Literature DB >> 11481737

Hospital, employment, and price indicators for the health care industry: first quarter 1999.

M L Seifert1, S K Heffler, C S Donham.   

Abstract

This feature presents highlights from statistics on health care utilization, prices, expenses, employment, and work hours, as well as on national economic activity, with brief analysis of these economic indicators. These statistics provide an early indication of changes occurring in the health care sector and within the general economy. Although most data are for the first quarter of 1999, American Hospital Association data (Tables 1 and 2) refer to the third quarter of 1998.

Entities:  

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Year:  1999        PMID： 11481737      PMCID： PMC4194619     

Source DB:  PubMed          Journal:  Health Care Financ Rev        ISSN： 0195-8631


The decline in employment in home health care services has slowed, falling 6.6 percent in the first quarter of 1999 after a fourth-quarter decline of 8.1 percent. Non-supervisory employment also declined, down 6.7 percent in the first quarter of 1999, driving a 4.7-percent decrease in this industry's implied payrolls. (Implied payrolls are calculated by multiplying the number of non-supervisory workers by their average weekly earnings. Average weekly earnings are average weekly hours times average hourly earnings.) Home health care service employment and payroll decreases began in the first quarter of 1998, following public sector actions to control Medicare spending growth and detect fraud and abuse. Employment in all private and government hospitals increased by 1.3 percent in the first quarter of 1999, driven by a 1.5-percent growth in private hospital employment and a 1.7-percent increase in local government hospital employment. Employment in Federal Government hospitals continued to decline. Inpatient days increased by 0.8 percent in the third quarter of 1998, compared with the same period of the previous year. This increase is the second in three quarters and only the second in a 6-year period. An increase of 1.2 percent in hospital admissions was tempered by a 0.4-percent decline in the adult length of stay, the 36th consecutive quarterly decline. Hospital Insurance (HI) Trust Fund assets rose 8.3 percent in the first quarter of 1999. Estimates in the 1999 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund indicate that, given current law and trends, the Part A trust fund will be exhausted in 2015. Consumer Price Index (CPI) medical price growth, which appeared to have reached a trough in the fourth quarter of 1997 at 2.6 percent, increased 3.5 percent for the third consecutive quarter in the first quarter of 1999. Faster growth in medical prices over the past year was attributable to accelerating drug and hospital price growth. Producer Price Index (PPI) growth for both skilled nursing facility (SNF) and home health care services fell to near historical lows in the first quarter of 1999.

Hospital Occupancy Rates

Reversing a second quarter decline, the adult occupancy rate again increased, rising 0.8 percentage points in the third quarter of 1998 (Figure 1). Inpatient days rose 0.8 percent from the same period of the previous year, and staffed beds decreased only 0.6 percent. The adult occupancy rate represents the ratio of the average daily hospital census (inpatient days divided by the number of days in the year) to the average number of staffed hospital beds. The adult occupancy rate has decreased about 14 percentage points over the long term, from 73.1 percent in the second quarter of 1983 to 58.7 percent in the third quarter of 1998. The number of staffed hospital beds has fallen about 18 percent, from 1,005,718 in the second quarter of 1983 to 824,630 in the third quarter of 1998. With the exception of the first and third quarters of 1998, the number of inpatient days has decreased every quarter since the first quarter of 1990. A 33.4-percent decline in inpatient days since the second quarter of 1983 has been the main reason for the long-term decline in the adult occupancy rate.
Figure 1

Staffed Beds, Inpatient Days, and Occupancy Rate: Percent Change and Change in Rate from Same Period of Previous Year: 1990-1998

Hospital Admissions and Out-Patient Visits

Hospital admissions rose 1.2 percent in the third quarter of 1998, compared with the same period of the previous year, while outpatient visits rose more rapidly, increasing 7.7 percent (Figure 2). The pace of growth in outpatient visits picked up from the 6.4 percent posted in the second quarter of 1998 and appears to be accelerating.
Figure 2

Outpatient Visits and Inpatient Admissions, Percent Change from Same Period of Previous Year: 1990-1998

For the third quarter of 1998, operating expenses increased 4.0 percent, compared with the same period of the previous year, and hospital revenues were up 3.0 percent. The 1.0-percentage-point difference in growth rates is the largest gap between expense and revenue growth rates in more than 9 years. Inpatient revenues increased by 1.1 percent but inpatient expenses grew by 1.9 percent. Outpatient revenues grew by 7.2 percent and outpatient expenses rose by 8.0 percent. On a per utilization basis, however, the expense per inpatient admission increased by 0.7 percent, while the expense per outpatient visit increased only 0.2 percent.

Medicare Trust Fund Operations

Total Medicare outlays (the sum of Part A and Part B outlays) decreased 4.3 percent in the first quarter of 1999. Although Medicare Part A outlays rose 1.0 percent, Part B outlays dropped 12.3 percent. The HI Trust Fund income grew 9.9 percent, and, by the end of the first quarter of 1999, the level of assets in the HI Trust Fund increased 8.3 percent from the same period 1 year earlier (Figure 3). This was the fourth consecutive quarterly increase in assets and was attributable to the 9.9-percent income increase coupled with only a 1.0-percent increase in outlays. A strong economy with low unemployment continued to boost HI Trust Fund income, while outlays slowed for reasons similar to those explaining lower outlays in 1998: Lower Medicare hospital updates for reimbursement rates for 1998 and 1999 under the Balanced Budget Act of 1997 and continuing efforts to combat fraud and abuse. Estimates found in the 1999 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund indicate that, given current law and trends, the Part A Trust Fund will be exhausted in 2015.
Figure 3

Medicare Hospital Insurance (HI) Trust Fund, Percent Change in Income, Outlays, and Assets from Same Period of Previous Year: 1992-1999

Health Sector Employment and Payrolls

A 1.2-percent increase in private health services employment in the first quarter of 1999 masks a second consecutive drop in nursing home employment (-0.6 percent) and a continuing decline in home health care services employment (Figure 4). Following nine quarters of deceleration, in the fourth quarter of 1998, nursing home employment growth experienced its first decline of the 1990s (-0.4 percent), compared with the same period of the previous year. The home health care employment decrease of 6.6 percent in the first quarter of 1999, however, represents a deceleration from the declines of the previous two quarters. For home health care services, the rapid employment growth of previous years began to slow after the first quarter of 1994; actual decreases began in the first quarter of 1998. These declines followed public sector actions to control Medicare spending and detect fraud and abuse. This latest quarter's home health care employment decline, along with shrinking average weekly hours worked (down 1.4 percent) caused a 4.7-percent decrease in implied payroll, well below the 3.5-percent increase in payrolls for the health sector overall. Payrolls for health industries other than home health care rose between 2.5 and 5.5 percent, while total private economy payrolls increased 5.2 percent.
Figure 4

Employment in Health Services, Nursing, Personal Care Facilities, and Home Health Care Services, Percent Change from Same Period of Previous Year: 1990-1999

Medical Prices

Medical prices, as measured by the CPI-U (urban consumers), grew 3.5 percent between the first quarter of 1998 and the first quarter of 1999 (Figure 5). The annualized growth for each of the past two quarters had also been 3.5 percent, nearly a percentage point faster than the recent trough in medical price growth of 2.6 percent reached in the fourth quarter of 1997. By comparison, the growth in the CPI for all items less energy has remained essentially flat, at about 2.1 percent between the fourth quarter of 1997 and the first quarter of 1999. If declining energy prices over this period were included, this divergence would be even more significant. Growth in the PPI for health services has also accelerated over the past year.
Figure 5

Percent Change in Consumer Price Indexes (CPIs) from Same Period of Previous Year: 1990-1999

The faster growth in medical prices appears to be the result of two major factors. First, drug price growth has accelerated rapidly in the past year. Second, hospital prices also grew faster in recent quarters. This acceleration in price growth for drugs and hospital services exceeded the slowdown in growth of nursing home and home health care services prices. Each of these trends is discussed in detail in the next few sections.

Prescription Drug Prices

As shown in Figure 6, growth in the CPI for prescription drugs continued its recent acceleration in the first quarter of 1999. Between the fourth quarter of 1997 and first quarter of 1999, consumer prescription drug price growth has increased from a 1.9 percent to a 5.5-percent growth rate, when compared with the same period 1 year earlier. Much of this acceleration is attributable to rapid increases in prices of several top-selling brands of prescription drugs for allergies, diabetes, acne, and arthritis.
Figure 6

Percent Change in Prescription Drug Price Indexes from Same Period of Previous Year: 1996-1999

The PPI for ethical (prescription) preparations shows a much faster acceleration in growth than the CPI over the past year. The large magnitude of the acceleration can be traced specifically to large increases in psychotherapeutic drug prices in the first half of 1998 because of sampling variability. However, even excluding psychotherapeutics, the PPI for prescription drugs still increased in the 5- to 6-percent range for 1998, compared with approximately 3 percent for 1997. Given the unusually large increase in this index for 1998, overall PPI prescription drug price growth should continue to decelerate in 1999 until it reaches a more stable level.

Hospital Services, Wages, and Prices

Both the producer and consumer prices for hospital services accelerated in the first quarter of 1999, continuing the recent trend. For each of these indexes, the acceleration has been in both inpatient and outpatient price growth. An analysis of average hourly earnings (AHE) for private hospital workers provides some insight into why output prices (those measured by the CPI and PPI) are increasing faster in current quarters. As shown in Figure 7, growth in the AHE for private hospital workers has increased from 2.8 percent in the second quarter of 1998 to 3.5 percent in the first quarter of 1999. The Employment Cost Index (ECI) for hospital workers (part of the occupational wage blend used in the HCFA PPS [prospective payment system] Hospital Input Price Index) has also exhibited a similar pattern over this period. The deceleration in the HCFA PPS Hospital Input Price Index over this period is attributable in part to the slowdown in growth of the PPI for prescription drugs following the tremendous increases of 1998, as described in the previous section.
Figure 7

Percent Change in Hospital Prices and Wages from Same Period of Previous Year: 1998-1999

Nursing Home Services Wages and Prices

Unlike that for hospitals, nursing home price growth has been constant or decelerating for the past four quarters. As Figure 8 shows, this seems to reflect the decelerating growth of hourly earnings in nursing homes and the relatively constant growth of input prices as measured by the HCFA SNF input price index. Standard & Poor's DRI projects the HCFA SNF input price index to continue to grow at similar rates over the next few quarters, despite the deceleration in AHE. This is because the HCFA SNF input price index reflects a constant skill mix of workers by using the ECI. The deceleration in the AHE for nursing homes (which does not hold skill mix constant) implies a shift to less skilled, lower paid workers. Part of this may be the result of the new PPS for Medicare SNF services mandated by the Balanced Budget Act (BBA) of 1997. It has been claimed by the industry that the payment system is forcing nursing homes to turn away more complex cases because the payment rates do not reflect the costs of providing these services (Hilzenroth, 1999). Growth in the public sector PPI for nursing homes is now at its lowest point since its introduction, decelerating from 4.7-percent annual growth in the fourth quarter of 1998 to 3.9 percent in the first quarter of 1999.
Figure 8

Percent Change in Nursing Home Prices and Wages from Same Period of Previous Year: 1998-1999

Home Health Care Services, Wages, and Prices

The BBA, as well as Medicare fraud and abuse initiatives, appear to have had a significant impact on home health wages and prices. The significance is caused by Medicare's large portion of total home health expenditures. Although input cost growth has remained stable over the past four quarters, home health care prices, as measured by the PPI, have decelerated from 2.9 percent in the second quarter of 1998 to 0.3 in the first quarter of 1999 (Figure 9). The Medicare portion of this index has decelerated from 2.3 to -0.6 percent over this same period. Yet an analysis of hourly earnings for home health care workers shows a dramatic acceleration in growth. Because payrolls and employment have declined dramatically in home health care agencies (Figure 4), the implication is that lower skill positions are being eliminated, causing a higher average hourly wage that is accelerating.
Figure 9

Percent Change in Home Health Care Prices and Wages from Same Period of Previous Year: 1998-1999

Overall, the deceleration in price growth and the declines in employment seem to support reports that many home health agencies have cut back on services not covered by Medicare or have closed or merged with other agencies in response to changes in Medicare policies and payments (U.S. General Accounting Office, 1998, 1999). With a PPS scheduled to be implemented on October 1, 2000, the industry may continue to be transformed over the next year.

