Detailed Tables:  Health Care

Indicator 25 : Health Care Expenditures
Indicator 26 : Components of Health Care Expenditures
Indicator 27 : Out-of-Pocket Health Care Expenditures
Indicator 28 : Access to Health Care
Indicator 29 : Use of Health Care Services
Indicator 30 : Nursing Home Utilization
Indicator 31 : Home Care

Indicator 25: Health Care Expenditures

TABLE 25A:  AVERAGE HEALTH CARE EXPENDITURES AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, IN 1996 DOLLARS, BY AGE GROUP, 1992 TO 1996
1992 1993 1994 1995 1996
65 TO 69  $     5,506  $     5,179  $     6,028  $     5,389  $     5,864
70 TO 74  $     5,761  $     6,451  $     6,690  $     7,380  $     6,744
75 TO 79  $     7,063  $     8,219  $     8,248  $     8,412  $     9,414
80 TO 84  $     9,535  $    10,328  $    10,836  $    11,555  $    11,258
85 OR OLDER  $    14,424  $    14,805  $    16,049  $>    16,452  $    16,465
Note: Data include both out-of-pocket expenditures and expenditures covered by insurance.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

TABLE 25B:  AVERAGE HEALTH CARE EXPENDITURES AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY SELECTED CHARACTERISTICS, 1996
TOTAL  $     8,742
AGE GROUP
65 TO 69  $     5,864
70 TO 74  $     6,744
75 TO 79  $     9,414
80 TO 84  $    11,258
85 OR OLDER  $    16,465
SEX
MEN  $     8,335
WOMEN  $     9,028
RACE
NON-HISPANIC WHITE  $     8,756
NON-HISPANIC BLACK  $     9,794
LEVEL OF INCOME
LOWEST FIFTH  $    12,602
SECOND FIFTH  $     9,790
THIRD FIFTH  $     7,635
FOURTH FIFTH  $     7,367
HIGHEST FIFTH  $     6,371
INSTITUTIONAL STATUS
NONINSTITUTIONAL  $     6,360
INSTITUTIONALIZED PART OR ALL OF THE YEAR  $    38,906
Note: Sample sizes were too small to present results for other race categories.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

TABLE 25C: PERCENTAGE OF HEALTH CARE EXPENDITURES INCURRED BY MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY LEVEL OF EXPENDITURES, 1996
SPENDING LEVEL PERCENTAGE OF HEALTH CARE EXPENDITURES INCURRED
TOP 1 PERCENT 12.9
TOP 5 PERCENT 37.2
TOP 10 PERCENT 55.6
Note: Data include both out-of-pocket expenditures and expenditures covered by insurance.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

TABLE 25D:  DISTRIBUTION OF HEALTH CARE EXPENDITURES AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY INSTITUTIONAL STATUS, 1996
NONINSTITUTIONAL POPULATION INSTITUTIONAL POPULATION
TOTAL 100.0 100.0
INPATIENT HOSPITAL 35.5 14.9
MEDICAL/OUTPATIENT 39.9 10.5
NURSING HOME 0.0 63.7
SKILLED NURSING FACILITY/HOME HEALTH 10.2 9.9
PRESCRIPTION DRUGS 10.2 0.2
OTHER 4.2 0.8
Note: Data include both out-of-pocket expenditures and expenditures covered by insurance. “Other” expenditures consist of dental and hospice expenses.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

Indicator 26: Components of Health Care Expenditures

TABLE 26A:  MAJOR COMPONENTS OF HEALTH CARE EXPENDITURES AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, 1992 AND 1996
1992 1996
TOTAL 100.0 100.0
INPATIENT HOSPITAL 32.6 28.8
MEDICAL/OUTPATIENT 31.4 30.3
NURSING HOME CARE 21.1 20.8
SKILLED NURSING FACILITY/
HOME HEALTH CARE
5.6 10.1
PRESCRIPTION DRUGS 6.7 6.9
OTHER 2.6 3.1
Note:  Data include both out-of-pocket expenditures and expenditures covered by insurance. “Other” expenditures consist of dental and hospice expenses.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

