Four questions then present themselves:
1. What are the costs of health care? 2. How do we pay for health care? 3. Is health care in America better than in any other place on Earth? 4. Why is health care so expensive?
■ Health Care Costs What Are the Costs of Health Care?
This question is critical, and there are countless ways to answer it. However, it is certainly at the root of the problems we now face. The American health care system is both a source of national pride—if one has an expensive and
Table 8–1 Gross Domestic Product, National Health Expenditures, and Per Capita Expenditures, Selected Years: 1960–2008
Gross Domestic Product (GDP) in Billions of Dollars
National Health Expenditures in Billions of Dollars
National Health Expenditures Per Capita ($)
1960 526 27.5 148 1980 2,788 253.4 1,100 2000 13,399 1,352.9 4,789 2008 14,441 2,338 7,681
Source: U.S. Department of Health and Human Services. (2010). National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011: Author. Retrieved from www.cdc.gov/nchs/data/hus/hus10.pdf 2011, December 18, 2011, p. 366.
Table 8–2 Per Capita Health Expenditures, Selected Years: 1960–2008
National Health Expenditures ($)
Private Health Expenditures ($)
Public Health Expenditures ($)
1960 148 1,100 36 1980 1,100 638 462 2000 4,790 4,789 2,111 2008 7,681 4,046 3,635
Source: U.S. Department of Health and Human Services. (2010). National Center for Health Statistics. Health, United States, 2010: With Special feature on Death and Dying. Hyattsville, MD. 2011: Author. Retrieved from www.cdc.gov/nchs/data/hus/hus10.pdf 2011, December 18, 2011, p. 366.
Health and Illness in Modern Health Care ■ 183
adequate health insurance package or the money, it certainly is possible to get the finest medical/technological care in the world—and a source of deep embarrassment—those who are poor or uninsured may be wanting for care as people with a low family income, do not have consistent health insurance. According to Kinney, “the elephant in the room when it comes to healthcare is its cost.” She explains that
the inflation in healthcare costs in the United States are due to: (1) the advances in medical science and associated technology and
pharmaceutical products; and (2) the advent of widespread health insurance coverage. (2010, p. 406)
The advances in technology contribute to overall health care costs and expenditures.
In Table 8–3 you can examine the growth in national health expenditures from 1960–2008.
Table 8–3 National Health Expenditures: United States, Selected Years: 1960–2008
(Amount in Billions)
1960 1980 2000 2008
National health expenditures $27.5 $253.4 $1,352.9 $2,338.7 Health services and supplies 24.9 233.5 1,264.1 2,181.3 Personal health care 23.3 214.8 1,139.2 1,952.3
Hospital care 9.2 101.0 416.9 718.4 Professional services 8.3 67.3 426.8 731.2
Physicians and clinical services 5.4 47.1 288.6 496.2 Other professional services 0.4 3.6 39.1 65.7 Dental services 2.0 13.3 62.0 101.2 Other personal health care services 0.6 3.3 37.1 68.1 Nursing home and home health 0.9 20.9 125.8 203.1 Home health care 0.1 2.4 30.5 64.7 Nursing home care 0.8 18.5 95.3 138.4 Retail outlet sales of medical products 4.9 25.7 169.8 299.6 Prescription drugs 2.7 12.0 120.6 234.1 Other medical products 2.3 13.6 49.2 65.5 Government administration and net cost of private health insurance
1.2 12.2 81.8 159.6
Government public health activities 0.4 6.4 43.0 69.4 Investment 2.6 19.9 88.8 157.5
Research 0.7 5.4 25.6 43.6 Structures and equipment 1.9 14.5 63.2 113.9
Source: U.S. Department of Health and Human Services. (2010). National Center for Health Statistics. Health, United States, 2010: With Special feature on Death and Dying. Hyattsville, MD. 2011: Author. Retrieved from www.cdc.gov/nchs/data/hus/hus10.pdf 2011, December 18, 2011, p. 369.
184 ■ Chapter 8
Table 8–4 compares the costs for hospitalizations with procedures from 1999 with those of 2006. In addition, personal health care expenditures also soared between 1998–2008. They nearly doubled from $1.0 trillion to nearly $2.0 trillion.
When I was studying nursing in 1960:
■ National health expenditures were $27.6 billion; in 2008, they were $2,338.7 trillion.
■ Hospital care expenditures were $9.2 billion; in 2008, they were $1,952.3 billion.
■ Physician and clinical services expenditures were $5.4 billion; in 2008, they were $496.2 billion.
■ Nursing home expenditures were $0.8 billion; in 2008, they were $138.4 billion.
■ Research funding was $0.7 billion; in 2008, it was $43.6 billion (Table 8–5 depicts the ways the health care dollar was spent from 1960 to 2008).
Table 8–4 also displays the costs of the most costly procedures in 1999 and 2006. The 6 most expensive principal procedures were selected based on aggregate national hospital costs in 2006. The costs were for the entire hospital stay, including the cost of performing the principal procedure.