Background Information on Data Sources and Methods

Community Hospital Statistics

Since 1963, the American Hospital Association (AHA), in cooperation with member hospitals, has been collecting data on the operation of community hospitals through its National Hospital Panel Survey. Community hospitals, which comprised more than 80 percent of all hospital facilities in the United States in 1997, include all non-Federal, short-term general, and other special hospitals open to the public. They exclude hospital units of institutions; psychiatric facilities; tuberculosis, other respiratory, and chronic disease hospitals; institutions for the mentally retarded; and alcohol and chemical-dependency hospitals. The survey samples approximately one-third of all U.S. community hospitals. The sample is designed to produce estimates of community hospital indicators by bed size and region (American Hospital Association, 1963-98). In Tables 1 and 2, statistics covering expenses, utilization, beds, and personnel depict trends in the operation of community hospitals annually for 1994 to 1997 and quarterly from 1995 through the third quarter 1998, after which data collection was discontinued.
Table 1

Selected Community Hospital Statistics: 1994-1998

ItemCalendar Year1995Q31995Q41996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q3
1994199519961997
Utilization
All Ages
 Admissions in Thousands32,93833,38933,26833,3888,2138,2608,5118,2678,1598,3318,5008,3428,2658,2818,6408,3268,361
 Admissions per 1,000 Population2122122121120120121124120118121123120119119124119119
 Inpatient Days in Thousands196,117190,377183,495181,31346,23946,46748,05145,53244,34945,56347,17745,17744,19344,76647,55344,60744,545
 Adult Length of Stay in Days6.05.75.55.45.65.65.65.55.45.55.55.45.35.45.55.45.3
65 Years of Age or Over
Admissions in Thousands12,45612,82012,87013,0503,0713,1843,3243,2043,0903,2523,3743,2533,1733,2503,4793,2603,193
Admissions per 1,000 Population2368375373375359371386372357375389374364373398373365
Inpatient Days in Thousands94,87791,16486,43185,31521,50722,05622,97221,44520,44821,56622,66121,17920,43121,04422,94120,85920,295
Adult Length of Stay in Days7.67.16.76.57.06.96.96.76.66.66.76.56.46.56.66.46.4
Under 65 Years of Age
Admissions in Thousands20,48320,56920,39820,3395,1435,0775,1875,0635,0705,0785,1265,0895,0925,0325,1625,0665,168
Admissions per 1,000 Population28786858486858684848485848482848384
Inpatient Days in Thousands101,24099,21397,06495,99924,73224,41125,07824,08723,90223,99724,51623,99923,76223,72224,71223,74824,251
Adult Length of Stay in Days4.94.84.84.74.84.84.84.84.74.74.84.74.74.74.84.74.7
Surgical Operations in Thousands23,28623,73924,16524,6015,8325,9155,9486,0876,0286,1026,0476,2456,1976,1116,2006,4056,461
Outpatient Visits in Thousands417,684452,558481,298507,523113,332114,438116,335119,874122,232122,857123,270127,607128,285128,361131,411135,812138,222
Adjusted Patient Days in Thousands3276,209273,638270,023275,86467,07967,10669,23267,39466,24767,08770,05068,81368,25868,68272,26169,19670,246
Number of Beds in Thousands891874854833871867862859849844842832829830829827825
Adult Occupancy Rate460.359.758.759.657.758.261.258.356.858.762.359.757.958.763.859.358.7
Total Hospital Revenues in Millions5$309,354$324,961$338,118$349,329$80,307$81,842$84,280$84,396$83,449$85,993$86,941$87,073$87,092$88,223$91,024$89,187$89,695
 Total Patient Revenues in Millions293,285307,228318,183327,93875,95677,23879,71079,34978,46180,66481,99881,78181,44182,71785,39183,58384,102
  Inpatient Revenues in Millions208,262213,771216,242215,55852,35853,48355,32253,60952,52654,78455,22353,69252,72853,91456,19453,88253,331
  Outpatient Revenues in Millions85,02393,457101,941112,38023,59923,75524,38725,74025,93425,88026,77428,09028,71328,80329,19729,70130,770
Total Expenses
Total Hospital Expenses in Millions292,801308,411320,789331,48276,80878,59479,36179,95879,59381,87782,09282,69482,83583,86285,25186,15586,169
 Labor in Millions156,826163,842168,796173,04740,85741,68841,87341,93541,92543,06342,88842,95843,32643,87544,50244,57644,812
 Non-Labor in Millions135,975144,569151,993158,43535,95136,90637,48838,02337,66838,81439,20439,73539,50939,98640,74941,58041,357
Inpatient Expense in Millions6207,897214,570217,994217,86952,94554,42155,08154,02053,28455,60855,28754,29153,63154,66056,10255,54054,643
 Amount per Patient Day1,0601,1271,1881,2021,1451,1711,1461,1861,2011,2201,1721,2021,2141,2211,1801,2451,227
 Amount per Admission6,3126,4266,5536,5256,4466,5886,4726,5346,5306,6756,5046,5086,4896,6006,4936,6716,535
Outpatient Expense in Millions684,90393,841102,796113,61423,86324,17224,28125,93726,30926,26926,80528,40329,20429,20129,14930,61531,527
 Amount per Outpatient Visit203207214224211211209216215214217223228227222225228

Collection of American Hospital Association (AHA) data used in this table was discontinued after third quarter 1998.

Admissions per 1,000 population is calculated using population estimates prepared by the Social Security Administration.

Adjusted patient days is an aggregate figure reflecting the number of days of inpatient care, plus an estimate of the volume of outpatient services, expressed in units equivalent to an inpatient day in terms of level of effort. It is derived by multiplying the number of outpatient visits by the ratio of outpatient revenue per outpatient visit to inpatient revenue per inpatient day, and adding the product to the number of inpatient days

The adult occupancy rate is calculated by the National Health Statistics Group, Office of the Actuary, Health Care Financing Administration. The AHA does not publish this statistic. Adult occupancy rate is the ratio of average daily census to average number of beds maintained during the reporting period.

Total hospital revenue is the sum of total patient revenue and all other operating revenue. Total patient revenue is the sum of inpatient revenue and outpatient revenue.

Inpatient expense and outpatient expense are calculated by the National Health Statistics Group, Office of the Actuary, Health Care Financing Administration. These statistics are calculated by applying the ratio of inpatient or outpatient revenue to total patient revenue multiplied by total hospital expenses.

NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCE: American Hospital Association; Trend Analysis Group: National Hospital Panel Survey Reports. Chicago. Monthly reports for January 1995-September 1998.

Table 2

Percent Change in Selected Community Hospital Statistics: 1994-1998

ItemCalendar Year1995Q31995Q41996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q3
1994199519961997
Annual Percent ChangePercent Change from the Same Period of Previous Year
Utilization
All Ages
 Admissions in Thousands0.91.4-0.40.40.70.3-1.4-0.2-0.70.9-0.10.91.3-0.61.6-0.21.2
 Admissions per 1,000 Population-0.10.4-1.3-0.6-0.2-0.6-2.3-1.1-1.6-0.1-1.10.00.4-1.50.7-1.10.3
 Inpatient Days in Thousands-2.9-2.9-3.6-1.2-3.0-3.4-4.6-3.7-4.1-1.9-1.8-0.8-0.4-1.70.8-1.30.8
 Adult Length of Stay in Days-3.8-4.2-3.3-1.5-3.7-3.7-3.2-3.6-3.5-2.8-1.7-1.7-1.6-1.2-0.8-1.1-0.4
65 Years of Age or Over
Admissions in Thousands2.02.90.41.41.61.9-1.60.50.62.21.51.52.7-0.13.10.20.7
Admissions per 1,000 Population0.81.8-0.50.60.60.9-2.6-0.4-0.31.20.60.71.9-0.72.5-0.40.1
Inpatient Days in Thousands-2.2-3.9-5.2-1.3-5.0-4.9-7.3-6.0-4.9-2.2-1.4-1.2-0.1-2.41.2-1.5-0.7
Adult Length of Stay in Days-4.2-6.6-5.6-2.7-6.5-6.7-5.8-6.5-5.5-4.3-2.8-2.7-2.7-2.3-1.8-1.7-1.3
Under 65 Years of Age
Admissions in Thousands0.20.4-0.8-0.30.2-0.7-1.3-0.6-1.40.0-1.20.50.4-0.90.7-0.51.5
Admissions per 1,000 Population-0.7-0.5-1.7-1.2-0.7-1.5-2.2-1.5-2.3-0.9-2.1-0.4-0.5-1.8-0.3-1.40.6
Inpatient Days in Thousands-3.6-2.0-2.2-1.1-1.2-2.0-2.0-1.6-3.4-1.7-2.2-0.4-0.6-1.10.8-1.02.1
Adult Length of Stay in Days-3.8-2.4-1.3-0.8-1.4-1.3-0.7-1.0-2.0-1.7-1.1-0.9-1.0-0.20.1-0.60.6
Surgical Operations in Thousands2.51.91.81.8-0.1-0.1-1.32.13.43.21.72.62.80.22.52.64.3
Outpatient Visits in Thousands7.08.36.45.45.95.74.75.47.97.46.06.55.04.56.66.47.7
Adjusted Patient Days in Thousands-1.0-0.9-1.32.2-0.9-1.8-2.8-1.1-1.20.01.22.13.02.43.20.62.9
Number of Beds in Thousands-1.2-1.8-2.4-2.4-1.9-2.1-2.1-2.1-2.6-2.6-2.4-3.1-2.3-1.7-1.6-0.7-0.6
Adult Occupancy Rate1-1.1-0.7-0.90.9-0.6-0.8-2.3-1.0-0.90.41.01.41.10.01.5-0.40.8
Total Hospital Revenues in Millions4.95.04.03.34.23.63.04.23.95.13.23.24.42.64.72.43.0
 Total Patient Revenues in Millions4.64.83.63.14.03.42.93.63.34.42.93.13.82.54.12.23.3
  Inpatient Revenues in Millions2.52.61.2-0.31.91.81.00.90.32.4-0.20.20.4-1.61.80.41.1
  Outpatient Revenues in Millions10.19.99.110.29.17.37.59.99.98.99.89.110.711.39.05.77.2
Operating Expenses
Total in Millions5.05.34.03.34.54.74.14.23.64.23.43.44.12.43.84.24.0
 Labor in Millions4.74.53.02.53.73.83.32.92.63.32.42.43.31.93.83.83.4
 Non-Labor in Millions5.36.35.14.25.65.84.95.74.85.24.64.54.93.03.94.64.7
Inpatient Expense in Millions2.93.21.6-0.12.43.12.11.40.62.20.40.50.6-1.71.52.31.9
 Amount per Patient Day6.06.35.41.15.56.77.15.34.94.22.21.31.00.00.73.61.1
 Amount per Admission2.01.82.0-0.41.72.83.61.61.31.30.5-0.4-0.6-1.1-0.22.50.7
Outpatient Expense10.510.59.510.59.78.78.810.510.28.710.49.511.011.28.77.88.0
 Amount per Outpatient Visit3.22.03.04.83.62.83.94.82.21.24.22.95.86.42.01.30.2

Change in rate, rather than percent change.

NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCE: American Hospital Association; Trend Analysis Group: National Hospital Panel Survey Reports. Chicago. Monthly reports for January 1995-September 1998.

For purposes of national health expenditures (NHE), survey statistics on revenues are analyzed in estimating the growth in the largest component of health care costs—community hospital expenditures. This one segment of NHE accounted for 30 percent of all health spending in 1997 (Braden et al., 1998). The survey also identifies important factors influencing expenditure growth patterns, such as changes in the number of beds in operation, number of admissions, length of stay use of outpatient facilities, and number of surgeries.

