National Medical Care Utilization and Expenditure Survey (Series). Series C, Analytical report最新文献

This report addresses a question of importance for policymakers: "What are the determinants of the total charges for health care that U.S. families face?" Policymakers' concerns about this question have two main grounds. First, U.S. health care costs are large and growing rapidly. They now exceed 11 percent of the gross national product, and the answer to the question can shed some light on their troubling growth. Second, total family charges for health care reflect the quantity of health care received by families, and it is important to know whether the determinants of total charges are principally the need for health care, or involve other factors less related to need. In this report, the determinants of total charges and their importance are identified principally through multiple regression analysis. Total charges are defined as the full amount charged for all types of health care for all family members regardless of whether these amounts are paid out of pocket, paid by insurance (or public health care coverage programs), or go unpaid. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on the approximately 5,000 multiple-person families interviewed in this year-long longitudinal survey. The report provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower income families (all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better off families (all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65). Multiple regression analysis was used to investigate the effect on total family charges of family demographic and sociocultural characteristics, family illnesses, special health events (such as births, deaths, and hospitalizations of family members), general family health status, family income, family health insurance characteristics, and family geographic and urbanization characteristics. Regressions were run separately for each of the three socio-economic family populations, with total family charges as the dependent variable and approximately 45 variables measuring these family characteristics as independent variables. Because of the large number of independent variables involved, a multiple-step regression process (described in appendix I) was used.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular conditions have a major economic as well as health impact on adults in the United States. In the National Medical Care Utilization and Expenditure Survey, conducted during 1980, health service data were obtained from a national sample of 17,123 civilian noninstitutionalized individuals. These data have been analyzed to define the impact and demographic patterns of health care utilization and costs attributable to adult cardiovascular conditions. Approximately 28 million persons in the United States, or 17.3 percent of the total civilian noninstitutionalized population 17 years of age and over, had a cardiovascular condition during 1980. Cardiovascular conditions were reported with increasing frequency in successively older age groups and were reported most frequently by black persons. The prevalence and economic impact differed by specific type of cardiovascular condition and whether the condition was complicated by another disease. To examine these differences, persons reporting cardiovascular conditions were categorized into four mutually exclusive groups: persons with hypertension alone, persons with arteriosclerotic cardiovascular and cerebrovascular disease associated with hypertension, persons with arteriosclerotic cardiovascular disease alone, and persons with cardiovascular disease associated with other conditions that might alter medical care utilization and disability. The disability, service utilization, and health care charges were compared among these groups, and data for each group were compared with those for the overall U.S. population. Survey participants were asked to rate their health relative to that of other people their age. The self-rating of persons reporting hypertension alone was lower than the national average. Only 17 percent of the general population rated their health as "fair" or "poor," but 27 percent of persons with hypertension alone used these descriptions. Overall, persons with hypertension alone were much less likely to be employed than the general population (52.2 percent versus 71.6 percent). However, when controlling for age, it was found that persons with hypertension alone were about as likely to be employed as the general population. On the average, persons with hypertension reported only slightly more work-loss days than did the general population (6.5 versus 4.9 days). A modest restriction of activity was reported by those with hypertension alone (20.1 days per year on the average compared with 15.6 for the general population). The mean number of ambulatory visits per year for those with hypertension alone was 7.9, only slightly greater than the 5.7 average for the overall population.(ABSTRACT TRUNCATED AT 400 WORDS)

This report focuses on two questions of current interest to policymakers. First, "What percent of U.S. families experience financially burdensome health expenses?" and, second, "What are the determinants of financially burdensome health expenses among U.S. families?" The first question is addressed by examining how the distribution in the United States of families with financially burdensome health expenses is affected by six different possible measures of financial burden. The second question is addressed by using multiple regression techniques on one of the measures selected as a preferred measure. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on approximately 5,000 multiple-person families interviewed in this longitudinal survey. It provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower-income families (defined as all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better-off families (defined as all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65 years of age). Two general conceptual approaches have been used in the literature to assess financially burdensome health expenses. The first approach measures financial burden by the size of a family's health bill in dollars. The second approach focuses on a family's ability to pay its health bill, and it measures financial burden as a ratio of health expenses to family income. There is no agreement on which of the two approaches is preferable and also no agreement on which of several operational measures in each category is the most appropriate. In order to shed light on this controversy, this report compares six potentially useful operational measures of financially burdensome health expenses. Three are dollar measures and three are ratio measures. The three dollar measures are (1) total charges for health care (irrespective of who pays the bill or whether or not the bill is paid), (2) out-of-pocket expenses for health care services (family-paid premiums for health insurance are not included), and (3) total out-of-pocket expenses for health (the previous measure plus out-of-pocket premiums).(ABSTRACT TRUNCATED AT 400 WORDS)

