Half Of US Population Accounts For Only 2.9% Of Healthcare Spending; 1%
Responsible For 21.4% Of Expenditures
By Tyler Durden
With the topic of peak class polarization once again permeating the
airwaves and clogging up NSA servers, and terms like 1% this or that being
thrown around for political punchlines and other talking points, one aspect
where social inequality has gotten less prominence, yet where the spread
between the "1%" and everyone else is perhaps most
substantial is in realm of healthcare spending: perhaps the biggest threat to
the long-term sustainability of the US debt
picture and economy in general. The numbers are stunning.
According to the latest data compiled by the Agency for
Healthcare Research and Quality, in 2010, just 1% of the population accounted
for a whopping 21.4% of total health care expenditures with an annual mean
expenditure of $87,570. Just below them, 5% of the population accounted for
nearly 50% of all healthcare spending. Just as stunning is the
"other" side: the lower 50 percent of the population ranked
by their expenditures accounted for only 2.8% of the total for 2009 and 2010
respectively. Perhaps in addition to bashing the "1%" of wealth
holders, a relatively straightforward and justified exercise in the current
political climate, it is time for public attention to also turn to the chronic
1% (and 5%)-ers who are the primary issue when it comes to the debt-funding
needed to preserve the US welfare state.
The spending distribution in chart format:
Broken down by age - While the elderly represented 13.3 percent of the
overall population, they represented 47.9 percent of those individuals who
remained in the top decile of spenders:
Broken down by sex - While women represented 50.9 percent of the overall
population, they represented 61.6 percent of those individuals who
remained in the top decile of spenders:
Broken down by race and ethnicity - Individuals identified as
Hispanic and black non-Hispanic single race were disproportionately represented
among the population that remained in the lower half of the distribution based
on health care spending:
More of the report's findings:
·
In 2009, 1 percent of the population accounted for
21.8 percent of total health care expenditures and 20.5 percent of the
population in the top 1 percent retained this ranking in 2009. The bottom half
of the expenditure distribution accounted for 2.9 percent of spending in 2009;
about three out of four individuals in the bottom 50 percent retained this
ranking in 2010.
·
Those who were in the top decile of spenders in both
2009 and 2010 differed by age, race/ethnicity, sex, health status, and
insurance coverage (for those under 65) from those who were in the lower half
in both years.
·
Those in bottom half of health care spenders were more
likely to report excellent health status, while those in the top decile of
spenders were more likely to be in fair or poor health relative to the overall
population.
·
While 15 percent of persons under age 65 were
uninsured for all of 2010, the full year uninsured comprised 26.1 percent of
those in the bottom half of spenders for both 2009 and 2010. Only 3.4 percent
of those under age 65 who remained in the top decile of spenders in both years
were uninsured for all of 2010.
·
Relative to the overall population, those who remained
in the top decile of spenders were more likely to be in fair or poor health,
elderly, female, non-Hispanic whites and those with public only coverage. Those
who remained in the bottom half of spenders were more likely to be in excellent
health, children and young adults, men, Hispanics, and the uninsured.
And the full report.
In 2009, 1 percent of the population accounted for 21.8 percent of total
health care expenditures,and in 2010, the top 1 percent accounted for 21.4
percent of total expenditures with an annual mean expenditure of $87,570. The
lower 50 percent of the population ranked by their expenditures accounted for
only 2.9 percent and 2.8 percent of the total for 2009 and 2010 respectively.
Of those individuals ranked at the top 1 percent of the health care expenditure
distribution in 2009 (with a mean expenditure of $90,061), 20.5 percent
maintained this ranking with respect to their 2010 health care expenditures.
In both 2009 and 2010, the top 5 percent of the population accounted for
nearly 50 percent of health care expenditures. Among those individuals ranked
in the top 5 percent of the health care expenditure distribution in 2009 (with
a mean expenditure of $40,682), approximately 34 percent retained this ranking
with respect to their 2010 health care expenditures. Similarly, the top 10
percent of the population accounted for 65.2 percent of overall health care
expenditures in 2009 (with a mean expenditure of $26,767), and 39.7 percent of
this subgroup retained this top decile ranking with respect to their 2010
health care expenditures. The data also indicate that a small percentage of the
individuals in the top percentiles in 2009 and 2010 had expenditures for only
one year because they died, were institutionalized, or were otherwise
ineligible for the survey in the subsequent year.
In both 2009 and 2010, the top 30 percent of the population accounted for
nearly 90 percent of health care expenditures. Among those individuals ranked
in the top 30 percent of the health care expenditure distribution in 2009, 62.6
percent retained this ranking with respect to their 2010 health care
expenditures (figure 1). Furthermore, individuals ranked in the top half of the
health care expenditure distribution in 2009 accounted for 97 percent of all
health care expenditures. Among this population subgroup, 74.9 percent
maintained this ranking in 2010. Alternatively, individuals ranked in the
bottom half of the health care expenditure distribution accounted for only 2.9
percent of medical expenditures (with a mean expenditure of $236 in 2009).