Medicare Trust Fund Operations

Separate trust funds finance the operations of the two parts of the Medicare program (Table 3). The HI program, or Medicare Part A, helps pay for inpatient hospital, home health, SNF, and hospice care for the aged and disabled. The HI program is financed primarily by payroll taxes paid by workers and employers. The taxes paid each year are used mainly to pay benefits for current beneficiaries. The Supplementary Medical Insurance (SMI) program, or Medicare Part B, pays for physician, outpatient hospital, home health, and other services for the aged and disabled. The SMI program is financed primarily by transfers from the general fund of the U.S. Treasury and by monthly premiums paid by beneficiaries. For both Medicare programs, income not currently needed to pay benefits and related expenses is held in the HI and SMI trust funds and invested in U.S. Treasury securities (Board of Trustees of the Federal Hospital Insurance Trust Fund, 1999; Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund, 1999).
Table 3

Hospital Insurance and Supplementary Medical Insurance (SMI) Trust Fund Operations: 1995-1999

IndicatorCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Total Medicare Outlays In Millions of Dollars$184,203$200,337$213,600$213,228$47,456$49,642$50,599$52,639$50,084$53,696$53,922$55,897$50,818$53,692$53,165$55,553$48,626
Hospital Insurance Trust Fund117,604129,929139,475133,67131,28832,16032,61533,86633,40735,30735,20835,55230,52633,94235,23033,97330,834
SMI Trust Fund66,59970,40874,12579,55716,16817,48217,98418,77316,67718,38918,71420,34520,29219,75017,93521,58017,792
Hospital Insurance Trust Fund Operations: In Millions of Dollars
 Income115,027124,603130,107140,54626,29337,00027,84033,47029,53536,64428,85235,07531,55141,08030,49637,41934,678
 Outlays117,604129,929139,475133,67131,28832,16032,61533,86633,40735,30735,20835,55230,52633,94235,23033,97330,834
 Difference(2,577)(5,325)(9,368)6,875(4,995)4,840(4,774)(396)(3,873)1,337(6,356)(477)1,0257,138(4,734)3,4463,844
Assets at End of Period1130,267124,942115,573122,448125,272130,112125,338124,942121,069122,406116,050115,573116,598123,736119,002122,448126,292
SMI Trust Fund Operations: In Millions of Dollars
 Income60,30685,60981,92487,71226,59619,65319,20820,15219,90620,85519,89321,27019,80320,99819,88427,02715,389
 Outlays66,59970,40874,12579,55716,16817,48217,98418,77316,67718,38918,71420,34520,29219,75017,93521,58017,792
 Difference(6,293)15,2027,7998,15510,4282,1711,2241,3783,2292,4661,179925(489)1,2481,9495,447(2,403)
Assets at End of Period113,13028,33236,13144,28623,55825,72926,95328,33231,56134,02735,20636,13135,64256,64076,524103,551118,940
Annual Percent ChangePercent Change from the Same Period of Previous Year
Total Medicare Outlays11.78.86.6-0.27.06.28.713.05.58.26.66.21.50.0-1.4-0.6-4.3
Hospital Insurance Trust Fund12.510.57.3-4.29.35.411.715.86.89.88.05.0-8.6-3.90.1-4.41.0
SMI Trust Fund10.45.75.37.32.97.83.68.43.15.24.18.421.77.4-4.26.1-12.3
Hospital Insurance Trust Fund Operations
 Income5.08.34.48.04.34.014.811.612.3-1.03.64.86.812.15.76.79.9
 Outlays12.510.57.3-4.29.35.411.715.86.89.88.05.0-8.6-3.90.1-4.41.0
Assets at End of Period-1.9-4.1-7.55.9-3.2-3.2-3.2-4.1-3.4-5.9-7.4-7.5-3.71.12.55.98.3
SMI Trust Fund Operations
 Income8.542.0-4.37.161.414.390.721.6-25.26.13.65.5-0.50.70.027.1-22.3
 Outlays10.45.75.37.32.97.83.68.43.15.24.18.421.77.4-4.26.1-12.3
Assets at End of Period-32.4115.827.522.616.721.694.3115.834.032.230.627.512.966.5117.4186.6233.7

As shown in the Monthly Treasury Statement. Excludes undisbursed balance.

NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCES: U.S. Department of the Treasury, Financial Management Service: Monthly Treasury Statement of Receipts and Outlays of the United States Government. (Board of Trustees of the Hospital Insurance Trust Fund, 1999; Board of Trustees of the Supplementary Medical Insurance Trust Fund, 1999); Office of the Actuary, Health Care Financing Administration.

Data on the financial operations of the Medicare trust funds, the HI Trust Fund and the SMI Trust Fund, are available from two sources. The monthly statistics on trust fund operations are published in the Monthly Treasury Statement of Receipts and Outlays of the United States Government, Table 8: Trust Fund Impact on Budget Results and Investment Holding (U.S. Department of the Treasury, 1998). The 1999 annual reports of the HI and SMI trust funds (Board of Trustees of the Federal Hospital Insurance Trust Fund, 1999; Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund, 1999) contain a detailed accounting of all financial operations for the prior fiscal year. The reports also contain actuarial analysis of the expected operations of the trust funds in future years and analysis of the actuarial status of the funds.
Table 8

Index Levels of Medical Prices: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Consumer Price Indexes, All Urban Consumers1
Medical Care Services2224.2232.4239.1246.8230.1231.5233.3234.7237.0238.4239.7241.2244.0245.9248.0249.3252.3
 Professional Services201.0208.3215.4222.2205.9207.5209.2210.7213.2215.1216.2217.1219.5221.8223.3224.4226.7
  Physician Services208.8216.4222.9229.5214.3215.8217.1218.3220.8222.8223.7224.2226.6228.8230.8231.7233.7
  Dental Services206.8216.5226.6236.2212.5215.1218.0220.5223.4225.8227.6229.6232.6235.1237.3239.7243.7
 Hospital and Related Services257.8269.5278.4287.5266.1267.7271.0273.1276.3277.2278.8281.3284.6285.7289.0290.8295.7
  Hospital Services (12/96 = 100)——101.7105.0————101.0101.3101.8102.7103.9104.3105.5106.2108.0
   Inpatient Hospital Services (12/96 = 100)——101.3104.0————100.8101.0101.5102.1103.1103.3104.4105.0106.7
   Outpatient Hospital Services (12/86 = 100)204.6215.1224.9233.2211.7213.9216.5218.1222.6223.7225.4227.7230.0231.6234.4236.7241.1
 Nursing Home Services (12/96 = 100)——102.3107.1————101.0101.8102.9103.5105.5106.7107.8108.2110.0
Medical Care Commodities204.5210.4215.3221.8208.4209.9211.1212.1213.8215.6215.6216.1218.2221.3223.1224.8226.8
 Prescription Drugs235.0242.9249.3258.6240.1242.3243.7245.3247.6249.8249.6250.1253.3257.6260.6263.0267.2
 Non-Prescription Drugs and Medical Supplies (1986 = 100)140.5143.1145.4147.7142.5142.9143.6143.6144.5145.4145.8146.1146.5147.7148.0148.6147.8
  Internal and Respiratory Over-the-Counter Drugs167.0170.2173.1175.4169.3169.5170.6171.3172.4173.3173.3173.4173.2175.6176.4176.4174.8
  Non-Prescription Medical Equipment and Supplies166.3169.1171.5174.9168.7169.3169.8168.8169.7171.2172.2173.1175.1174.5173.9176.0176.5
Producer Price Indexes3
Industry Groupings4
 Health Services (12/94 = 100)102.4104.6106.1107.7104.1104.4104.7105.2105.8105.9106.2106.3107.1107.5107.9108.3109.2
  Offices and Clinics of Doctors of Medicine (12/93 = 100)106.8107.6109.0111.3107.4107.5107.5107.9108.7108.8109.3109.2110.7111.2111.5112.0113.2
   Medicare Treatments (12/93 = 100)109.6105.5105.8110.5105.5105.5105.5105.5105.8105.8105.8105.8110.5110.5110.5110.5113.2
   Non-Medicare Treatments (12/93 = 100)105.9107.8109.6111.4107.5107.7107.8108.2109.2109.4109.9109.8110.6111.2111.6112.2113.1
  Hospitals (12/92 = 100)110.0112.6113.6114.4112.2112.3112.7113.4113.5113.6113.5113.5114.0114.2114.4115.0115.7
   General Medical and Surgical Hospitals (12/92 =100)109.9112.5113.6114.6112.2112.2112.5113.2113.4113.4113.8113.8114.1114.4114.6115.2115.8
    Inpatient Treatments (12/92 = 100)109.2111.8112.8113.6111.5111.6111.6112.4112.5112.5113.2113.0113.3113.4113.6114.1114.8
     Medicare Patients (12/92 = 100)104.7108.1108.8108.1107.8107.8107.8109.1109.1109.1109.1108.0108.0108.0108.0108.4108.4
     Medicaid Patients (12/92 = 100)109.8112.2110.9110.2111.7112.5111.9112.5110.7110.0111.4111.5110.9110.6109.6109.7109.8
     All Other Patients (12/92 = 100)111.7113.7115.6117.8113.6113.4113.6114.2114.8115.1116.0116.3117.0117.4118.1118.8120.0
    Outpatient Treatments (12/92 = 100)113.3116.2117.4118.6115.6115.8116.6117.0117.4117.5117.1117.5118.0118.4118.6119.3120.0
     Medicare Patients (12/92 = 100)111.2113.1116.1118.8112.3112.5113.4114.4115.3115.9116.7116.4117.4118.3119.0120.6122.2
     Medicaid Patients (12/92 = 100)106.4106.1105.0105.9107.1107.1105.9104.4104.8104.9105.0105.2105.2105.3105.3107.8107.8
     All Other Patients (12/92 = 100)114.2117.7118.8119.8116.9117.1118.1118.6119.0119.0118.4118.9119.3119.7119.9120.2120.7
  Skilled and Intermediate Care Facilities (12/94 = 100)103.6110.0114.7119.6108.2109.5110.7111.6113.3113.9115.5116.1117.7118.6120.6121.4122.5
   Public Payers (12/94 = 100)103.8110.5115.4120.4108.6110.1111.2112.1113.7114.4116.3117.0118.4119.0121.5122.6123.1
   Private Payers (12/94 = 100)103.6109.8114.3119.1108.2109.1110.4111.4113.3113.8114.9115.4117.4118.7120.0120.3122.4
  Medical Laboratories (6/94 = 100)104.0105.3106.1106.4105.3105.2105.3105.3105.8106.1106.2106.2106.3106.5106.4106.4106.2
  Home Health Care Services (12/96 = 100)——103.4106.2————101.6103.4103.7104.7105.7106.4106.3106.6106.0
   Medicare Payers (12/96 = 100)——102.2103.6————101.5101.5102.5103.1103.2103.8103.2104.3102.5
   Non-Medicare Payers (12/96 = 100)——100.3103.0————100.2100.099.9101.2102.6103.1103.2103.0103.1
Commodity Groupings
 Drugs and Pharmaceuticals210.9214.7219.1242.6213.8214.6215.2215.2218.1218.2219.2221.0229.8244.5247.4248.7251.1
  Ethical (Prescription) Preparations257.0265.4273.5322.9262.5265.1266.8267.0271.0272.5273.6276.8295.3328.3332.9335.3337.2
  Proprietary (Over-the-Counter) Preparations186.6185.1184.8184.5188.3184.5183.3184.2186.1183.9184.3184.9184.7184.3184.4184.7185.3
 Medical, Surgical, and Personal Aid Devices141.3143.1143.1143.4143.5143.4142.6142.7142.9143.2143.2143.1143.3143.0143.3144.0144.2
  Personal Aid Equipment133.7139.3140.3143.4136.8139.8140.2140.3140.3140.4139.4141.1142.0143.9143.9143.9146.6
  Medical Instruments and Equipment (6/82 = 100)128.3130.1128.1126.7130.3130.1129.7130.1127.8128.1128.6127.8127.0126.4126.6126.9127.3
  Surgical Appliances and Supplies (6/83 = 100)154.8156.9158.8160.6157.4158.1156.3155.8158.5158.9158.6159.2160.7160.1160.3161.3161.3
  Ophthalmic Goods (12/83 = 100)122.2120.3119.8119.6122.2119.7119.8119.5120.4119.9119.4119.5119.2119.1119.6120.7120.2
  Dental Equipment and Supplies (6/85 = 100)137.5141.0146.6151.2140.7140.7141.0141.7145.9146.5146.8147.0148.8150.8152.1153.0153.7

Unless otherwise noted, base year is 1982-1984 = 100.

Includes the net cost of private health insurance, not shown separately.

Unless otherwise noted, base year is 1982 = 100. Producer Price Indexes are classified by industry (price changes received for the industry's output sold outside the industry) and commodity (price changes by similarity of end-use or material composition).

Further detail for Producer Price Industry groupings, such as types of physician practices, hospital diagnosis-related groups, are available from the Bureau of Labor Statistics.

NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCES: U.S. Department of Labor, Bureau of Labor Statistics: CPI Detailed Report. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999. U.S. Department of Labor, Bureau of Labor Statistics: Producer Price Indexes. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999.