Acute respiratory conditions are common causes of health disturbance in the general population. They are generally self-limiting, although occasionally recurrent, and seldom result in large health care costs for each episode of illness. The National Medical Care Utilization and Expenditure Survey (NMCUES), conducted during 1980, provided an opportunity to assess the effect of acute respiratory conditions on utilization of medical services and on functional capability as well as the cost of related medical care. Acute respiratory conditions were reported by survey respondents and separated into five subgroups: colds, influenza, nasopharyngitis, otitis media, and lower respiratory infections. Allergic conditions and chronic respiratory disorders (tuberculosis, chronic obstructive pulmonary disease, and pneumoconioses) were excluded. The subgroupings of acute respiratory conditions appear to separate the disorders in a manner consistent with the epidemiologic characteristics of each condition. About one-half (50.4 percent) of the U.S. civilian noninstitutionalized population had one or more acute respiratory conditions during 1980. The highest rates for upper respiratory conditions (colds, influenza, nasopharyngitis, and otitis media) were reported for those under 18 years of age, and rates were lower in successively older groups. Lower respiratory infection rates were higher in the youngest and oldest groups. Despite a high incidence in the general population, most symptomatic episodes of colds, influenza, and nasopharyngitis did not result in ambulatory care visits or hospital admissions. Otitis media and lower respiratory infections were more often associated with medical visits. Acute respiratory conditions were associated with lower disability levels than the average for the U.S. civilian noninstitutionalized population during 1980 (5.9 restricted-activity days for acute respiratory conditions, compared with an overall average of 13.8 restricted-activity days). Persons with upper respiratory conditions (colds, influenza, otitis media, and nasopharyngitis) averaged 2.3 to 5.4 restricted-activity days, but persons with lower respiratory infections experienced an average of 8.2 restricted-activity days. Indirect costs attributed to acute respiratory conditions in 1980 were $7.7 billion for employed persons and $698 million for homemakers, for a total of $8.4 billion, about the same as total direct costs ($8.3 billion). These indirect costs were several times larger than the annual indirect costs estimated for either cardiovascular diseases or musculoskeletal diseases, two common chronic or recurrent condition groups. The high indirect costs reflect the high frequency of episodes in the general population during 1980 and the greater likelihood of associated bed-disability and work-loss days than for other conditions.(ABSTRACT TRUNCATED AT 400 WORDS)

In this report, data from the 1980 National Medical Care Utilization and Expenditure Survey are used to present health characteristics, types and quantities of services used, and the charges for these services for persons with musculoskeletal diseases. Slightly more than 44 million people, or 19.8 percent of the U.S. civilian noninstitutionalized population, were reported in the survey to have at least one musculoskeletal disorder. These data are generally consistent with those from other health surveys, which show that the prevalence of musculoskeletal disorders increases for successive age categories, that such disorders are more common among women than among men, and that they are less prevalent among black persons than among persons of other races. In terms of both functional limitation and perceived health status, persons with musculoskeletal conditions are, with some notable exceptions, in relatively poor health. Persons having back problems in addition to problems with peripheral joints (such as the knee, hip, or shoulder) were more likely to rate their health as "fair" or "poor" compared with persons having only back problems or compared with persons in the civilian noninstitutionalized population as a whole. Musculoskeletal disorders accounted for a considerable proportion of all disability days reported by the total civilian noninstitutionalized population: 13 percent of restricted-activity days, 8.8 percent of bed-disability days, and 11.2 percent of all work-loss days were directly attributable to musculoskeletal conditions. The disabling effects of musculoskeletal problems pose a significant economic burden; they accounted for a total of $3.9 billion in lost productivity costs during 1980 for employed persons in the work force and for homemakers. For persons with musculoskeletal problems, the mean number of ambulatory visits per year was nearly twice the rate of 5.2 for the general civilian noninstitutionalized population. Of ambulatory visits made to all health care providers by persons with these conditions, 35.6 percent were related in some way to the treatment of their musculoskeletal problems. Musculoskeletal conditions are somewhat different from many other illnesses because their treatment is within the professional domain of several types of health care providers. Approximately 13 percent of persons with any type of musculoskeletal disorder received care from chiropractors during the year and this figure rose to nearly 30 percent for back problems only. However, nearly 33 percent of persons with musculoskeletal problems made no visits for treatment of their condition.(ABSTRACT TRUNCATED AT 400 WORDS)

