.5 14.3 Other Professional Services 16.0 16.1 17.1 8.7 12.8 19.9 26.5 13.3 29.0 15.4 8.7 16.4 21.3 17.7 Prescription Drugs - 43.0 12.3 12.6 - 83.8 11.2 10.5 - 77.0 10.0 13.3 - 56.6 13.0 12.6 - 45.2 9.9 24.4 Nursing Home Care 26.4 3.1 12.7 18.1 4.3 12.7 40.5 6.8 16.1 43.8 1.6 13.5 10.8 - 0.1 6.3 Home Health Care 13.5 4.3 11.2 - 0.3 9.5 11.2 14.5 2.6 8.2 16.7 7.2 11.5 10.9 4.7 11.9 Other Services 7.4 8.3 10.1 6.9 12.7 13.4 8.9 10.4 9.3 22.9 7.7 17.1 5.2 7.4 15.1 Administration and Net Cost of Insurance 0.7 17.7 9.3 - 11.8 18.6 5.6 7.6 22.2 11.3 9.5 23.0 12.0 9.7 21.4 16.5 19.7 35 M A R Y L A N D H E A L T H C A R E C O M M I S S I O N 36 MARYLAND HEALTH CARE COMMISSION |