Private Health Sector: Employment, Hours, and Earnings

The Bureau of Labor Statistics (BLS) collects monthly information on employment for all workers, and employment, earnings, and work hours for non-supervisory workers in a sample of approximately 305,000 establishments. Data are collected through cooperative agreements with State agencies that also use this information to create State and local area statistics. The survey is designed to collect industry-specific information on wage and salary jobs in non-agricultural industries. It excludes statistics on self-employed persons and on those employed in the military (U.S. Department of Labor, 1998a). Employment in this survey is defined as number of jobs. Persons holding multiple jobs would be counted multiple times. Approximately 5 percent of the population holds more than one job at any one time. (Other surveys that are household-based, such as the Current Population Survey [CPS], also record employment. In the CPS, however, each person's employment status is counted only once, as either employed, unemployed, or not in the labor force, which includes discouraged workers.) Once each year, monthly establishment-based employment statistics are adjusted to benchmarks created from annual establishment census information, resulting in revisions to previously published employment estimates. Tables 4, 5, and 6 present statistics on employment, non-supervisory employment, average weekly hours, and average hourly earnings for the private non-farm business sector and industries in health services.
Table 4

Employment, Hours, and Earnings in Private Health Service Establishments, by Selected Type of Establishment: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Total Employment in Thousands
Non-Farm Private Sector97,885100,189103,133106,00797,534100,073101,379101,769100,362103,027104,261104,882103,432105,972107,129107,495105,879
 Health Services9,2309,4789,7039,8469,3649,4519,5219,5769,6079,6849,7399,7819,7799,8319,8729,9019,896
  Offices and Clinics of Physicians1,6091,6781,7391,8031,6491,6721,6921,7001,7121,7321,7471,7651,7731,7921,8151,8321,840
  Offices and Clinics of Dentists592611629646601608614619623628631634636643649655657
  Nursing Homes1,6911,7301,7561,7621,7131,7251,7401,7451,7421,7531,7641,7671,7601,7631,7651,7601,750
  Private Hospitals3,7723,8123,8603,9263,7943,8063,8183,8293,8363,8523,8703,8833,8933,9173,9433,9523,952
  Home Health Care Services629675710672654671679694701713714714692678660656646
Non-Supervisory Employment in Thousands
Non-Farm Private Sector80,12582,09284,54186,76279,66782,02283,16783,51282,07184,50585,55686,03284,49586,76287,75488,03586,418
 Health Services8,1788,4058,5998,7248,3038,3818,4428,4928,5128,5858,6328,6688,6688,7138,7498,7658,762
  Offices and Clinics of Physicians1,3141,3771,4281,4861,3511,3721,3891,3961,4041,4231,4351,4501,4621,4781,4981,5061,513
  Offices and Clinics of Dentists517535550563527534538543545549552553555561565570574
  Nursing Homes1,5261,5591,5791,5851,5431,5541,5671,5701,5671,5761,5861,5881,5831,5861,5881,5811,572
  Private Hospitals3,4503,4893,5373,5983,4713,4843,4963,5073,5133,5293,5473,5603,5683,5903,6143,6203,621
  Home Health Care Services582624655618605621628642646657657657638624608604595
Average Weekly Hours
Non-Farm Private Sector34.534.434.634.633.934.434.834.634.334.634.934.834.434.534.834.734.2
 Health Services32.832.733.033.132.532.632.832.832.933.033.133.133.233.033.133.032.9
  Offices and Clinics of Physicians32.532.933.233.032.632.832.933.233.233.233.133.333.332.932.832.932.7
  Offices and Clinics of Dentists28.028.228.428.327.928.228.228.428.428.628.228.528.428.228.328.327.9
  Nursing Homes32.532.432.432.632.232.332.732.332.332.332.732.532.432.432.932.632.2
  Private Hospitals34.534.434.935.034.434.334.334.434.634.834.935.135.234.934.934.934.9
  Home Health Care Services28.628.128.929.027.727.828.328.328.628.929.029.129.229.029.128.928.8
Average Hourly Earnings
Non-Farm Private Sector$11.43$11.81$12.28$12.78$11.69$11.74$11.82$12.01$12.15$12.18$12.27$12.51$12.65$12.70$12.78$12.98$13.11
 Health Services12.4512.8513.2613.7312.7412.7812.8713.0113.1313.1713.2913.4613.5713.6513.7713.9114.05
  Offices and Clinics of Physicians12.5413.1713.7914.3112.9513.0813.2213.4413.6113.6713.8314.0314.1914.2614.2914.5014.62
  Offices and Clinics of Dentists12.4012.8813.6314.1612.6912.7712.9213.1713.4613.5813.6213.8513.9814.0814.1814.3914.53
  Nursing Homes8.779.019.349.778.958.959.029.109.209.269.409.519.639.719.829.9010.01
  Private Hospitals14.3014.7015.0315.4614.6214.6314.7314.8114.9114.9415.0515.2215.2815.3615.5415.6715.82
  Home Health Care Services10.9111.1811.3511.4911.1111.1311.2211.2811.3611.2911.3311.4011.4011.4111.5311.6311.81
Hospital Employment in Thousands
Total5,0695,0675,0775,1325,0685,0685,0665,0655,0605,0695,0855,0925,0965,1215,1525,1605,164
Private3,7723,8123,8603,9263,7943,8063,8183,8293,8363,8523,8703,8833,8933,9173,9433,9523,952
Federal233232224223234233231229225224225224224224224221221
State395376360348385378372368366362358354349347348348349
Local669648632635656651646640633631632631631633637640642

Excludes hospitals, clinics, and other health-related establishments run by all governments.

NOTES: Data presented here conform to the 1987 Standard Industrial Classification. Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999.

Table 5

Percent Change in Employment, Hours, and Earnings in Private Health Service Establishments, by Selected Type of Establishment: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Annual Percent ChangePercent Change from the Same Period of Previous Year
Total Employment in Thousands
Non-Farm Private Sector3.02.42.92.82.02.32.52.62.93.02.83.13.12.92.82.52.4
 Health Services2.72.72.41.52.72.82.72.62.62.52.32.11.81.51.41.21.2
  Offices and Clinics of Physicians4.14.33.63.74.54.64.43.83.83.63.33.83.63.53.93.83.8
  Offices and Clinics of Dentists3.33.13.02.72.93.03.03.33.63.12.82.42.22.52.93.33.3
  Nursing Homes2.62.31.50.32.52.62.21.91.71.61.41.31.10.60.1-0.4-0.6
  Private Hospitals0.21.01.31.70.91.01.01.21.11.21.41.41.51.71.91.81.5
  Home Health Care Services12.47.35.3-5.58.68.26.46.37.26.35.12.8-1.3-4.9-7.5-8.1-6.6
Non-Supervisory Employment in Thousands
Non-Farm Private Sector3.22.53.02.62.12.42.62.73.03.02.93.03.02.72.62.32.3
 Health Services2.72.82.31.42.82.92.72.72.52.42.22.11.81.51.41.11.1
  Offices and Clinics of Physicians4.24.83.74.15.05.14.84.23.93.83.33.84.23.84.43.93.5
  Offices and Clinics of Dentists3.23.52.72.33.33.73.53.73.42.82.62.01.82.02.43.03.5
  Nursing Homes2.62.21.30.32.52.42.11.71.51.41.21.11.00.60.1-0.4-0.7
  Private Hospitals0.31.11.41.71.11.11.11.31.21.31.51.51.61.71.91.71.5
  Home Health Care Services12.37.34.9-5.58.68.06.36.36.85.94.72.4-1.4-5.1-7.5-8.1-6.7
Average Weekly Hours
Non-Farm Private Sector-0.6-0.10.6-0.1-1.10.20.10.41.30.50.30.40.3-0.3-0.3-0.3-0.8
 Health Services-0.2-0.31.10.2-0.8-0.3-0.10.21.11.20.91.11.0-0.10.1-0.3-1.1
  Offices and Clinics of Physicians0.21.31.0-0.70.61.21.41.71.81.20.60.20.2-0.8-1.1-1.2-1.7
  Offices and Clinics of Dentists-0.60.61.0-0.6-0.60.71.60.82.01.40.00.6-0.1-1.40.2-0.9-1.9
  Nursing Homes0.5-0.30.10.5-0.20.2-0.2-0.90.2-0.2-0.10.60.40.30.80.3-0.7
  Private Hospitals-0.3-0.51.40.3-0.9-0.9-0.50.10.71.51.71.81.60.4-0.1-0.6-0.9
  Home Health Care Services1.2-1.83.10.4-3.4-3.2-1.20.73.23.82.52.82.00.30.1-0.8-1.4
Average Hourly Earnings
Non-Farm Private Sector2.83.43.94.13.03.43.43.74.03.83.84.14.14.24.23.83.6
 Health Services2.93.23.23.53.13.43.33.13.03.13.23.53.43.63.63.33.6
  Offices and Clinics of Physicians2.35.04.73.84.05.15.65.55.14.54.64.44.24.33.43.33.0
  Offices and Clinics of Dentists3.63.95.83.93.63.44.04.56.16.45.55.23.83.74.13.93.9
  Nursing Homes3.22.73.74.52.72.42.72.92.83.44.24.54.64.94.54.13.9
  Private Hospitals3.42.82.32.93.13.32.72.02.02.12.22.72.52.83.22.93.5
  Home Health Care Services2.32.51.41.32.42.62.72.32.31.41.01.10.41.11.72.03.6
Hospital Employment in Thousands
Total-0.10.00.21.10.10.0-0.2-0.1-0.20.00.40.50.71.01.31.31.3
Private0.21.01.31.70.91.01.01.21.11.21.41.41.51.71.91.81.5
Federal-0.2-0.6-3.2-0.61.70.3-2.6-1.9-4.1-3.7-2.6-2.2-0.50.0-0.6-1.3-1.3
State-2.9-4.9-4.2-3.3-4.6-4.6-5.2-5.4-5.0-4.4-3.7-3.9-4.5-4.1-2.9-1.60.0
Local-0.6-3.1-2.50.5-2.6-3.0-3.3-3.4-3.4-3.1-2.1-1.3-0.40.30.81.41.7

Excludes hospitals, clinics, and other health-related establishments run by all governments.

NOTES: Data presented here conform to the 1987 Standard Industrial Classification. Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999.

Table 6

Percent Change in Implied Non-Supervisory Payrolls, Employment, Average Weekly Hours, and Average Hourly Earnings in Private Health Service Establishments, by Selected Type of Establishment: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Annual Percent ChangePercent Change from the Same Period of Previous Year
Health Services
Payrolls5.55.86.75.25.16.06.06.16.86.96.56.86.35.15.14.23.5
 Employment2.72.82.31.42.82.92.72.72.52.42.22.11.81.51.41.11.1
 Average Weekly Hours-0.2-0.31.10.2-0.8-0.3-0.10.21.11.20.91.11.0-0.10.1-0.3-1.1
 Average Hourly Earnings2.93.23.23.53.13.43.33.13.03.13.23.53.43.63.63.33.6
Offices and Clinics of Physicians
Payrolls6.811.49.67.29.811.812.311.811.29.88.88.68.87.46.76.04.8
 Employment4.24.83.74.15.05.14.84.23.93.83.33.84.23.84.43.93.5
 Average Weekly Hours0.21.31.0-0.70.61.21.41.71.81.20.60.20.2-0.8-1.1-1.2-1.7
 Average Hourly Earnings2.35.04.73.84.05.15.65.55.14.54.64.44.24.33.43.33.0
Offices and Clinics of Dentists
Payrolls6.38.29.75.76.38.09.39.212.010.98.27.85.64.36.96.15.5
 Employment3.23.52.72.33.33.73.53.73.42.82.62.01.82.02.43.03.5
 Average Weekly Hours-0.60.61.0-0.6-0.60.71.60.82.01.40.00.6-0.1-1.40.2-0.9-1.9
 Average Hourly Earnings3.63.95.83.93.63.44.04.56.16.45.55.23.83.74.13.93.9
Nursing Homes
Payrolls6.54.65.35.45.05.24.63.64.64.65.46.36.15.95.44.02.5
 Employment2.62.21.30.32.52.42.11.71.51.41.21.11.00.60.1-0.4-0.7
 Average Weekly Hours0.5-0.30.10.5-0.20.2-0.2-0.90.2-0.2-0.10.60.40.30.80.3-0.7
 Average Hourly Earnings3.22.73.74.52.72.42.72.92.83.44.24.54.64.94.54.13.9
Private Hospitals
Payrolls3.33.45.25.03.33.53.43.53.95.05.56.25.85.05.14.14.1
 Employment0.31.11.41.71.11.11.11.31.21.31.51.51.61.71.91.71.5
 Average Weekly Hours-0.3-0.51.40.3-0.9-0.9-0.50.10.71.51.71.81.60.4-0.1-0.6-0.9
 Average Hourly Earnings3.42.82.32.93.13.32.72.02.02.12.22.72.52.83.22.93.5
Home Health Care Services
Payrolls16.28.19.7-4.07.57.37.99.512.711.68.36.41.0-3.7-5.8-7.0-4.7
 Employment12.37.34.9-5.58.68.06.36.36.85.94.72.4-1.4-5.1-7.5-8.1-6.7
 Average Weekly Hours1.2-1.83.10.4-3.4-3.2-1.20.73.23.82.52.82.00.30.1-0.8-1.4
 Average Hourly Earnings2.32.51.41.32.42.62.72.32.31.41.01.10.41.11.72.03.6
Non-Farm Private Sector
Payrolls5.55.87.76.64.06.16.26.98.57.47.17.77.56.76.55.95.2
 Employment3.22.53.02.62.12.42.62.73.03.02.93.03.02.72.62.32.3
 Average Weekly Hours-0.6-0.10.6-0.1-1.10.20.10.41.30.50.30.40.3-0.3-0.3-0.3-0.8
 Average Hourly Earnings2.83.43.94.13.03.43.43.74.03.83.84.14.14.24.23.83.6

Excludes hospitals, clinics, and other health-related establishments run by all governments.

