National health expenditures, 1993

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically.     

Full-time employees of U.S. local health departments, 1992-1993.

This article describes a study to assess the most recent data on full-time U.S. local health department (LHD) staff positions. The authors used data from the National Association of County and City Health Officials' 1992-1993 national survey of LHDs. The study concludes that nurses, environmental specialists, sanitarians, and administrators constitute the core of the public health workforce in smaller and mid-sized LHDs. Numerous vacancies in these core occupations signal a weakness in the front lines of public health and vulnerability in its ability to respond to urgent health threats. To address these problems, a renewed commitment to recruiting, retraining, and retaining the local public health worker is urgently needed.     

我国老年人医疗卫生支出影响因素研究

目的:为完善老年人医疗保障体系提供政策建议。方法:基于Andersen医疗服务利用行为模型框架,利用中国健康与养老追踪调查2011年数据,建立我国老年人医疗卫生支出影响因素的Tobit模型。结果:需要因素中的自评健康状况与是否患有慢性病,能力因素中的医疗保险、养老保险与自评生活水平,以及倾向因素中的年龄、性别、婚姻状况和城乡身份显著影响我国老年人的医疗卫生支出。结论:建议按照"堵疏结合,区别对待"的原则,构建我国老年人医疗保障体系。     

National health expenditures projections through 2030

If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP). By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP. The projections presented here incorporate the assumptions and conclusions of the Medicare trustees in their 1992 report to Congress on the status of Medicare, and the 1992 President's budget estimates of Medicaid outlays.     

National health expenditures, 1987.

The 1987 national health expenditure estimates are examined from different perspectives in the following two articles. In the first article, revised expenditure estimates for 1984-87 are presented. A breakdown of the type of services and products purchased is included, as well as the source of funds used to finance health care. In the second article, health care expenditure estimates are used to explore marginal analysis as a policy tool for understanding health spending in relation to our Nation's ability to finance that spending. The concept of marginal analysis is also used to examine selected periods that were relevant to health policy and the timing of public and private changes in health policy in the past.     

Trends in state agency oral health and public health expenditures, 1984 through 1989.

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 states reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states.     

US childhood mortality, 1950 through 1993: Trends and socioeconomic diffferentials.

OBJECTIVES: This study examined trends and differentials in US childhood mortality from 1950 through 1993 according to sex, race/ethnicity, education, family income, and cause of death. METHODS: Log-linear, multiple regression, and Cox proportional hazards regression models were applied to the data from the National Vital Statistics System, the National Longitudinal Mortality Study, and the Area Resource File. RESULTS: Substantial declines in US childhood mortality have occurred in the past 4 decades, primarily due to decreases in mortality from unintentional injuries, cancer, pneumonia and influenza, and congenital anomalies. The overall declining trend, however, has been dampened by a twofold to threefold increase in the suicide and homicide rates among children since 1968. Male, Black, American Indian, Hawaiian, and Puerto Rican children and those in the lower socioeconomic strata were at an increased risk of death. CONCLUSIONS: Increasing trends in mortality from violence, firearm injuries, and human immunodeficiency virus/acquired immunodeficiency syndrome pose a major obstacle to continued declines in US childhood mortality. Reducing socioeconomic disparities and improving access to and use of health care may bring about further declines in overall and injury-related childhood mortality.     

State health care expenditures under competition and regulation, 1980 through 1991.

OBJECTIVES. This paper examines health expenditure growth under two alternative policy approaches: competition-based managed care and state government rate regulation. METHODS. Data are presented on cumulative growth in real per capita health expenditures between 1980 and 1991 so as to compare California, a state with a pro-competitive policy, with the US average and with four states with established regulation programs. RESULTS. Real per capita expenditures for hospital services in the United States grew 54% between 1980 and 1991, while in California the growth was half the national rate, or 27%. Real per capita expenditures for physician services and drug expenditures in the United States grew by 82% and 65%, respectively, while in California these expenditures increased only 58% and 41%, respectively. California's growth rate was below that of all four regulatory states for all measures of health care cost inflation. CONCLUSIONS. On the basis of these findings, a properly structured competitive approach could play a significant role in controlling health expenditures in the United States.     

The education of local health department top executives.

An analysis was done on the educational backgrounds of current top agency executives of U.S. local health departments (LHD), using the National Association of City and County Health Officials 1992-1993 national survey of LHDs as the data source. Nurses are often the executive in jurisdictions with less than 50,000, while executives of jurisdictions with more than 250,000 are predominantly physicians. Overall, 78 percent of LHD executives have no formal public health training, and executives of larger jurisdictions are more likely to have a public health degree. Because a majority of executives lack formal training opportunities for them need major expansion. Particular emphasis should be placed on expanding short-term opportunities such as state-based leadership and distance-based learning programs.     

Mortality related to sexually transmitted diseases in US women, 1973 through 1992.

OBJECTIVES: This study estimated the trends in mortality related to sexually transmitted diseases (STDs) and their sequelae in US women from 1973 through 1992. METHODS: The total number of deaths was obtained from US national mortality data and from AIDS surveillance data, and current literature was reviewed to estimate proportions of diseases attributable to sexual transmission. RESULTS: From 1973 through 1984, total STD-related deaths decreased 24%. However, from 1985 through 1992, STD-related deaths increased by 31%, primarily because of increasing numbers of deaths from sexually transmitted human immunodeficiency virus (HIV) infection. The most important changes during the 20-year period were the emergence of and continued increase in the number of deaths related to hetero-sexually transmitted HIV. CONCLUSIONS: The leading causes of STD-related mortality in women, viral STDs and their sequelae, are generally not recognized as being sexually transmitted. Increases in STD-related mortality are primarily due to sexually transmitted HIV, which will soon surpass cervical cancer as the leading cause.     

Projections of national health expenditures through the year 2000

In this article, the authors present a scenario for health expenditures during the 1990s. Assuming that current laws and practices remain unchanged, the Nation will spend $1.6 trillion for health care in the year 2000, an amount equal to 16.4 percent of that year's gross national product. Medicare and Medicaid will foot an increasing share of the Nation's health bill, rising to more than one-third of the total. The factors accounting for growth in national health spending are described as well as the effects of those factors on spending by type of service and by source of funds.     

Monitoring health in the war-affected areas of the former Yugoslavia, 1992-1993

In October 1992 the World Health Organization (WHO) set up ahealth monitoring programme in the former Yugoslavia to obtaininformation on communicable disease upon which to base decisionsabout medical aid requirements. This paper covers the firstyear of the programme (October 1992–October 1993) anddetails the steps taken to set it up. Information was soughtfrom personal contacts, ‘ad hoc’ sources (UnitedNations agencies and non-governmental organizations) and thehealth authorities of the regions of former Yugoslavia. An attemptwas made to establish a sentinel monitoring system to provideroutine data to allow health predictions to be made. A bulletinwas produced to disseminate surveillance results and healthadvice. The system obtained sufficient data (mostly from ‘adhoc’ sources) for WHO to take informed decisions aboutmedical aid but the sentinel system was not established successfully.     

National health expenditures, 1991

Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector.