Table Of ContentHEALTH CARE FINANCING ADMINISTRATION
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Ttie Healtti Care FinancingAdministration
U.S. Department of Health and (l-ICFA) is responsible fortiie Medicare
Human Services program andFederalparticipation in
Donna E. Shalala, Secretary State-operatedMedicaidplans. HCFA's
mission is to finance "...the timelyand
Health Care Financing Administration economic deliveryofappropriate health care
Nancy-Ann Min DeParle, Administrator to eligible beneficiaries." Medicare and
Michael Hash, DeputyAdministrator Medicaidpayments andprogrampolicies
have significantandfar-reaching effects on
Office of Strategic Planning beneficiaries, providers, andpayers.
Daniel R. Waldo, Acting Director Understanding these effects andtheir
causes is essentialto theplanningand
This report was produced by: implementation ofchanges to the health
care deliverysystem.
Systems, Technical and Analytical
Resources Group The Data Compendium contains historic,
William D. Saunders, J.D., Director currentandprojecteddata on Medicare
enrollmentandMedicaidrecipients,
Publication Coordinator expenditures andutilization. Data pertaining
George D. Lintzeris to budget, administrative/operatingcosts,
individualincome, financing, andhealth care
providers/suppliers are also included.
Nationaldata notspecific to the Medicare or
Medicaidprograms maybe found
Foradditionalinformation, contact: throughoutthepublication.
George D. Lintzeris
410-786-0166 This compendiumhas beenpreparedfor
severalyears forHCFA's Leadership as a
reference documentandas a supplementto
briefing materials forlegislative initiatives. It
was compiledbythe Systems, Technical
andAnalytic Resources Group, Office of
Strategic Planning with majorcontributions
from the various Offices in HCFA. Data
suppliedbyprofessionalorganizations and
otherFederalagencies are gratefully
acknowledged.
Symbols in Tables:
NA notavailable
- notapplicable
M
Health Care Financing Administration
t'j''^
1999
DATA
COMPENDIUM
U.S. Department ofHealth and Human Services
Health Care Financing Administration
Office ofStrategic Planning
Baltimore, Maryland
July 1999
TABLE OF CONTENTS
Page
Budget Overview
I. 1
o HCFA Disbursements 2
o Program Benefit Payments 3
Charts: Trends in Program Benefit Payments 4,5
o Program Benefit Payments Per Enrollee 6
o HCFA Benefit Outlays by Program 7
II. Expenditures 8,9
Medicare
Benefit Payments by Major Service Categories 10
Trust Fund Projections 11
o Benefit Payments by Type of Benefit 11
o Chart: Medicare Benefit Payments byType of Benefit 12
Medicaid
o Vendor Payments by Basis of Eligibility 13
o Vendor Payments by Type of Service and Basis of Eligibility 13
o Vendor Payments byType of Service 14
o Chart: Medicare and Medicaid Benefit Payments byType of Service 15
National
o Health Care byType of Expenditure 16
o HCFA Benefit Payments by Major Personal Health Expenditure Service
Categories 17
Public vs. Private Funding 18
Chart: Growth in Gross Domestic Product versus Growth in National Health
Expenditures 19
o Chart: Personal Health Care Expenditures 20
o Chart: Medicaid, Medicare, and Other Personal Health Care
Expenditures by Type of Service 21
o Chart: Percent of National Health Expenditures by Type of Service 22
o Chart: Per Capita Personal Health Care Expenditures 23
o Expenditures by Source of Funding 24,25
o Health Care Price Indicators 26,27
o Charts: Consumer Price Indexes 28,29
o Chart: Workhours in Private Health Care Establishments versus
Non-Agricultural Establishments 30
III. Administrative/Operating 31
Medicare
o Trust Fund Operations 32,33
o Chart: Hospital and Supplementary Medical Insurance Trust Fund
Balances 34
o SMI Trust Fund Incon^ie 35
o Ratio of SMI Benefit Payments to Premium Income 36
o Chart: Medicare Premiums as Percent ofTotal SMI Income 37
o Administrative Expenses 38
o Chart: Administrative Expenses 39
o Operating Data: Contractors, Claims Processing 40
Appeals 40
o Physician/Supplier Charge Reductions 41
o Determination Data for Physician/Supplier Claims 42
Medicaid
Administrative Expenses 43
IV. Populations 44
Medicare
o Enrollees 45
o Enrollment/Demographics 46,47
o State Buy-Ins for SMI 48
Medicaid
o Recipients 49,50
National
o Chart: Aged Population ofthe United States 51
o Chart: Projected Growth ofthe Aged Population 52
o Chart: Population Covered Under HCFA Programs 53