NOTES: Data presented here conform to the 1987 Standard Industrial Classification. Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999.

National Economic Indicators

National economic indicators provide a context for understanding health-specific indicators and how change in the health sector relates to change in the economy as a whole. Table 7 presents national indicators of output and inflation.
Table 7

Selected National Economic Indicators: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Gross Domestic Product
Billions of Dollars7,2707,6628,1118,5117,4957,6297,7037,8187,9558,0638,1718,2558,3848,4418,5388,6818,800
Billions of 1992 Chain-Weighted Dollars6,7626,9957,2707,5526,8826,9847,0207,0937,1677,2377,3117,3657,4657,4997,5677,6787,755
Implicit Price Deflator (1992 = 100.0)107.5109.5111.6112.7108.9109.2109.7110.2111.0111.4111.8112.1112.3112.6112.8113.1113.5
Personal Income
Personal Income in Billions6,0726,4266,7847,1266,2846,3906,4796,5506,6676,7446,8216,9057,0047,0827,1617,2587,351
Disposable Income in Billions5,2775,5355,7956,0285,4355,4975,5775,6305,7115,7685,8225,8795,9375,9896,0526,1336,215
Prices1
Consumer Price Index, All Items152.4156.9160.5163.0155.0156.5157.4158.5159.6160.2160.8161.5161.9162.8163.4164.0164.6
 All Items Less Medical Care148.6152.8156.3158.6151.0152.5153.3154.4155.5156.0156.7157.2157.5158.4159.0159.5160.1
  Energy105.2110.1111.5102.9105.3112.0111.9111.3112.5110.7112.6110.2103.6103.8103.9100.297.9
  Food and Beverages148.9153.7157.7161.1151.6152.8154.3156.2157.0157.1158.0158.9160.1160.5161.3162.5163.8
 Medical Care220.5228.2234.6242.1226.0227.4229.1230.4232.6234.1235.1236.4239.1241.4243.4244.7247.5
Producer Price Index2 Finished
Consumer Goods125.6129.5130.2128.9127.4129.3130.2131.2130.7129.9130.2130.1128.2128.8129.2129.4129.5
Energy78.183.283.475.178.884.284.785.184.982.584.281.875.976.175.972.771.1
Food129.0133.6134.5134.3131.1132.1134.9136.1134.4134.5134.5134.7133.4133.7135.1135.0134.7
Finished Goods Except Food and Energy141.9144.3145.1147.7144.0144.2144.0145.0145.2145.0144.4145.8146.3147.3147.4149.9151.4
Annual Percent ChangePercent Change from the Same Period of Previous Year
Gross Domestic Product
Billions of Dollars4.65.45.94.94.55.85.55.86.15.76.15.65.44.74.55.25.0
Billions of 1992 Chain-Weighted Dollars2.33.43.93.92.43.93.53.94.13.64.13.84.23.63.54.23.9
Implicit Price Deflator (1992 = 100.0)2.31.91.91.02.01.91.81.81.92.01.81.71.21.00.90.91.1
Personal Income
Personal Income in Billions5.55.85.65.05.16.06.35.96.15.55.35.45.15.05.05.15.0
Disposable Income in Billions5.14.94.74.04.35.05.34.95.14.94.44.44.03.84.04.34.7
Prices1
Consumer Price Index, All Items2.82.92.31.62.72.82.93.22.92.32.21.91.51.61.61.51.7
 All Items Less Medical Care2.72.92.31.42.72.82.93.13.02.32.21.81.31.51.51.41.6
  Energy0.64.61.3-7.71.65.24.47.56.8-1.10.6-1.0-8.0-6.3-7.7-9.0-5.4
  Food and Beverages2.83.32.62.12.52.83.64.23.52.82.41.72.02.22.12.32.3
Medical Care4.53.52.83.23.83.73.43.12.93.02.62.62.83.13.53.53.5
Producer Price Index2 Finished
Consumer Goods1.93.10.5-1.02.32.93.43.82.60.5-0.1-0.8-1.9-0.8-0.7-0.51.0
Energy1.46.50.2-9.82.85.26.611.57.7-2.0-0.6-4.0-10.6-7.8-9.9-11.0-6.3
Food1.83.50.7-0.22.23.24.54.12.51.8-0.3-1.0-0.7-0.60.40.21.0
Finished Goods Except Food and Energy2.11.70.51.82.31.81.60.90.80.60.30.50.81.62.12.93.5

Base period = 1982-1984, unless otherwise noted.

Formerly called the “Wholesale Price Index.”

NOTES: Q designates quarter of year. Unlike Tables 1-5, quarterly data on gross domestic product, personal income, and disposable personal income are seasonally adjusted at annual rates.

SOURCES: U.S. Department of Commerce, Bureau of Economic Analysis: Survey of Current Business. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999; U.S. Department of Labor, Bureau of Labor Statistics.

Gross domestic product (GDP) measures the output of the U.S. economy as the market value of goods and services produced within the geographic boundaries of the United States by U.S. or foreign citizens or companies. Constant dollar or “real” GDP removes the effects of price changes from the valuation of goods and services produced, so that the growth of real GDP reflects changes in the “physical quantity” of the output of the economy. In the most recent comprehensive revision of the National Income and Product Accounts, the method for removing the effects of price changes was altered. The GDP estimates are now deflated using “chain-weighted” price indexes. This method replaces the previous fixed-weight method of deflating the GDP estimates (U.S. Department of Commerce, 1996, 1998).

Prices

Consumer Price Indexes

BLS publishes monthly information on changes in prices paid by consumers for a fixed market basket of goods and services. Tables 7, 8, and 9 present information on the all-urban CPI that measures changes in prices faced by 87 percent of the non-institutionalized U.S. population. The more restrictive wage-earner CPI gauges prices faced by wage earners and clerical workers. These workers account for approximately 32 percent of the non-institutionalized population (U.S. Department of Labor, 1998b).
Table 9

Percent Change in Medical Prices from Same Period a Year Ago: 1995-1999

Type of EstablishmentCalendar Year1996Q11996Q21996Q31996Q41997Q11997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1
1995199619971998
Annual ChangePercent Change from the Same Period of Previous Year
Consumer Price Indexes, All Urban Consumers1
Medical Care Services25.03.72.93.24.13.83.53.23.03.02.72.82.93.13.53.43.4
 Professional Services4.43.73.43.23.83.73.53.63.63.73.43.13.03.13.33.33.2
  Physician Services4.53.63.03.04.23.73.33.23.03.33.02.72.62.73.23.33.1
  Dental Services4.94.74.74.24.24.64.95.15.24.94.44.14.14.14.34.44.8
 Hospital and Related Services5.04.53.33.34.74.74.64.23.83.52.93.03.03.03.63.43.9
  Hospital Services (12/96 = 100)————————————2.93.03.63.33.9
   Inpatient Hospital Services (12/96 = 100)————————————2.32.32.92.83.5
   Outpatient Hospital Services (12/86 = 100)4.95.14.63.75.05.75.44.45.24.64.14.43.33.54.03.94.8
 Nursing Home Services (12/96 = 100)————————————4.44.84.84.54.3
Medical Care Commodities1.92.92.33.02.43.13.22.92.62.72.11.92.02.63.54.04.0
 Prescription Drugs1.93.32.63.82.93.63.53.33.13.12.41.92.33.14.45.25.5
 Non-Prescription Drugs and Medical Supplies (1986 = 100)1.81.91.61.61.52.02.31.71.41.81.51.71.41.61.51.70.9
  Internal and Respiratory Over-the-Counter Drugs0.61.91.71.31.32.11.92.41.82.21.61.30.51.31.81.70.9
  Non-Prescription Medical Equipment and Supplies3.91.71.42.01.71.82.80.60.61.11.42.53.22.01.01.70.8
Producer Price Indexes3
Industry Groupings4
 Health Services (12/94 = 100)—2.21.41.52.52.42.11.81.61.51.51.01.31.41.61.91.9
  Offices and Clinics of Doctors of Medicine (12/93 = 100)3.90.71.32.11.00.70.40.81.31.21.61.21.82.12.02.52.2
   Medicare Treatments (12/93 = 100)4.7-3.70.34.4-3.7-3.7-3.7-3.70.30.30.30.34.44.44.44.42.4
   Non-Medicare Treatments (12/93 = 100)3.61.81.71.61.91.51.62.01.61.62.01.51.31.61.52.12.3
  Hospitals (12/92 = 100)3.52.40.80.72.72.72.51.81.21.20.80.10.40.50.81.31.5
   General Medical and Surgical Hospitals (12/92 = 100)3.72.41.00.82.92.82.31.51.11.11.20.60.70.80.71.21.5
    Inpatient Treatments (12/92 = 100)3.12.30.90.72.82.82.31.40.80.91.40.50.70.80.41.01.4
     Medicare Patients (12/92 = 100)2.03.30.6-0.74.14.14.11.21.21.21.2-1.0-1.0-1.0-1.00.40.4
     Medicaid Patients (12/92 = 100)2.52.2-1.1-0.72.12.62.41.7-0.9-2.2-0.5-0.90.20.5-1.6-1.6-1.0
     All Other Patients (12/92 = 100)3.71.81.71.92.32.01.41.41.11.52.21.91.92.01.82.12.6
    Outpatient Treatments (12/92 = 100)6.22.61.01.03.32.92.21.91.61.50.50.50.50.81.31.51.6
     Medicare Patients (12/92 = 100)4.01.72.62.41.91.31.42.32.73.02.91.81.92.02.03.54.0
     Medicaid Patients (12/92 = 100)2.9-0.2-1.10.91.31.20.1-3.4-2.1-2.1-0.80.80.40.30.32.52.5
     All Other Patients (12/92 = 100)6.93.01.00.83.73.42.62.41.81.60.30.30.30.61.31.11.1
  Skilled and Intermediate Care Facilities (12/94 = 100)—6.14.34.36.16.56.25.74.74.04.34.13.94.14.54.64.1
   Public Payers (12/94 = 100)—6.54.44.36.67.26.55.54.74.04.64.44.24.04.54.73.9
   Private Payers (12/94 = 100)—5.94.14.25.95.86.06.04.74.24.03.63.64.44.44.34.3
  Medical Laboratories (6/94 = 100)—1.30.80.33.71.8-0.60.30.50.90.90.90.40.30.20.2-0.1
  Home Health Care Services (12/96 = 100)———2.8————————4.02.92.41.80.3
   Medicare Payers (12/96 = 100)———1.4————————1.62.30.61.1-0.6
   Non-Medicare Payers (12/96 = 100)———2.7————————2.53.13.31.70.5
Commodity Groupings
 Drugs and Pharmaceuticals2.41.82.110.72.52.01.90.82.01.71.92.75.412.012.812.59.3
  Ethical (Prescription) Preparations2.83.33.118.13.93.63.62.03.22.82.53.68.920.521.721.214.2
  Proprietary (Over-the-Counter) Preparations1.8-0.8-0.1-0.11.5-1.1-1.8-1.8-1.2-0.30.60.4-0.70.20.1-0.10.3
 Medical, Surgical, and Personal Aid Devices0.71.30.00.22.01.80.80.4-0.4-0.20.40.30.3-0.10.00.60.6
  Personal Aid Equipment2.74.20.72.24.36.13.82.62.60.4-0.60.61.22.53.22.03.2
  Medical Instruments and Equipment (6/82 = 100)1.31.4-1.5-1.12.01.60.81.1-1.9-1.5-0.9-1.7-0.7-1.4-1.5-0.70.2
  Surgical Appliances and Supplies (6/83 = 100)-0.61.41.21.12.02.61.1-0.30.70.51.52.21.40.71.11.30.4
  Ophthalmic Goods (12/83 = 100)2.2-1.6-0.4-0.10.4-1.8-2.5-2.5-1.50.1-0.30.0-1.0-0.70.21.00.9
  Dental Equipment and Supplies (6/85 = 100)1.72.53.93.23.22.02.82.23.64.14.13.82.03.03.64.03.3

Unless otherwise noted, base year is 1982-1984 = 100.

