Health Care Spending: Context and Policy

[Excerpt] The United States spends a large and growing share of national income on health care. In 2007, health spending is expected to approach $2.3 trillion and account for more than 16Health care costs put significant pressure on the federal budget — both directly, through spending on Medicare, Medicaid, and other federal benefits, and indirectly, through tax expenditures for health insurance and expenses. The Congressional Budget Office projects that spending for Medicare, Medicaid, and the State Children’s Health Insurance Program will total$634 billion and account for about 23% of federal outlays in 2007. Federal tax expenditures for health benefits; health coverage for military personnel, veterans, and federal employees; and spending by Public Health Service agencies are expected to add $272 billion in costs. Given competing constituent interests and the complex interdependence of public and private benefits and actors, policymakers face difficult challenges in helping to ensure access to health care and health insurance without exacerbating federal budget pressures or contributing to marketwide inflation. Three broad policy directions have both promise and limitations for addressing health spending: (1) changing health care, (2) changing federal programs, and (3) changing tax policy. The first, changing health care, considers the potential for influencing spending by improving the quality and delivery of health care services. A key limitation of this direction is uncertainty about whether any particular change will reduce or increase health spending. The second direction, changing federal programs, focuses more narrowly on federal spending for federal benefits. To influence spending, policymakers can set budgets for programs, services, or beneficiaries. They can change eligibility rules or program benefits. And they can change other program features, including payment methods and amounts, and how beneficiaries obtain coverage. In this category, the primary challenge is balancing explicit tradeoffs between competing goals regarding access and spending. The final direction, changing tax policy, focuses both on making health care more affordable for individuals and families, and on influencing consumers’ choices as they purchase health insurance and health care. A key benefit of tax subsidies — including exclusions, credits, deductions, and tax-advantaged accounts — relates to flexibility. In general, these tools help consumers buy the health insurance and health care they prefer. A drawback is that tax subsidies may drive up consumer demand and spending on the one hand, while failing to help ensure access to health coverage on the other. This report will be updated

Spending by Employers on Health Insurance: A Data Brief

[Excerpt] To attract and maintain a skilled workforce, many businesses provide health insurance and other benefits for their employees. As the cost of health insurance rises, employers face a growing challenge paying for benefits while managing labor costs to succeed in a competitive market. All types of businesses report problems, including both small businesses and firms with thousands of employees and retirees. Despite concerns about the cost of benefits, small and large employers together provide health coverage for most Americans, about 60% of the population in 2006.1 But as the amount that employers pay for health insurance has been increasing — both absolutely and as a share of labor costs — the percent of the population covered has been decreasing. To describe employer contributions for health insurance, this report presents data from two employer surveys. The first, conducted by the Kaiser Family Foundation and the Health Research and Educational Trust, provides information on premiums for employer-sponsored health insurance. The second, from the Department of Labor, provides information on employer costs for employee compensation, including costs for wages and salaries, health insurance, and other benefits

Spending by Consumers on Health Care and Health Insurance: A Data Brief

Over the 20-year period from 1986 to 2005, health care accounted for 5.4% of consumer spending, on average. According to data from the Consumer Expenditure Survey (CES), health care accounted for 5.7% of consumer spending in 2005, slightly higher than the 20-year average but lower than the 2004 share of 5.9%. In the CES, consumer spending for health care includes spending for health insurance and spending for other health care (medical services, medical supplies, and drugs). In 2005, health insurance accounted for 2.9% of consumer spending. Other health care accounted for 2.8% of spending. Consumers spent less on health care than on housing or transportation or food, both in 2005 and in every year since 1986. In 2005, housing accounted for 32.7% of consumer spending; transportation, 18.0%; and food, 12.0%. Average spending in these categories exceeded spending on health care in part because some consumers spend little or nothing on health care and health insurance. Those who spend relatively little on health may do so because they are healthy, because they have generous employer-sponsored or government health benefits, or because they are uninsured and lack access to care. Health care accounts for a higher share of spending, on average, for lower-income people. In 2005, health care accounted for 7.6% of spending by consumers in the lowest income quintile, compared with 4.4% of spending by those in the highest income quintile. Housing and food also account for a higher share of spending for lower-income people. In 2005, housing accounted for 39.4% of spending by those in the lowest income quintile, compared with 31.0% for those in the highest quintile. The spending shares for food were 15.9% and 11.1% for the lowest and highest income quintiles, respectively. As people age, they spend more on health care. In 2005, health care accounted for 2.5% of spending by consumers younger than 25, compared with 15.6% of spending by those 75 or older. Health care is different from other spending categories in its consistent pattern of increasing spending with increasing age. It accounted for 3.4% of consumer spending for those in the 25-to-34 age group, 4.1% of spending for those 35 to 44, 4.8% of spending for those 45 to 54, 6.9% of spending for those 55 to 64, and 10.8% of spending for those 65 to 74. Within the health care category, as people age, they spend more, on average, on both health insurance and other health care. The data in this report reflect direct spending by consumers on health care. They do not include spending by employers for employee health benefits, even though consumers may pay indirectly for such benefits through lower wages. Similarly, the data presented here do not include government spending for health care programs, even though consumers help pay for government benefits through income and employment taxes. This report will be updated

