Health Care Industry Market Research

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Health Expenditures and Services in the U.S.:

Health care costs continue to rise in the U.S. and throughout the developed world.  Total U.S. health care expenditures were estimated to be $3.54 trillion in 2017, and are projected to soar to $5.55 trillion in 2025.

The health care market in the U.S. during 2017 included the major categories of hospital care ($1,140.8 billion); dental, physician and clinical services ($845.0 billion); prescription drugs ($360.1 billion), along with nursing home and home health care ($269.4 billion).  Registered U.S. hospitals totaled 5,564 properties in 2015, according to an American Hospital Association survey, containing 897,961 beds serving 35.1 million admitted patients yearly (the latest data available).

Medicare, the U.S. federal government’s health care program for Americans 65 years or older, provided coverage to an estimated 58.6 million seniors during 2017.  National expenditures on Medicare for fiscal 2017 were projected to be $718.7 billion, including premiums paid by beneficiaries and health care costs covered by Medicare.  By 2030, the number of people covered by Medicare will balloon to about 82 million due to the massive number of Americans who will become of eligible age.

Medicaid is the federal government’s health care program for low-income and disabled persons (including children), as well as certain groups of seniors in nursing homes.  National expenditures on Medicaid totaled an estimated $586.5 billion in 2017.  The majority of that expense is paid for by the federal government.  However, the states pick up a significant share of the cost, which is a massive burden on state budgets.

Health spending in the U.S., at about 18.3% of Gross Domestic Product (GDP) in 2017, is projected to grow steadily.  Health care spending in America accounts for a larger share of GDP than in any other country, by a wide margin.  Despite the incredible investment America continues to make in health care, 9.4% of people in the U.S. (29.8 million) lacked health care coverage for the entire year of 2015.  For some, insurance was unavailable or unaffordable.  In other cases, a lack of insurance was due to a personal decision not to pay for it.  According to the Kaiser Family Foundation, most uninsured people are in low-income working families, but a large segment of those counted among America’s uninsured are non-U.S. citizens, both lawful and illegal residents.

In March 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), designed to strengthen insurance company regulation and provide medical coverage to millions of uninsured Americans.  The act called for sweeping changes.  Provisions taking effect within the first six months of signing included coverage for adult children up to age 26 on their parents’ policies; making it unlawful for insurers to place lifetime caps on payouts or deny coverage should a policy holder become ill; and new policies are required to pay the full cost of selected preventive care and exempt such care from deductibles.  Effective in 2010, small businesses with fewer than 25 employees and average annual wages of less than $50,000 became eligible for tax credits to cover up to 35% of staff insurance premiums.

Online health care insurance “exchanges” began enabling consumers to shop for health coverage.  A 3.8% unearned income tax is levied on individuals earning more than $200,000 per year and families earning more than $250,000 per year, to fund the programs in the act.  As of 2016, employers, with the equivalent of 50 full-time employees, which do not offer health benefits will pay a fine per full time staff member if any of the workers receives a tax credit to buy coverage.  A similar fine took effect in 2015 for employers with the equivalent of 100 full-time employees.  Most businesses with more than 200 employees are required to enroll all staff automatically in health insurance plans.  Also, the government began fining citizens who choose not to have health insurance.  Consumers whose annual incomes do not exceed set amounts may receive financial assistance if they purchase their own health insurance.

Despite the immense effort and expense, many Americans are greatly disappointed in the results of the Affordable Care Act.  Insurance policies sold under the exchanges had 2017 premium increases averaging roughly 25% for mid-level “Silver” coverage plans.  Some locales saw massive increases.  For example, Birmingham, Alabama’s Silver plans increased 71%, while those in Phoenix, Arizona rose by 145%.  The number of insurance firms offering coverage via the exchanges plummeted.

Increases in Silver plan premiums for 2018 were forecast to increase by roughly 20%.  While the 2017 increases were largely an attempt by insurers to raise premiums sufficiently to cover their surprisingly high health coverage expenses, part of the 2018 increases were due to uncertainty on the part of insurers as to whether or not federal government support of coverage for certain categories of individuals would continue.

Health costs overall continue to rise dramatically.  The ACA is clearly still a work in progress.  Some residents of Colorado went a step further by placing Constitutional Amendment 69 on the ballot for November 2016, which would have provided universal healthcare for all Colorado residents.  Although the amendment did not gain approval, largely due to unhappiness with the vast state tax increases that would have been be required, the effort was a clear indication of continued consumer discontent with current conditions.