Similar to the experience of the top half of the population based on their medical
expenditure rankings, 73.9 percent of those in the lower half of the
expenditure distribution retained this classification in 2010.
Given the high concentration of medical expenditures incurred by the top
decile of the population ranked by health care spending (65.2 percent),
identifying the characteristics of those individuals exhibiting significant
reductions in health care spending in a subsequent year is also of interest.
Among those ranked in the top decile in 2009 based on their high level of medical
expenditures, 29 percent shifted to a ranking in the lower 75 percent of the
expenditure distribution in 2010 (data not shown). Individuals ranked in the
lower 75 percent of health care spending accounted for only 13.6 percent of all
medical expenditures in 2010.
Individuals who were between the ages of 45 and 64 and the elderly (65 and
older) were disproportionately represented among the population that remained
in the top decile of spenders for both 2009 and 2010. While the elderly
represented 13.3 percent of the overall population, they represented 47.9
percent of those individuals who remained in the top decile of spenders.
For those individuals who remained in the lower half of the distribution based
on health care expenditures over the two-year span, the elderly represented
only 3.1 percent of the population. Alternatively, children (0-17) and
young adults (18-29) were disproportionately represented among the population
that remained in the bottom half of spenders (32.4 percent and 23.5 percent, respectively).
In contrast, children and young adults represented only 2.1 percent and 2.9
percent, respectively, of those individuals who remained in the top decile of
spenders. Individuals in the top decile ordered by medical expenditures in 2009
that shifted below the first quartile in 2010 were predominantly between the
ages of 30 and 64.
Individuals identified as Hispanic and black non-Hispanic single race were
disproportionately represented among the population that remained in the lower
half of the distribution based on health care spending. While Hispanics
represented 16.3 percent of the overall population in 2010, they represented
24.8 percent of those individuals who remained in the bottom 50 percent of
spenders (figure 3). For those individuals who remained in the top decile of
spenders, Hispanics represented only 6.0 percent of the population. Individuals
in the top decile ordered by medical expenditures in 2009 that shifted below
the first quartile in 2010 were more likely to be non-Hispanic whites and other
races (74.9 percent) relative to their representation in the overall population
(66.6 percent).
Individuals who remained in the top decile of spenders in 2009 and 2010
also differed significantly by sex, compared with those who remained in the
lower half of the distribution ranked by medical care expenditures. While
women represented 50.9 percent of the overall population, they represented 61.6
percent of those individuals who remained in the top decile of spenders(figure
4). For those individuals who remained in the lower half of the distribution
based on health care expenditures over the two-year span, women represented
only 43.3 percent of the population. Alternatively, men were disproportionately
represented among the population that remained in the bottom half of spenders
(56.7 percent). In contrast, men represented only 38.4 percent of those individuals
who remained in the top decile of spenders. Individuals in the top decile
ordered by medical expenditures in 2009 that shifted below the first quartile
in 2010 were predominantly female (58.3 percent).
Health status was a particularly salient factor that distinguished those
individuals who remained in the top decile of spenders. Overall, 2.8 percent of
the population was reported to be in poor health in 2010, and another 7.8
percent was classified in fair health (figure 5). In contrast, of those individuals
who remained in the top decile of spenders, 20.2 percent were in poor health
and another 26.7 percent were in fair health. Furthermore, for those
individuals remaining in the bottom half of spenders, only 0.5 percent were
reported to be in poor health and 4.1 percent in fair health. Individuals in
excellent health were disproportionately represented among those who remained
in the lower half of spenders both years (41.2 percent). Alternatively, for
those individuals remaining in the top decile of spenders, only 5.2 percent
were reported to be in excellent health and 14.5 percent in very good health.
Individuals in the top decile ordered by medical expenditures in 2009 that
shifted below the top quartile in 2010 were predominantly in excellent, very good,
or good health (25.8, 34.8, and 23.2 percent, respectively).
Focusing on the under age 65 population, health insurance coverage status
also distinguished individuals who remained in the top decile of spenders from
their counterparts in the lower half of the distribution. Individuals who were
uninsured for all of calendar year 2010 were disproportionately represented
among the population that remained in the lower half of the distribution based
on health care spending. While 15 percent of the overall population under age
65 was uninsured for all of 2010, the full year uninsured comprised 26.1
percent of all individuals remaining in the bottom half of spenders (figure 6).
Alternatively, only 3.4 percent of those under age 65 who remained in the top
decile of spenders were uninsured. In addition, while 17.9 percent of the
overall population under age 65 had public-only coverage for all of 2009, 32.6
percent of those who remained in the top decile of spenders had public-only
coverage.
With respect to poverty status classifications, 36.2 percent of the overall
population resided in families or single-person households with high incomes in
2010 (figure 7) and 15.2 percent had incomes at or below the poverty threshold. A lower
representation of high income individuals (26.6 percent) and a higher
representation of the poor (19.3 percent) were observed among those who
remained in the lower half of spenders in both 2009 to 2010.
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