Health Care Spending and the Aging of the Population

[Excerpt] Health care spending has been growing as a share of national income, as a share of federal spending, and as a share of many consumers’ income. Because people tend to use more health care as they age, many observers are concerned that an aging population will accelerate growth in health care spending, and that such growth will lead to economic and fiscal crisis. Over the next several decades, both national and federal spending on health care are expected to grow rapidly for two basic reasons. The first is changing demographics. As the share of older people in the population grows, health spending also will grow to reflect generally higher per capita health care costs for this population, compared with younger people

Health Insurance Basics: Roles for the Market and Government in Providing, Financing, and Regulating Private Insurance Coverage

[Excerpt] Both the market and government have important roles in ensuring the availability, affordability, and adequacy of private health insurance. These roles complement one another, but even together the market and government have limitations. The market provides a variety of insurance products for consumers and employers with different needs and preferences. These products differ on many dimensions, including the breadth of provider networks, amount of beneficiary cost-sharing, and techniques for managing the use of health care services. Large employers, small employers, and individuals have different health insurance options, but all must make tradeoffs between the cost of coverage and desired features. A strength of the market is its flexibility to adapt over time to changing circumstances. As economic conditions, consumer preferences, and government policies evolve, the market generates different products with different features. The primary limitation of the market is its failure to provide affordable options for all consumers. The federal government helps ensure access to health coverage through public programs, such as Medicare and Medicaid, and it influences the market for private insurance through tax and regulatory policies. Some tax subsidies help people purchase insurance, and others — including those for Health Savings Accounts — help pay for medical expenses not covered by insurance. By far the largest subsidy is the tax exclusion for employer-provided health benefits. Because of this exclusion, most people get health insurance through work. Tax subsidies make health insurance and health care seem more affordable for certain taxpayers, but do not provide equivalent support to everyone. In addition, subsides may increase health care spending by reducing the apparent cost of health insurance and health care services. Regulations affect both access to insurance and the adequacy of benefits. States have primary responsibility for regulating insurance, but the federal government has sought to address selected issues regarding health coverage. For example, the Health Insurance Portability and Accountability Act of 1996 and the Consolidated Omnibus Budget Reconciliation Act of 1985 include provisions that allow certain people to obtain or continue health coverage under certain circumstances. In addition, several federal laws mandate coverage for specific health benefits. Although regulations provide some protection for consumers, neither federal nor state rules guarantee access to coverage for everyone. In addition, even where regulations require insurers or employers to offer coverage, consumers may find this coverage unaffordable. This report will be updated

The Public Health Service

This document provides an overview of the Public Health Service (PHS) within the U.S. Department of Health and Human Services, including a brief history and discussion of the agencies and offices that constitute the PHS today. Information on the mission, key programs, and budgets of PHS agencies and offices is also included

Theorizing gender and digital gameplay: Oversights, accidents and surprises

This paper attempts to tell a story of a different kind about gender and digital gameplay. Resisting the repetition of stereotypes about who plays, how and why, we show how, as researchers, our own assumptions and presumptions about gender keep surprise at bay, enforcing instead "findings" that solidify an inner "truth" about gender. Re-citing hegemonic gender ideologies that tell us nothing we don't already know, we argue here, is no accident. Rather than recurring encounters with the all-too-familiar, we are entitled to expect to be surprised by the research we do, and more serious interpretive work, in conjunction with alternative methodologies, promise very different findings than those hitherto attributed to women and girls playing games

Research on Women and Video Games Needs to Improve

Research on gender and video games often conflates gender with sex, which leads to stereotyping of girls and women. In general, research on gameplay treats women like a second sex and gender like an insignificant variable.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c