TABLE26B:  DISTRIBUTION OF MAJOR COMPONENTS OF HEALTH CARE EXPENDITURES AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY AGE GROUP AND INCOME LEVEL, 1996
AGE GROUP
65 TO 69 70 TO 74 75 TO 79 80 TO 84 85 OR OLDER
AVERAGE EXPENDITURE $5,864 $6,744 $9,414 $11,258 $16,465
TOTAL 100.0 100.0 100.0 100.0 100.0
INPATIENT HOSPITAL 34.3 33.3 31.4 25.8 19.3
MEDICAL/OUTPATIENT 38.5 37.8 32.0 26.9 16.9
NURSING HOME CARE 6.5 8.6 15.2 26.5 46.1
SKILLED NURSING FACILITY/
HOME HEALTH CARE
5.4 7.1 11.6 13.1 13.3
PRESCRIPTION DRUGS 10.7 9.0 6.9 5.4 2.8
OTHER 4.6 4.2 2.8 2.3 1.6
INCOME LEVEL
LOWEST FIFTH SECOND FIFTH THIRD FIFTH FOURTH FIFTH HIGHEST FIFTH
AVERAGE $12,602 $9,790 $7,635 $7,367 $6,371
TOTAL 100.0 100.0 100.0 100.0 100.0
INPATIENT HOSPITAL 24.9 29.5 32.3 32.2 26.9
MEDICAL/OUTPATIENT 21.3 28.6 35.2 35.3 38.8
NURSING HOME CARE 35.9 22.2 12.6 10.8 10.4
SKILLED NURSING FACILITY/
HOME HEALTH CARE
12.5 11.5 8.7 9.0 6.5
PRESCRIPTION DRUGS 4.2 6.1 8.3 8.8 9.8
OTHER 1.2 2.2 2.9 3.9 7.5
Note: Data include both out-of-pocket expenditures and expenditures covered by insurance. “Other” expenditures consist of dental and hospice expenses.
Reference population: These data refer to Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

Indicator 27: Out-of-Pocket Health Care Expenditures

TABLE 27:  PERCENTAGE OF TOTAL OUT-OF-POCKET EXPENDITURES ALLOCATED TO HEALTH CARE COSTS IN HOUSEHOLDS HEADED BY PERSONS AGE 65 OR OLDER, BY INCOME LEVEL, 1987 TO 1998
1987 1989 1992 1994 1996 1998
PERCENTAGE ALLOCATED TO HEALTH CARE
LOWEST FIFTH 10.4% 11.6% 13.5% 14.8% 12.5% 12.7%
SECOND FIFTH 13.5% 14.4% 15.8% 15.4% 14.4% 13.9%
THIRD FIFTH 12.7% 14.6% 14.9% 14.7% 14.6% 15.6%
FOURTH FIFTH 12.3% 13.2% 13.2% 12.0% 13.3% 13.3%
HIGHEST FIFTH 7.9% 8.0% 9.4% 8.9% 8.6% 9.2%
AVERAGE EXPENDITURES ON HEALTH CARE
LOWEST FIFTH  $         886  $     1,029  $     1,375  $     1,685  $     1,488  $     1,654
SECOND FIFTH  $     1,390  $     1,670  $     2,022  $     2,112  $     2,064  $     2,265
THIRD FIFTH  $     1,550  $     2,185  $     2,413  $     2,700  $     2,828  $     3,228
FOURTH FIFTH  $     1,926  $     2,613  $     2,911  $     2,990  $     3,152  $     3,398
HIGHEST FIFTH  $     2,065  $     2,566  $     3,086  $     3,376  $     3,483  $     3,614
AVERAGE TOTAL EXPENDITURES
LOWEST FIFTH  $     8,502  $     8,835  $    10,172  $    11,375  $    11,900  $    13,032
SECOND FIFTH  $    10,332  $    11,617  $    12,784  $    13,747  $    14,378  $    16,252
THIRD FIFTH  $    12,232  $    14,965  $    16,189  $    18,401  $    19,315  $    20,696
FOURTH FIFTH  $    15,676  $    19,788  $    22,011  $    24,894  $    23,647  $    25,509
HIGHEST FIFTH  $    26,301  $    32,117  $    32,659  $    37,757  $    40,602  $    39,170
Note:  Expenditures on health care, for purposes of this report, include out-of-pocket spending on health insurance, medical services and supplies, and prescription drugs. Quintiles are used to define the five levels of income. In this analysis, the term “household” is used in place of “consumer unit.” A consumer unit is used to describe members of a household related by blood, marriage, adoption, or other legal arrangement; single persons who are living alone or sharing a household with others but who are financially independent; or two or more persons living together who share responsibility for at least two of three major types of expenses—food, housing, and other expenses. The income distribution was determined for the subset of all consumer units where the reference person was age 65 or older.
Reference population: These data refer to the resident noninstitutional population.
Source: Consumer Expenditure Survey.