Includes the net cost of private health insurance, not shown separately.

Unless otherwise noted, base year is 1982 = 100. Producer Price Indexes are classified by industry (price changes received for the industry's output sold outside the industry) and commodity (price changes by similarity of end-use or material composition).

Further detail for Producer Price Industry groupings, such as types of physician practices, hospital diagnosis-related groups, etc., are available from the Bureau of Labor Statistics.

NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted.

SOURCES: U.S. Department of Labor, Bureau of Labor Statistics: CPI Detailed Report. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999; U.S. Department of Labor, Bureau of Labor Statistics: Producer Price Indexes. Washington. U.S. Government Printing Office. Monthly reports for January 1995-March 1999.

The index reflects changes in prices charged for the same quality and quantity of goods or services purchased in the base period. For most items, the base period of 1982-1984 is used to define the share of consumer expenditures purchasing specific services and products. Those shares or weights remain constant in all years, even though consumption patterns of the household may change over time. This type of index is called a fixed-weight or Laspeyres index. CPIs for health care goods and services depict list price changes for out-of-pocket expenditures. The CPI for medical care services also includes an indirect measure of price change for health insurance coverage purchased directly by consumers. The composite CPI for medical care weights together product-specific or service-specific CPIs in proportion to household out-of-pocket expenditures for these items. In addition, some medical care sector indexes measure changes in list or charged prices, rather than in prices actually received by providers after discounts are deducted. In several health care areas, received or transaction prices are difficult to capture, although BLS is making advances in this area. In the NHE, a combination of CPIs for selected medical care items, input price indexes for nursing homes, and the PPI for hospitals are used as measures of inflation for the health industry. The indexes are used to develop a chain-weighted price index for personal health care to depict price changes affecting the entire health care industry more accurately than does the overall CPI medical care index (Levit et al., 1998).

Producer Price Indexes

BLS produces monthly information on average changes in selling prices received by domestic producers for their output. These prices are presented in Tables 7, 8, and 9 as the PPI. The index is designed to measure transaction prices and is different from the CPI, which in some cases measures list or full-charge prices. The PPI is a fixed-weight or Laspeyres index, with base-period weights determined by values of receipts. The base period varies among series. The PPI consists of indexes in several major classification structures, including the industry and commodity classifications that are included in the Health Care Indicators. The PPI by industry classification measures price changes received for the industry's output sold outside the industry. PPI changes for an industry are determined by price changes for products primarily made by establishments in that industry. The industry into which an establishment is classified is determined by those products accounting for the largest share of its total value of shipments. The PPI by commodity classification measures price changes of the end product (end use or material composition). The classification system for PPI commodity groups is unique to the PPI and is divided into 15 major commodity groupings. Although PPIs for medical commodities have existed for many years, PPIs for health service industries are relatively new. Most index series began in 1994, and the index series for the composite health services industry does not begin until December 1994. However, the PPI for hospitals began in December 1992, providing enough data for a useful time series. The PPI for hospitals is a measure of transaction prices or net prices received by the producer from out-of-pocket, Medicare, Medicaid, and private third-party payer sources. The PPI for hospitals should not be compared with the CPI for hospital and related services. Although other PPI and CPI series are somewhat comparable (for example, the PPI-Offices and Clinics of Doctors of Medicine and the CPI-Physicians' Services), the PPI and CPI for hospitals have important differences in survey scope and methodology. The PPI for hospitals measures price changes for the entire treatment path, measures net transaction price, includes Medicare and Medicaid, samples both urban and rural hospitals, and reflects total hospital revenue from all sources in its index weights. On the other hand, the CPI for hospitals measures price changes for a discrete sample of hospital services singly, measures published charges, excludes Medicare and Medicaid, samples only urban hospitals, and reflects only consumer out-of-pocket expenses and household health insurance premium payments in its index weights. These differences make a direct comparison between the PPI and CPI hospital services indexes inappropriate. The PPI for the health services industry is available by detailed industry groupings. For example, general medical and surgical hospitals consist of inpatient and outpatient treatments, which in turn consist of Medicare, Medicaid, and all other patients. These patient categories consist of more detail, such as diagnosis-related groups (DRGs) for Medicare. Although most of the data used to measure PPI price changes for health services are collected through a sample, there are specific instances where data are collected from both a sample and from price changes in Federal regulation. This is the case for Medicare hospital inpatient services and Medicare offices and clinics of doctors of medicine. The producer price changes in Medicare hospital inpatient services are computed from a combination of a national sample of DRGs in hospitals, DRG relative weights from the PPS final rules published in the current and historical year, and other adjustments. The producer price changes in Medicare offices of doctors of medicine are computed from a combination of a geographic area sample of payments under the HCFA Common Procedure Coding System (HCPCS), HCPCS updates from the November 2, 1998, Federal Register, and other adjustments. Because of different methodologies, these two Medicare PPIs are not comparable to the national updates computed by HCFA and published in the Federal Register.

Input Price Indexes

In 1979, HCFA developed the Medicare Hospital Input Price Index (hospital market basket), which was designed to measure the pure price changes associated with expenditure changes for hospital services. In the early 1980s, the SNF and Home Health Agency (HHA) Input Price Indexes, often referred to as “market baskets,” were developed to price a consistent set of goods and services over time. Also in the early 1980s, the original Medicare Hospital Input Price Index was revised for use in updating payment rates for routine costs of Medicare inpatient services. All of these indexes have played an important role in helping to set Medicare payment percent increases and in understanding the contribution of input price increases to growing health expenditures. The Input Price Indexes, or market baskets, are Laspeyres or fixed-weight indexes that are constructed in two steps. First, a base period is selected. For example, for the PPS Hospital Input Price Index, the base period is 1992. Cost categories, such as food, fuel, and labor, are identified and their 1992 expenditure amounts determined. The proportion or share of total expenditures included in specific spending categories is calculated. These proportions are called cost or expenditure weights. There are 26 expenditure categories in the 1992-based PPS Hospital Input Price Index. Second, a price proxy is selected to match each expenditure category. Its purpose is to measure the rate of price increases of the goods or services in that category. The price proxy index for each spending category is multiplied by the expenditure weight for the category. The sum of these products (weights multiplied by the price index) over all cost categories yields the composite Input Price Index for any given time period, usually a fiscal year or a calendar year. The percent change in the Input Price Index is an estimate of price change over time for a fixed quantity of goods and services purchased by a provider. The Input Price Indexes are estimated on a historical basis and forecast for several years. The HCFA-chosen price proxies are forecast under contract with Standard and Poor's DRI. Following every calendar year quarter, in March, June, September, and December, DRI updates its macroeconomic forecasts of wages and prices based on updated historical information and revised forecast assumptions. Some of the data in Tables 10-12 are forecast and are expected to change as more recent historical data become available and subsequent quarterly forecasts are revised. The methodology and price proxy definitions used in the Input Price Indexes are described in the Federal Register notices that accompany the revisions of the PPS Hospital, HHA, and PPS SNF payment updates. A description of the current structure of the PPS Input Price Index is in the August 29, 1997, Federal Register, and the most recent PPS hospital update for payment rates was published in the July 31, 1998, Federal Register. The latest HHA regulatory Input Price Index was published in the August 11, 1998, Federal Register. The latest SNF input price index was published in the May 12, 1998, Federal Register.
Table 10

Quarterly Index Levels and Four-Quarter Moving Average Percent Change in the Prospective Payment System (PPS) Hospital Input Price Index, by Expense Category: 1997-2001

Expense Category1Price/Wage VariableBase Year Weights FY 199221997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1Forecast
1999Q21999Q31999Q42000Q12000Q22000Q32000Q42001Q1
Index Levels
Total—100.000114.2115.1115.9116.7117.9118.9119.3119.9120.9122.0122.8123.6124.3125.3126.1127.0
 Compensation—61.390116.1117.1118.1119.0119.9121.2121.8122.7123.9125.0125.9126.9127.6128.8129.7130.8
  Wages and SalariesHCFA Occupational Wage Index450.244115.7116.9117.9118.9119.8121.1121.8122.8123.9125.0126.0126.9127.7128.9129.8130.8
  Employee BenefitsHCFA Occupational Benefits Index411.146117.6118.1119.0119.6120.6121.4122.1122.5123.6124.7125.6126.6127.2128.3129.4130.7
 Other Professional FeesECI-W/S: Professional/Technical (Private)2.127117.3117.9118.9119.8120.9122.2123.0123.3124.5125.7126.6127.7128.6129.8130.7131.9
 Energy and Utilities3—1.542109.3113.6111.3109.0109.8113.4109.6109.3110.5114.3112.0112.6112.8116.7114.0114.9
 Professional Liability InsuranceHCFA-Professional Liability Premium1.18996.195.996.096.196.296.496.897.597.998.198.197.897.898.098.398.6
 All Other—33.752111.5112.1112.5113.4115.1115.5115.6116.0116.7117.5118.3118.9119.5120.0120.7121.5
  Other Products3—24.825110.5110.8111.0112.0114.0114.2114.1114.2114.8115.6116.2116.7117.2117.4118.0118.6
   PharmaceuticalsPPI-Prescription Drugs4.162119.3119.7121.1129.2143.7145.7146.8148.8150.3151.2152.6154.3155.6156.2157.7159.8
   Food: Direct PurchasePPI-Processed Foods2.314110.5109.9109.4107.7107.6108.4107.9107.6105.8105.9105.8106.1106.8107.1107.2107.6
   Food: Contract ServiceCPI-Food Away from Home1.072111.6112.3113.2113.8114.5115.3116.0116.9117.7118.6119.7120.8121.7122.8123.8124.7
   ChemicalsPPI-Industrial Chemicals3.666115.3115.9115.7114.0111.7110.3109.2108.3108.7110.6111.2111.0110.8110.5111.3111.1
   Medical InstrumentsPPI-Medical Instruments/Equipment3.080104.5104.9104.2103.6103.1103.3103.5103.9104.0104.2104.3104.6104.7104.7104.9105.6
   Rubber and PlasticsPPI-Rubber/Plastic Products4.750107.3107.4107.3107.2106.9106.6106.5106.1107.0107.5108.0108.4108.6108.8108.8108.8
   Paper ProductsPPI-Converted Paper and Paperboard2.078109.2109.3111.6113.6113.3113.3112.1111.5112.9115.0115.9116.6117.2118.1119.2120.0
   Miscellaneous ProductsPPI-Finished Goods2.236107.2107.2107.3106.1106.4106.6106.9106.9107.7108.0108.5108.9109.3109.5110.1110.6
  Other Services3—8.927114.3115.8116.6117.5118.1119.1119.6120.8121.9123.0124.1125.0126.1127.2128.2129.3
   All Other: Labor-IntensiveECI-Comp: Service Workers7.277115.0116.9117.8118.8119.4120.6121.2122.5123.8124.9126.2127.2128.4129.7130.8131.9
Four-Quarter Moving-Average Percent Change
Total—100.0002.12.02.12.32.62.93.03.02.92.72.72.82.92.92.82.7
 Compensation—61.3902.62.62.72.93.13.33.33.33.33.23.23.33.23.23.13.1
  Wages and SalariesHCFA Occupational Wage Index450.2442.92.83.03.23.43.53.53.43.43.33.43.43.33.23.13.1
  Employee BenefitsHCFA Occupational Benefits Index411.1461.71.51.61.72.02.42.52.62.62.52.62.93.03.03.03.0
 Other Professional FeesECI-W/S: Professional/Technical (Private)2.1272.72.62.62.83.03.23.33.33.33.12.93.13.23.33.43.3
 Energy and Utilities3—1.5422.62.32.00.70.60.3-0.7-0.2-0.20.11.01.62.02.32.32.0
 Professional Liability InsuranceHCFA-Professional Liability Premium1.189-1.1-1.5-1.8-1.5-1.0-0.40.20.71.11.41.61.30.90.40.10.2
 All Other—33.7521.11.11.01.21.82.32.72.82.32.01.92.02.32.42.32.2
  Other Products3—24.8250.50.30.20.31.11.92.52.82.11.71.41.51.81.91.91.7
   PharmaceuticalsPPI-Prescription Drugs4.1622.92.63.14.59.013.718.119.515.110.66.64.03.83.63.53.4
    Food: Direct PurchasePPI-Processed Foods2.3143.71.80.5-0.6-1.6-1.7-1.8-1.4-1.1-1.3-1.5-1.8-1.2-0.30.51.2
    Food: Contract ServiceCPI-Food Away From Home1.0722.92.92.82.72.62.62.62.62.62.72.93.03.23.43.43.4
    ChemicalsPPI-Industrial Chemicals3.6660.00.3-0.2-1.3-1.7-2.8-4.0-4.6-4.5-3.3-1.50.41.61.61.10.5
     Medical InstrumentsPPI-Medical Instruments/Equipment3.080-0.4-0.8-1.5-1.2-1.2-1.3-1.1-0.8-0.20.40.70.80.70.60.60.7
    Rubber and PlasticsPPI-Rubber/Plastic Products4.750-0.7-0.6-0.5-0.3-0.4-0.4-0.5-0.8-0.6-0.20.41.21.51.61.40.9
    Paper ProductsPPI-Converted Paper and Paperboard2.078-5.8-4.9-3.3-1.30.82.32.51.50.4-0.10.72.33.33.63.53.0
    Miscellaneous ProductsPPI-Finished Goods2.2362.11.30.4-0.5-0.8-0.9-0.9-0.30.20.71.21.51.61.61.61.5
  Other Services3—8.9272.83.23.43.63.63.33.12.92.93.03.33.43.53.53.43.4
   All Other: Labor-IntensiveECI-Comp: Service Workers7.2772.93.53.84.14.23.83.53.33.23.33.63.83.83.93.83.7

