Chapter 14Financing

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Personal Health Care Expenditures, 1965

Physicians20%

Nursing Homes

4%

Home Health0.2%

Hospitals34%

Other42%

(total = $35.2 billion)

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Personal Health Care Expenditures, 2001

Rx Drugs11%

Physicians22%

Other26%

Home Health3%

Nursing Homes

8%

Hospitals37%

(total = $1.424 trillion)

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Nursing Home Sources of Payment by Selected Years

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Medicare and Medicaid Spending for Nursing Home Care, 1985-2000

$0

$10

$20

$30

in M

illio

ns

1985 1987 1989 1991 1993 1995 1997 1999

Medicare Medicaid

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Home Health Sources of Payment by Selected Years

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Medicare and Medicaid Spending for Home Health Care, 1985-2000

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

in M

illi

on

s

1985 1988 1991 1994 1997 2000

Medicare Medicaid

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Growth in Medicare Enrollment

25

30

35

40

1984 1987 1990 1993 1996 1998 2000

in M

illi

on

s

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Medicare HMO Enrollment

1.81.3 1.5

2.22.5

2.9

3.7

4.8

5.7

6.5 6.25.8

5.2

0

1

2

3

4

5

6

7

in M

illio

ns

1990 1992 1994 1996 1998 2000 2002

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Medicare Provider Payment Distribution for Selected Years

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Medicaid Provider Payment Distribution for Selected Years

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815 1,1301,550

1,9302,430

2,9303,417

3,8374,350

4,9605,542

5,842

8,300

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

in T

ho

usa

nd

s

1987 1989 1991 1993 1995 1997 2001

Long-Term Care Insurance Policies Sold

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Examples of IntegratedFinancing Systems

• CCRCs

• PACE

• S/HMOs

• State demonstrations