Indicator 28: Access to Health Care

TABLE 28A:   PERCENTAGE OF MEDICARE BENEFICIARIES AGE 65 OR OLDER WHO REPORTED PROBLEMS WITH ACCESS TO HEALTH CARE, 1992 TO 1996
1992 1993 1994 1995 1996
PERCENT REPORTING DIFFICULTY OBTAINING CARE 3.1 2.6 2.6 2.6 2.3
PERCENT REPORTING THEY DELAYED GETTING CARE DUE TO COST 9.8 9.1 7.6 6.8 5.5
Reference population: These data refer to noninstitutional Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

TABLE 28B:  ACCESS TO AND SATISFACTION WITH HEALTH CARE AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY AGE GROUP AND RACE AND HISPANIC ORIGIN, 1996
AGE GROUP
TOTAL 65 TO 74 75 TO 84 85 OR OLDER
PERCENT REPORTING DIFFICULTY OBTAINING CARE 2.3 2.7 1.7 2.2
PERCENT REPORTING THEY DELAYED GETTING CARE DUE TO COST  5.5 6.5 4.5 3.0
PERCENT REPORTING THEY WERE UNSATISFIED OR VERY  UNSATISFIED WITH HEALTH CARE 3.0 2.8 3.1 4.0
RACE AND HISPANIC ORIGIN
TOTAL NON-HISPANIC WHITE NON-HISPANIC BLACK HISPANIC
PERCENT REPORTING DIFFICULTY OBTAINING CARE 2.3 2.1 3.8 2.9
PERCENT REPORTING THEY DELAYED 5.5 5.0 9.6 7.3
GETTING CARE DUE TO COST        
PERCENT REPORTING THEY WERE UNSATISFIED OR VERY UNSATISFIED WITH HEALTH CARE 3.0 2.9 2.5 3.7
Reference population: These data refer to noninstitutional Medicare beneficiaries.
Source: Medicare Current Beneficiary Survey.

Indicator 29: Use of Health Care Services

TABLE 29A:  RATES OF HEALTH CARE SERVICE USAGE BY MEDICARE BENEFICIARIES AGE 65 OR OLDER, 1990 TO 1998 (PER 1,000)
USE OF SERVICES
1990 1991 1992 1993 1994 1995 1996 1997 1998
HOSPITALIZATION 307 311 311 306 337 344 352 364 365
HOME HEALTH VISITS 2,141 - 3,822 4,648 6,352 7,608 8,376 8,227 5,058
SKILLED NURSING FACILITY ADMISSIONS 23 - 28 33 43 50 59 67 69
PHYSICIAN VISITS AND CONSULTATIONS 10,800 11,800 11,800 12,100 12,500 12,900 13,000 13,000 13,100
AVERAGE LENGTH OF HOSPITAL STAY (DAYS) 8.8 8.6 8.3 7.9 7.4 6.9 6.5 6.2 6.1
- = NOT AVAILABLE
Note:  Data for 1998 should be considered preliminary. Some data for 1991 are not available (—). For hospitalizations, home health visits, and skilled nursing facility admissions, utilization rates for 1994–1998 exclude HMO enrollees from the numerator and denominator because utilization data are not available for this group. Prior to 1994, HMO enrollees were included in the denominators causing utilization rates to be understated. Prior to 1994, HMO enrollees represented 7 percent or less of the Medicare population; in 1998 they represented about 18 percent.  For physician visits, data on HMO enrollees are excluded for all years.
Reference population: These data refer to Medicare beneficiaries in fee-for-service only.
Source: Medicare claims and enrollment data.