Life Expectancy at Birth and at Age 65 54,55
o Chart: Deaths of Medicare Aged Enrollees 56
V. Utilization 57
Medicare
Short-Stay Hospital
o Selected Utilization Measures 58
o Inpatient Hospital Days per Person 59
o Discharges by Length of Stay 60
o Diagnostic Related Group Ranking 61,62
Parte
o Leading Part B Procedure Codes based on Allowed Charges 63-65
Leading Part B BETOS Procedures Based on Allowed Charges 66
Beneficiaries Served
o Persons Served byType of Coverage 67
o Persons Served by Type of Service 67
o Chart: Persons Served per 1,000 Enrollees 68
o Use of Selected Types of Long-Term Care 69
o Chart: Persons Served and Rate per ,000 Enrollees 69
1
o End Stage Renal Disease Care by Approved Facilities 70
o National Summary of Utilization for Home Health Agencies,
Hospice, Skilled Nursing Facilities, and Outpatient Facilities 71
Medicaid
o Recipients byType of Service 72
o Units of Service 72
National
o Community Hospital Utilization Trends 73
VI. Providers/Suppliers 74
Medicare/Medicaid
Medicare Hospital Status 75
o Chart: Medicare Participating Hospitals 76
Medicare Inpatient Hospital 77
Other Medicare Providers and Suppliers 77
o Selected Medicare Facilities by Type of Control 78
o Medicare PIP Facilities 78
Medicare Participating Physician Program 79
o Medicare Assigned Claims 79
Medicare Participating Physician Program by Specialty 80
Charts: Medicare Assignment Rates 81
o Medicare Benefit and Premium Summary of TEFRA Risk HMOs and CMPs 82
o Medicare Enrollment and Payment Summary of HMOs and CMPs 83
o Medicare Prepaid Operations, Pre- and Post- TEFRA 83
o Medicare Summary of Monthly Risk Contracts 84
o Medicare Summary of Risk and Cost Contracts by Category 85
National
o Physicians 86
o Active Federal and Non-Federal Physicians by HCFA Region 87
o Chart: Active Federal and Non-Federal Physicians per 100,000 Civilian
Population 88
o Physician Specialty Summary 89
o Physician Income and Expenses by Specialty 89
Physician Income and Expenses 90
o Physician Registry by Specialty 91-92
VII. state Data 93
Expenditures
o Medicare Estimated Benefit Payments 94
o Medicaid Medical Assistance Payments 95
o Mean Medicaid Outlays 96
Populations
o Medicare Enrollment 97-98
o Medicare and Prepaid Enrollment Distribution by State 99-100
o Medicaid Recipients 101
o Chart: Medicare Enrollment as a Percent of Population 102
Chart: Medicaid Recipients as a Percent of Population 103
o Medicare State Buy-Ins for Part A and Part B 104
Utilization
o Medicare Persons Served 105
o National Community Hospital Care 106
o Medicare Skilled Nursing Facility Non Swing Bed Utilization 107,108
o Medicare Home Health Agency Utilization 109,110
o Medicare Hospice Utilization 111,112
Providers/Suppliers
o Medicare Inpatient Hospitals 113
Medicare Skilled Nursing Facilities and Certified Beds 114
Medicaid Long-Term Care Facilities 115
o National Community Hospitals 116
o Medicare Part B Participating Physicians and LLPs by State 117
Medicare Part B Assignment Rates by State 118
o Physicians Billing Medicare 119
VIM. Financing 120
o Financing of Medicare and Medicaid Programs 121,122
Medicare Cost Sharing and Premium Amounts 123,124
o Medicare Annual Maximum Taxable Earnings and HI Contribution Rates 125
o Federal Medicaid Assistance Percentages 126
Federal Medical Assistance Percentages by Region 127
Glossary 128
IV
BUDGET OVERVIEW
I.
Information about the Federal, DHHS and HCFA budgets.
HIGHLIGHTS
o Medicare benefitpayments are expectedto increase by5.7percent
from 1998 to 1999andby6.6percentfrom 1999 to 2000.
o FederalandState Medicaidmedicalassistancepayments are
expectedto increase by 7.1 percentfrom 1998 to 1999andby
5.8percentfrom 1999 to2000.
o Program benefitpayments forMedicare andMedicaidcombined
are expectedto increase by6.3percentfrom 1998 to 1999andby
6.2percentfrom 1999 to2000.
NOTE: CHANGES IN ESTIMATED MEDICARE PROGRAMPAYMENTS FOR
FISCAL YEARS (FYS) 1999 AND 2000
CThoempesetnimdamtemofFY 1999and FY2000 program outlays included in the 1999 Data
are basedon estimatespreparedforthePresident's FY2000 budset
released in February 1999.
o Theseestimatesdonotreflectupdatedprojectionsincluded in thePresident'sFY2000
Mid-Session Review(MSR)releasedinJune 1999. Information on theFY2000 MSR
projections canbefound on theInternetathttp://www.access.gpo.gov/usbudget/.
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