For data sources used to estimate the Input Price Index relative weights and choice of price proxies, refer to the August 29, 1997, Federal Register. For the most recent PPS update for payment rates, refer to the July 31, 1998, Federal Register.

Category weights may not sum to total or subtotals because of detail not included.

Represents a subtotal. Detailed categories not shown are listed below by subtotal, detailed category, and base-year weight: Energy and Utilities: Fuel Oil, Coal, and Other Fuel (0.369), Electricity (0.927), and Water and Sewage (0.246). Other Products: Photographic Supplies (0.391), Apparel (0.869), and Machinery and Equipment (0.207). Other Services: Telephone (0.581), Postage (0.272), and Other Non-Labor Intensive (0.796).

The HCFA Occupational Wage and Occupational Benefit Indexes are computed as the weighted-average of 10 ECI categories (ECI for Hospital workers and 9 ECI occupational categories).

NOTES: A dash (—) in the Price/Wage Variable column denotes a total or subtotal produced by adding two or more categories. FY is fiscal year. Q designates quarter of year. HCFA is Health Care Financing Administration. ECI is Employment Cost Index. W/S is wages and salaries. PPI is Producer Price Index. CPI is Consumer Price Index. Comp is compensation. The four-quarter moving-average percent change for the quarter indicated by the column heading is the rate of change in the average index level for four quarters ending in that quarter over the same period of the previous year. The four-quarter moving-average index level for the quarter indicated by the column heading is computed by summing the index level for that quarter and the prior three quarters and dividing by 4. The process is repeated to compute the four-quarter moving-average index level for the same quarter a year ago. The average index level for the quarter indicated by the column heading is divided by the average index level of the same quarter a year ago, and the quotient is subtracted from 1 and multiplied by 100 to determine the four-quarter moving-average percent change in the index.

SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the National Health Statistics Group. Second quarter 1999 forecasts were produced under contract to HCFA by Standard & Poor's DRI.

Table 12

Quarterly Index Levels and Four-Quarter Moving-Average Percent Change of the Home Health Agency (HHA) Input Price Index, by Expense Category: 1997-2001

Expense Category1Price/Wage VariableBase Year Weights FY 199341997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1Forecast
1999Q21999Q31999Q42000Q12000Q22000Q32000Q42001Q1
Index Levels
Total—100.000112.0113.1113.9114.6115.4116.4117.0117.9119.0120.1121.0121.9122.8123.9124.8125.8
 Compensation2—77.668112.0113.2114.2115.1115.9117.1117.8118.7119.9121.0122.0122.9123.8124.9125.9126.9
  Wages and Salaries2HHA Occupational Wage Index564.226112.2113.6114.6115.5116.4117.6118.3119.4120.6121.7122.7123.7124.6125.8126.7127.6
  Employee Benefits2HHA Occupational Benefits Index513.442110.7111.5112.3112.9113.7114.5114.9115.5116.5117.4118.4119.4120.1121.1122.1123.3
 Operations and MaintenanceCPI(U)-Fuel and Other Utilities0.832107.8109.4108.4106.0106.8108.4105.2104.6105.7107.1107.0107.4107.9109.4109.2109.7
 Administrative and General3—9.569113.3114.1114.5115.2116.0116.8117.0117.9118.7119.5120.0121.0121.8122.7123.3124.6
  TelephoneCPI(U)-Telephone Services0.725106.2105.7105.6105.8106.7106.6106.4106.1105.9105.8106.0106.4106.6106.7106.9107.3
  Paper and PrintingCPI(U)-Household Paper Products0.529114.4114.2114.6115.6116.6116.7117.3117.4117.1116.3116.0116.6116.9117.0117.2117.4
  PostageCPI(U)-Postage0.724110.3110.3110.3110.3110.3110.3110.3113.6113.7113.7113.7113.7113.7113.7113.7117.8
  Other Administrative Costs3CPI(U)-Services7.591114.2115.3115.7116.6117.4118.4118.7119.5120.5121.5122.2123.4124.3125.4126.2127.4
 TransportationCPI(U)-Private Transportation3.405111.1110.8110.7109.1108.8108.3108.5107.4110.9111.2112.4112.7113.7113.8115.0115.4
 Capital-Related—3.204110.2111.0111.5112.0112.3112.8113.4113.8114.4115.1115.8116.6117.3118.1118.8119.7
  InsuranceCPI(U)-Household Insurance0.560113.1114.3114.8115.1114.5114.0114.6114.8115.6117.1117.7118.5119.3120.3120.9121.6
  Fixed CapitalCPI(U)-Owner's Equivalent Rent1.764113.6114.6115.6116.4117.3118.4119.4120.1120.9121.9123.0124.0125.2126.3127.4128.5
  Movable CapitalPPI-Machinery and Equipment0.880101.8101.6101.3101.2100.9100.7100.6100.7100.5100.3100.2100.3100.3100.3100.4100.7
 Other Expenses3CPI(U)-All Items less Food and Energy5.322112.1112.4113.1113.9114.6115.1115.7116.4117.4118.3119.2120.3121.2122.1123.1124.3
Four-Quarter Moving-Average Percent Change
Total—100.0002.72.82.92.93.03.02.92.92.92.93.13.33.33.33.23.1
 Compensation2—77.6682.82.93.13.33.43.53.43.33.33.33.43.53.43.43.33.2
  Wages and Salaries2HHA Occupational Wage Index564.2263.03.13.33.53.63.73.63.53.53.43.53.63.53.53.33.3
  Employee Benefits2HHA Occupational Benefits Index513.4421.61.72.02.22.42.62.62.52.42.42.62.93.03.23.23.2
 Operations and MaintenanceCPI(U)-Fuel and Other Utilities0.8323.63.32.50.90.0-0.7-1.8-1.6-1.6-1.6-0.50.51.32.22.32.1
 Administrative and General3—9.5692.82.72.62.42.32.32.32.32.32.32.42.42.52.62.72.8
  TelephoneCPI(U)-Telephone Services0.7252.21.91.50.90.40.40.50.60.3-0.1-0.4-0.40.00.40.70.8
  Paper and PrintingCPI(U)-Household Paper Products0.5291.20.60.50.71.21.51.92.01.61.00.1-0.4-0.6-0.30.20.5
  PostageCPI(U)-Postage0.7240.00.00.00.00.00.00.00.71.52.33.02.31.50.80.00.9
  Other Administrative Costs3CPI(U)-Services7.5913.23.13.02.92.82.82.72.62.62.62.72.93.03.23.23.2
 TransportationCPI(U)-Private Transportation3.4052.31.70.7-0.6-1.1-1.8-2.2-2.0-1.00.21.73.33.53.43.02.4
 Capital-Related—3.2042.02.02.02.02.01.91.81.71.71.81.92.12.32.42.52.6
  InsuranceCPI(U)-Household Insurance0.5603.03.02.62.62.11.40.90.10.10.81.52.42.93.03.02.8
  Fixed CapitalCPI(U)-Owner's Equivalent Rent1.7642.92.92.93.03.13.23.23.23.23.13.03.13.23.33.53.6
  Movable CapitalPPI-Machinery and Equipment0.880-0.5-0.5-0.5-0.5-0.7-0.7-0.8-0.7-0.6-0.5-0.5-0.4-0.4-0.3-0.10.1
 Other Expenses3CPI(U)-All Items less Food and Energy5.3222.62.52.42.32.22.32.32.32.42.42.62.93.13.23.33.3

For data sources used to estimate the Input Price Index relative weights and choice of price proxies, refer to the July 1, 1996, Federal Register.

Includes allocated Contract Services' Labor.

Includes allocated Contract Services' Non-Labor.

Category weights may not sum to total because of rounding.

The HHA Occupational Wage and Occupational Benefit Indexes are computed as weighted-averages of five ECI categories (ECI for Civilian Hospital Workers and four ECI occupational categories).

NOTES: A dash (—) in the Price/Wage Variable column denotes a total or subtotal produced by adding two or more categories. FY is fiscal year. Q designates quarter of year. CPI(U) represents Consumer Price Index for all urban consumers. PPI is Producer Price Index. ECI is Employment Cost Index. The four-quarter moving-average percent change for the quarter indicated by the column heading is the rate of change in the average index level for four quarters ending in that quarter over the same period of the previous year. The four-quarter moving-average index level for the quarter indicated by the column heading is computed by summing the index level for that quarter and the prior three quarters and dividing by 4. The process is repeated to compute the four-quarter moving-average index level for the same quarter a year ago. The average index level for the quarter indicated by the column heading is divided by the average index level of the same quarter a year ago, and the quotient is subtracted from 1 and multiplied by 100 to determine the four-quarter moving-average percent change in the index.

SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the National Health Statistics Group. Second quarter 1999 forecasts were produced under contract to the Health Care Financing Administration by Standard & Poor's DRI.