TABLE 29B:  USE OF HOME HEALTH AND SKILLED NURSING FACILITY SERVICES BY MEDICARE BENEFICIARIES AGE 65 OR OLDER, BY AGE GROUP, 1998
65 TO 74 75 TO 84 85 OR OLDER
HOME HEALTH VISITS PER 1,000 ENROLLEES 2,350 6,262 12,709
SKILLED NURSING FACILITY ADMISSIONS PER 1,000 ENROLLEES 27 83 200
Note: Data for 1998 should be considered preliminary.
Reference population: These data refer to Medicare beneficiaries in fee-for-service only.
Source: Medicare claims and enrollment data.

Indicator 30: Nursing Home Utilization

TABLE 30A:  RATE OF NURSING HOME RESIDENCE AMONG PERSONS AGE 65 OR OLDER, BY SEX AND AGE GROUP, 1985, 1995, AND 1997 (PER 1,000)
1985 1995 1997
TOTAL
65 OR OLDER 54.0 45.9 45.3
65 TO 74 12.5 10.1 10.8
75 TO 84 57.7 45.9 45.5
85 OR OLDER 220.3 198.6 192.0
MEN
65 OR OLDER 38.8 32.8 32.0
65 TO 74 10.8 9.5 9.8
75 TO 84 43.0 33.3 34.6
85 OR OLDER 145.7 130.8 119.0
WOMEN
65 OR OLDER 61.5 52.3 51.9
65 TO 74 13.8 10.6 11.6
75 TO 84 66.4 53.9 52.7
85 OR OLDER 250.1 224.9 221.6
Note: Rates for 65 or older category are age-adjusted using the 2000 standard population. In 1997 population, figures are adjusted for net underenumeration using the 1990 National Population Adjustment Matrix from the U.S. Census Bureau.
Reference population: These data refer to the resident population. Persons residing in personal care or domiciliary care homes are excluded.
Source: National Nursing Home Survey.

TABLE 30B:  NUMBER OF NURSING HOME RESIDENTS AGE 65 OR OLDER, BY SEX AND AGE GROUP, 1985, 1995, AND 1997, IN THOUSANDS
1985 1995 1997
TOTAL
65 OR OLDER 1,318 1,423 1,465
65 TO 74 212 190 198
75 TO 84 509 512 528
85 OR OLDER 597 720 738
MEN
65 OR OLDER 334 357 372
65 TO 74 81 79 81
75 TO 84 141 144 159
85 OR OLDER 113 133 132
WOMEN
65 OR OLDER 984 1,066 1,093
65 TO 74 132 111 118
75 TO 84 368 368 369
85 OR OLDER 485 587 606
Reference population: These data refer to the population residing in nursing homes. Persons residing in personal care or domiciliary care homes are excluded.
Source: National Nursing Home Survey.