The total costs of illness and injury in the U.S. civilian noninstitutionalized population in 1980 amounted to $381.7 billion. The direct costs of illness and injury--resource expenditures for the diagnosis, treatment, and management of medical and dental conditions--were $153.9 billion, or 40.3 percent of total costs. Indirect costs--economic losses from morbidity and mortality--were $227.9 billion, or 59.7 percent of total costs. Of indirect costs, $104.9 billion resulted from productivity losses because of morbidity, and $123.0 billion represent the present value of lost productivity from premature mortality based on a net effective discount rate of 4 percent. These estimates, based on data from the 1980. National Medical Care Utilization and Expenditure Survey (NMCUES), differ from other estimates of the costs of illness and injury in 1980 (Gibson and Waldo, 1982; Rice, Hodgson, and Kopstein, 1985). The differences, which can be resolved, are attributable to two major factors: (1) NMCUES includes only the civilian noninstitutionalized population, but the other estimates include the institutionalized population and the military; and (2) NMCUES indirect cost estimates for the population unable to work include persons who were retired for health reasons in 1979 and 1980, disabled homemakers, and other persons who were disabled for the entire year 1980 but were not retired for health reasons in 1979, but the Rice et al. estimates do not include the last two categories in the population unable to work. The principal NMCUES findings on the total costs of illness in the civilian noninstitutionalized population reinforce the importance of considering distributional effects. Persons 65 years of age and over represent one-tenth of this population yet account for more than one-fourth of direct costs and more than their share of total costs, even though the institutionalized elderly are excluded. More than two-thirds of total costs for this age category are accounted for by direct costs. Direct costs also account for more than two-thirds of total costs for people under 17 years of age. However, this youngest age category, which constitutes over one-fourth of the civilian noninstitutionalized population, generates only 12.3 percent of direct costs. In contrast, indirect costs account for well more than 60 percent of total costs for the working-age population (17-64 years of age). Within the working-age population, per capita direct costs are highest among persons who are not full participants in the work force, many of whom are not working full time or at all because of injury or ill health.(ABSTRACT TRUNCATED AT 400 WORDS)

Data from the National Medical Care Utilization and Expenditure Survey of 1980 are used to examine the characteristics of high-volume users of health care services, contrasting them with low-volume users and those who used no services at all. The three major types of medical care services examined are hospital inpatient care, ambulatory visits, and prescribed medications. Low users were defined, respectively, as those who during the year had either one or two hospital days, one nondental visit to a physician or nonphysician, and one prescribed medicine acquisition. High users were those with, respectively, 17 or more hospital days, 20 or more visits, and 25 or more prescribed medicine acquisitions. A very small percent of the U.S. civilian noninstitutionalized population and of those who used services at all during the year consume a large percent of services in each of the three service types. High users of inpatient hospital care constitute 1.7 percent of the civilian noninstitutionalized population and 15 percent of persons hospitalized during the year, yet they used 54.4 percent of all hospital days used by the reference population. High users of ambulatory services constitute 4.5 percent of the reference population and only 5.7 percent of all users of ambulatory services, yet they accounted for 32.3 percent of all ambulatory visits. For prescribed medications, only 3.7 percent of the civilian noninstitutionalized population are high users, comprising 5.9 percent of all users, but they account for 32.9 percent of all prescription acquisitions. At the other extreme, low users of ambulatory care visits represent 17 percent of the reference population, and 21 percent of all users of such care, but only 3.3 percent of all visits. High users share certain characteristics. They are more likely than low users to be older and poorer, to have poorer health status and more medical conditions, and are more likely to have functional limitations. Both univariate and multivariable analyses show that the most important distinguishing characteristics of high users of any of the three medical services are poor health status, severe functional limitations, and the presence of multiple medical conditions--most importantly cancer, cardiac disorders, musculoskeletal diseases, respiratory diseases, and injuries and poisonings. Almost all high-volume users of every category of service (88 percent for hospital days, 89 percent for ambulatory visits, and 94 percent for prescribed medications) had at least three different diagnostic conditions reported during the year.(ABSTRACT TRUNCATED AT 400 WORDS)

In the household survey phase of the National Medical Care Utilization and Expenditure Survey of 1980, a survey was conducted of 17,123 persons who constituted a representative sample of the civilian population in the United States not residing in institutions. Through repeated interviews the survey obtained information on the health conditions of these people, the health care services they received in 1980, the costs of these services, and the sources of payment for services. This report, one of a series of reports on the survey findings, provides a profile of low-income children: Their health insurance coverage, health service use, and expenditures for physician visits. Children under 18 years of age in families below 150 percent of the 1980 Federal poverty level are considered low income. However, children who were ineligible to participate in the survey for part of the year are excluded, such as those who were born, who died, or who were institutionalized in 1980. A physician visit is defined as a face-to-face contact with a physician or a nonphysician working under the supervision of a physician. In addition, visits to nurse practitioners and physician assistants who were reported as "independent providers" are included. Otherwise, visits to independent providers (primarily chiropractors and optometrists), mental health visits, visits by physicians to hospital inpatients, and telephone contacts are excluded. Of the 63.9 million children under 18 years of age in the United States in 1980, about one-fourth (16.8 million) lived in low-income families, according to estimates from the National Medical Care Utilization and Expenditure Survey. Nearly one-half (46 percent) of the 16.8 million low-income children were covered by Medicaid for all or part of 1980: 31 percent were covered by Medicaid only for the full year, 3 percent were covered by Medicaid for part of 1980 and uninsured for the remainder of the year, and 12 percent were covered by both Medicaid and private insurance during the year. An additional 30 percent of the low-income children were privately insured for the full year, while 8 percent had private insurance coverage for part of the year and were uninsured otherwise. Sixteen percent of the children in low-income families, or 2.7 million children, were uninsured for all of 1980. When added to the 3 percent with part year Medicaid coverage and the 8 percent with private coverage part of the year, over one-fourth (28 percent) were uninsured for at least part of 1980.(ABSTRACT TRUNCATED AT 400 WORDS)