The Trump administration has been focused on altering the ACA.  If reform legislation is enacted over the near term, then more control over Medicaid may be given to the 50 states, streamlining the ACA’s massive expansion of Medicaid.  The act’s mandate that Americans must carry insurance or face penalties may be dropped.  More consumer control over care and insurance may be emphasized, while Medicare may be given the power to negotiate drug prices.  As of mid-September 2017, it remained to be seen whether any such actions would get through Congress.

Health Expenditures Globally and in OECD Developed Nations:

A comprehensive study published by the Organization for Economic Cooperation & Development (OECD) covering more than 30 nations, including the majority of the world’s most developed economies (but excluding Brazil, Russia, India or China), found stark contrasts between health costs in the United States and those of other nations.  In 2016 (the latest complete data available), the average of a list that includes, for example, the UK, France, Germany, Mexico, Canada, South Korea, Japan, Australia and the U.S., spent 8.9% of GDP on health care.  The highest figures in this study were in America at 17.2% of GDP, Switzerland at 12.4%, Germany at 11.3%, Sweden at 11.0%, France at 11.0%, Japan at 10.9% The Netherlands at 10.5%, and Norway at 10.5%.

Total health care expenditures around the world are difficult to determine, but $7.5 trillion would be a fair estimate for the formal health care industry for 2017.  That would place health care at about 10% of global GDP, with expenditures per capita of about $1,000.  This $7.5 trillion breaks down to approximately $3.5 trillion in the U.S., $3.0 trillion in non-U.S. OECD nations and $1.0 trillion elsewhere around the world.  Outside the U.S. and the rest of the OECD, that would allow roughly $100 per capita per year.  Clearly, there is vast disparity in the availability and cost of care among nations, as there is with personal income and GDP.  Health care spending per capita in the U.S. was equal to about $10,833 during 2017, while spending in the world’s remotest villages is next to nothing.  The trend over the near future is for the modest amount now spent on health care in emerging nations to rise dramatically, while OECD nations like America struggle to contain their own mountainous costs.  Globally, the total prescription drug market was over $1 trillion in 2017 and is expected to reach $1.5 trillion by 2021, according to IMS Health.

Health Care Costs in the U.S.

Particularly in the U.S., continuous increases in the cost of health care, growing at rates far exceeding the rate of inflation in general, have been inflicting financial pain on health consumers and payers of all types.  Employers, including government, are hit hard by vast increases in the cost of providing coverage to employees and retirees.

Many major employers are utilizing unique new programs in efforts to reduce employee illness, and thereby cut costs.  For example, the use of preventive care programs is growing, as is the use of employee education aimed at better managing the effects of diseases such as diabetes.  Some very large employers are even hiring in-house physicians and nurses, or contracting with outside providers for on-premises care facilities, to offer primary and preventive care in the workplace.

Patients and insurance companies are also dealing with sticker shock over the nation’s prescription drug costs.  Other factors edging costs upward include expensive new medical technologies and patients’ demands for greater flexibility in choosing doctors and specialists at their own discretion.  At the same time, hospitals and health systems write off massive amounts of potential revenues to bad debt, which increases costs for bill-paying patients.

In the wake of the tremendous growth of all aspects of the health care industry from the end of World War II onward, efficiency, competition, price transparency and productivity were, regretfully, largely overlooked.  Much of this occurred because employers, plus federal and state governments, pay such a large portion of the health care bill, to the extent that patients were generally not sensitive to health care costs.

As of 2012, according to the U.S. Centers for Disease Control, 117 million Americans (nearly one-half of all adults) suffered from one or more of the most common chronic diseases, such as cancer, diabetes, heart disease, pulmonary conditions, stroke or hypertension.  In addition to the massive cost of health care for these patients, the lost time at work and lost economic output due to these illnesses substantially reduced the nation’s GDP.  These burdens could be vastly reduced through better consumer health practices and better preventive medicine.  For example, obesity, lack of exercise and cigarette smoking are immense contributors to these diseases.  The Centers for Disease Control and Prevention reported that medical costs for obesity-related diseases rose as high as $147 billion in 2008, compared to $74 billion in 1998.  That number has likely grown to more than $220 billion today.