TABLE 30C:  PERCENTAGE OF NURSING HOME RESIDENTS AGE 65 OR OLDER WHO ARE INCONTINENT AND DEPENDENT IN MOBILITY AND EATING, BY AGE GROUP AND SEX, 1985 AND 1997
DEPENDENT MOBILITY INCONTINENT DEPENDENT EATING DEPENDENT MOBILITY, EATING, AND INCONTINENT
1985 1997 1985 1997 1985 1997 1985 1997
TOTAL
65 OR OLDER 75.7 79.3 55.0 64.9 40.9 45.1 32.5 35.7
65 TO 74 61.2 73.1 42.9 59.2 33.5 42.1 25.7 30.7
75 TO 84 70.5 77.1 55.1 64.3 39.4 44.8 30.6 34.5
85 OR OLDER 83.3 82.6 58.1 66.9 43.9 46.1 35.6 37.8
MEN
65 OR OLDER 71.2 76.3 54.2 65.0 36.0 42.8 28.0 33.6
65 TO 74 55.8 72.3 38.8 60.1 32.8 42.7 24.1 32.9
75 TO 84 65.7 75.1 54.4 65.9 32.6 43.7 25.5 34.6
85 OR OLDER 79.2 78.3 58.1 65.6 39.2 42.1 30.9 33.0
WOMEN
65 OR OLDER 77.3 80.2 55.4 64.8 42.4 45.6 33.9 35.9
65 TO 74 64.5 73.7 45.4 58.6 34.0 41.6 26.7 29.2
75 TO 84 72.3 78.0 55.3 63.6 42.0 45.3 32.6 34.4
85 OR OLDER 84.3 83.5 58.1 67.2 45.0 46.9 36.7 38.8
Note: Residents dependent in mobility and eating require the assistance of a person or special equipment. Residents who are incontinent have difficulty in controlling bowels and/or bladder or have an ostomy or indwelling catheter. Rates for the 65 or older category are age-adjusted using the 1995 National Nursing Home Survey population.
Reference population: These data refer to the population residing in nursing homes. Persons residing in personal care or domiciliary care homes are excluded.
Source: National Nursing Home Survey.

Indicator 31: Home Care

TABLE 31A:  PERCENTAGE OF MEDICARE BENEFICIARIES AGE 65 OR OLDER WHO RECEIVED HOME CARE FOR A CHRONIC DISABILITY, BY TYPE OF ASSISTANCE, 1982, 1989, AND 1994
1982 1989 1994
PERCENTAGE RECEIVING CARE
18.1 16.4 15.1
TYPE OF ASSISTANCE
TOTAL 100.0 100.0 100.0
INFORMAL CARE ONLY 73.6 66.6 64.3
INFORMAL AND FORMAL CARE 21.0 24.4 28.0
FORMAL CARE ONLY 5.4 9.0 7.8
Note: Home care refers to paid or unpaid assistance provided to a person with a chronic disability, living in the community.
Reference population: These data refer to Medicare beneficiaries.
Source: National Long Term Care Survey.

TABLE 31B:  DISTRIBUTION OF TYPES OF ASSISTANCE AMONG MEDICARE BENEFICIARIES AGE 65 OR OLDER WHO RECEIVED HOME CARE FOR A CHRONIC DISABILITY, BY LEVEL OF DISABILITY, 1982, 1989, AND 1994
INFORMAL CARE ONLY INFORMAL AND FORMAL CARE FORMAL CARE ONLY TOTAL NUMBER
(IN THOUSANDS)
1982
LEVEL OF DISABILITY      
IADLS ONLY 80.8 12.1 7.1 1,687
1 ADL 74.5 19.8 5.7 1,068
2 ADLS 68.6 25.3 6.1 569
3 ADLS 66.0 29.3 4.7 341
4 ADLS 65.4 32.1 2.6 394
5 ADLS 65.3 33.2 1.5 548
TOTAL 73.6 21.0 5.4 4,607
1989
LEVEL OF DISABILITY      
IADLS ONLY 77.7 12.6 9.7 1,509
1 ADL 69.0 20.5 10.5 1,153
2 ADLS 61.1 26.9 12.0 734
3 ADLS 58.7 34.8 6.5 519
4 ADLS 53.3 41.2 5.5 479
5 ADLS 54.4 41.6 4.0 399
TOTAL 66.6 24.4 9.0 4,793
1994
LEVEL OF DISABILITY      
IADLS ONLY 78.3 12.2 9.5 1,488
1 ADL 64.9 24.4 10.7 1,114
2 ADLS 62.8 30.0 7.3 745
3 ADLS 57.4 37.2 5.4 443
4 ADLS 51.1 46.2 2.6 434
5 ADLS 41.4 55.3 3.3 512
TOTAL 64.3 28.0 7.8 4,736
Note: Home care refers to paid or unpaid assistance provided to a person with a chronic disability living in the community. See “Indicator 18: Disability” for information on the definition of disability.
Reference Population: These data refer to Medicare beneficiaries.
Source: National Long Term Care Survey.

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