Periodically, the Input Price Indexes are revised to a new base year so that cost weights will reflect changes in the mix of goods and services that are purchased. Each revision allows for new base weights, a new base year, and changes to certain price variables used for price proxies. Each Input Price Index is presented in a table with both an index level and a four-quarter moving-average percent change. The Hospital Input Price Index for PPS is in Table 10, the SNF Input Price Index is in Table 11, and the HHA Input Price Index is in Table 12.
Table 11

Quarterly Index Levels and Four-Quarter Moving-Average Percent Change in the Skilled Nursing Facility Input Price Index, by Expense Category: 1997-2001

Expense Category1Price/Wage VariableBase Year Weights CY 199221997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1Forecast
1999Q21999Q31999Q42000Q12000Q22000Q32000Q42001Q1
Index Levels
Total—100.000116.1116.8117.5118.4119.6120.5120.9122.1123.1124.1124.9125.9126.8127.6128.4129.5
 Compensation—67.059118.1118.9119.8120.9121.9122.8123.5125.1126.2127.2128.3129.4130.4131.2132.3133.6
  Wages and SalariesECI-W/S: Nursing Homes (Private)54.262118.6119.6120.5122.1123.1124.3124.8126.6127.7128.9129.9131.2132.2133.0134.1135.6
  Employee BenefitsECI-Ben: Nursing Homes (Private)12.797116.0115.9116.8115.9116.8116.6117.7118.8119.9120.3121.5121.8123.1123.5124.9125.3
 Non-Medical Professional FeesECI-Comp: Professional and Technical Workers (Private)1.916117.3117.9118.9119.8120.9122.2123.0123.3124.5125.7126.6127.7128.6129.8130.7131.9
 Utilities3—2.500110.1114.7110.8109.1110.6114.7110.1109.7111.2115.5112.1112.5113.7118.2114.7115.2
 Other Expenses—18.747111.7112.2112.5113.3114.9115.5115.6116.0116.7117.4117.9118.5119.2119.8120.3121.0
  Other Products3—10.964111.8111.9112.3113.7116.9117.5117.5117.8118.2119.0119.6120.3121.0121.4122.1122.9
  Other Services3—7.783114.6115.7116.3117.0117.6118.3118.8119.6120.9121.9122.8123.8124.8125.9126.8127.8
 Capital-Related Expenses—9.777109.2109.7109.7109.9110.4110.9110.9111.1111.6112.0112.1112.2112.7113.1113.2113.3
  Depreciation3—5.915115.7116.7117.2118.1118.5119.4119.9120.7121.1122.0122.4123.2123.6124.4124.8125.6
  Interest3—3.18996.195.694.793.494.093.492.591.392.191.390.589.290.089.388.687.4
  Other Capital-Related ExpensesCPI(U)-Residential Rent0.674113.6114.6115.5116.3117.2118.3119.4120.3121.1122.4123.7124.5125.4126.6127.5128.2
Four-Quarter Moving-Average Percent Change
Total—100.0002.42.42.42.42.62.82.93.03.03.03.13.13.13.12.92.9
 Compensation—67.0592.72.72.72.72.93.03.13.23.33.43.63.63.63.53.33.2
  Wages and SalariesECI-W/S: Nursing Homes (Private)54.2622.93.13.13.23.43.53.63.73.73.73.83.83.73.63.43.3
  Employee BenefitsECI-Benefits: Nursing Homes (Private)12.7971.71.31.00.80.80.80.71.21.62.32.92.92.92.82.72.7
 Non-Medical Professional FeesECI-Comp: Professional and Technical Workers (Private)1.9162.72.62.62.83.03.23.33.33.33.12.93.13.23.33.43.3
 Utilities3—2.5001.81.61.50.70.70.5-0.20.10.10.30.91.41.82.32.42.3
 Other Expenses—18.7471.81.71.61.51.92.32.62.72.42.11.91.82.02.12.12.1
  Other Products3—10.9641.40.90.70.81.83.04.04.53.62.61.91.61.92.12.22.1
  Other Services3—7.7832.93.03.02.92.82.62.52.42.42.62.93.23.33.43.33.3
 Capital-Related Expenses—9.7771.41.41.31.31.21.11.11.11.11.11.11.01.01.01.01.0
  Depreciation3—5.9152.62.62.62.52.52.42.42.32.22.22.22.12.12.02.02.0
  Interest3—3.189-1.4-1.5-1.7-1.9-2.1-2.2-2.3-2.2-2.2-2.2-2.1-2.2-2.2-2.2-2.2-2.2
  Other Capital-Related ExpensesCPI(U)-Residential Rent0.6742.82.82.93.03.13.23.23.33.43.43.43.53.53.53.43.3

For data sources used to estimate the Input Price Index relative weights and choice of price proxies, refer to the May 12, 1998, Federal Register.

Category weights may not sum to total because of rounding.

Represents a subtotal. Detailed categories not shown are listed below by subtotal, detailed category, and base year weight: Utilities: Electricity (1.626), Fuels non-highway (0.332), and Water and Sewage (0.542). Other Products: Pharmaceuticals (2.531), Food (3.353), Chemicals (0.720), Rubber and Plastics (1.529), Paper Products (1.005), and Miscellaneous Products (1.826). Other Services: Telephone Services (0.385), Labor-Intensive Services (3.686), and Non-Labor Intensive Services (3.713). Depreciation: Building and Fixed Equipment (4.118) and Movable Equipment (1.797). Interest: Government and Non-Profit SNFs (1.658) and For-Profit SNFs (1.531).

NOTES: A dash (—) in the Price/Wage Variable column denotes a total or subtotal produced by adding two or more categories. CY is calendar year. Q designates quarter of year. ECI is Employment Cost Index. W/S is wages and salaries. Comp is compensation. CPI(U) represents Consumer Price Index for all urban consumers. SNFs is skilled nursing facilities. The four-quarter moving-average percent change for the quarter indicated by the column heading is the rate of change in the average index level for four quarters ending in that quarter over the same period of the previous year. The four-quarter moving-average index level for the quarter indicated by the column heading is computed by summing the index level for that quarter and the prior three quarters and dividing by 4. The process is repeated to compute the four-quarter moving-average index level for the same quarter a year ago. The average index level for the quarter indicated by the column heading is divided by the average index level of the same quarter a year ago, and the quotient is subtracted from 1 and multiplied by 100 to determine the four-quarter moving-average percent change in the index.

SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the National Health Statistics Group. Second quarter 1999 forecasts were produced under contract to the Health Care Financing Administration by Standard & Poor's DRI.

Medicare Economic Index

In 1972, Congress mandated the development of the Medicare Economic Index (MEI) to measure the changes in costs of physicians' time and operating expenses. The input price change measured by the MEI is considered in connection with the update factor for the Medicare Part B physician fee schedule under the Resource-Based Relative Value Scale (RBRVS, November 22, 1996, Federal Register) or is used as an advisory indicator by Congress in updating the fee schedule. The MEI is a fixed-weighted sum of annual price changes for various inputs needed to produce physicians' services with an offset for productivity increases. Like a traditional Laspeyres index, the MEI is constructed in two steps. First, a base period is selected (1996 for the MEI), cost categories are identified, and the 1996 expenditure shares by cost category are determined. Second, price proxies are selected to match each relative expenditure category. These proxies are weighted by the category weight determined from expenditure amounts and summed to produce the composite MEI. Unlike a traditional Laspeyres index, the compensation portion of the MEI is adjusted for productivity, so economywide productivity and physician-practice productivity are not both included in the update, resulting in a double counting of productivity. Forecasts of the MEI are made periodically throughout the fiscal year by Standard & Poor's DRI for HCFA using several different sets of economic assumptions. Standard & Poor's DRI produces four main forecasts of the MEI: (1) a Presidential budget forecast in December; (2) the Mid-session Review in June, based on assumptions for the Federal budget exercises; (3) the Medicare Trustees' Report forecast in February, based on assumptions by the Medicare Trustees; and (4) the Medicare Premium Promul-gation forecast in August, based on baseline assumptions by Standard & Poor's DRI. Standard & Poor's DRI also produces forecasts of the MEI using their own economic assumptions forecast. The forecasts based on Standard & Poor's DRI assumptions are presented in Health Care Indicators. Much of the forecast data changes as more recent historical data become available and the assumptions change. The methodology, weights, and price-proxy definitions used in the MEI are described in the November 2, 1998, Federal Register. The MEI data are presented in Table 13 as index levels and four-quarter moving-average percent changes.
Table 13

Quarterly Index Levels and Four-Quarter Moving-Average Percent Change in the HCFA Medicare Economic Index (MEI) with DRI Forecast Assumptions, by Expense Category: 1997-2001

Expense Category1Price/Wage VariableBase Year Weights CY 199621997Q21997Q31997Q41998Q11998Q21998Q31998Q41999Q1Forecast
1999Q21999Q31999Q42000Q12000Q22000Q32000Q42001Q1
Index Levels
Total—100.000101.8102.3103.3104.1104.4104.9105.7106.3106.8107.3108.1108.8109.2109.7110.4111.1
 Physician Earnings—54.460102.0102.4103.8104.6104.7105.0106.2106.8107.0107.5108.5109.0109.3109.6110.5111.0
  Wages and SalariesAHE-Private344.197102.2102.6104.4105.2105.3105.6107.0107.7107.9108.3109.5110.0110.3110.6111.6112.0
  BenefitsECI-Benefits, Private310.263100.9101.1101.6101.8102.3102.6102.8103.3103.4103.9104.2104.8105.1105.6105.9106.6
 Practice Expenses—45.540101.6102.2102.6103.4104.1104.8105.1105.7106.4107.1107.6108.4109.1109.8110.2111.1
  Non-Physician Compensation—16.812101.8102.4103.1103.8104.3105.1105.3106.0106.5107.2107.6108.2108.7109.2109.6110.2
   Wages and Salaries—12.424102.0102.8103.5104.3104.9105.8106.0106.7107.3108.0108.4109.1109.6110.2110.6111.2
    Professional/TechnicalECI-W/S: Professional/Technical35.662101.7102.5103.0103.6104.2105.1105.5106.2106.6107.2107.6108.2108.7109.4109.6110.1
    ManagersECI-W/S: Administrative/Managerial32.410102.5103.4104.8106.1106.5107.8107.2108.2108.8109.8110.3111.2111.8112.4113.3114.0
    ClericalECI-W/S: Clerical33.830102.1102.8103.3104.0104.8105.4105.8106.3107.3107.9108.3108.9109.3109.9110.2110.8
    ServicesECI-W/S: Service Occupations30.522102.2103.8104.5105.0105.4106.2106.5107.2108.1108.8109.6110.1110.7111.5112.1112.5
   Employee BenefitsECI-Benefits, Private White Collar34.388101.1101.1101.9102.5102.8103.2103.5104.1104.1104.7105.0105.8106.1106.5106.8107.7
 Office ExpensesCPI(U)-Housing11.581102.2103.2103.2103.9104.7105.6105.6106.2107.1108.1108.4109.4110.2111.4111.6112.7
 Medical Materials/SuppliesPPI-Drugs/PPI-Surgical/CPI-Medical Supplies4.516102.7103.0103.7106.8111.1111.6112.4113.2114.0114.4115.2116.1116.8117.0117.8119.0
 Professional Liability InsuranceHCFA-Professional Liability Premiums3.15297.598.298.798.996.597.197.698.298.799.399.9100.6101.2101.8102.4103.1
 Medical EquipmentPPI-Medical Instruments/Equipment1.87898.899.198.598.097.697.998.198.498.598.798.899.199.299.299.4100.0
 Other Professional Expenses—7.601102.0102.1102.7103.0103.5103.8104.3104.6106.0106.7107.6108.4109.3110.0111.0111.9
  AutomobileCPI(U)-Private Transportation1.300100.7100.4100.398.898.698.298.397.4100.5100.8101.9102.1103.1103.2104.3104.6
  All OtherCPI(U)-All Items less Food/Energy6.301102.3102.5103.1103.9104.5105.0105.6106.1107.1107.9108.7109.7110.5111.4112.3113.4
Four-Quarter Moving-Average Percent Change
Total—100.0002.42.32.22.22.42.52.52.42.32.22.22.32.32.32.22.2
 Physician Earnings—54.4602.42.52.52.52.62.62.52.42.32.22.22.22.22.12.02.0
  Wages and SalariesAHE-Private344.1972.72.82.92.92.92.92.82.72.52.52.42.42.32.22.12.0
  BenefitsECI-Benefits, Private310.2631.01.01.11.11.21.31.31.41.31.21.31.31.41.51.61.7
 Practice Expenses—45.5402.32.01.91.92.12.32.42.42.42.32.32.42.42.52.52.4
  Non-Physician Compensation—16.8122.12.02.12.32.42.62.52.42.32.12.12.12.12.12.01.9
   Wages and Salaries—12.4242.32.32.42.62.72.92.72.62.52.32.32.32.22.22.12.0
    Professional/TechnicalECI-W/S: Professional/Technical35.6622.01.92.02.32.52.62.52.52.52.32.22.12.02.01.91.9
    ManagersECI-W/S: Administrative/Managerial32.4103.23.03.23.43.64.03.63.12.72.12.22.42.62.72.62.6
    ClericalECI-W/S: Craft33.8302.32.32.42.52.52.62.52.52.42.42.32.42.32.12.01.8
    ServicesECI-W/S: Service Occupations30.5222.42.93.03.23.32.92.62.42.32.32.52.72.62.62.42.3
   Employee BenefitsECI-Benefits, Private White Collar34.3881.31.11.21.31.41.81.81.71.61.51.51.51.61.71.71.7
 Office ExpensesCPI(U)-Housing11.5812.92.72.62.42.32.32.32.32.32.32.42.62.72.93.03.0
 Medical Materials/SuppliesPPI-Drugs/PPI-Surgical/CPI-Medical Supplies4.5164.53.42.92.74.46.07.47.76.34.83.42.52.52.42.42.4
 Professional Liability InsuranceHCFA-Professional Liability Premiums3.152-0.9-1.6-2.0-1.1-0.8-0.5-0.5-1.0-0.20.71.62.32.42.42.52.5
 Medical EquipmentPPI-Medical Instruments/Equipment1.8780.1-0.5-1.3-1.1-1.0-1.1-0.8-0.6-0.10.50.70.80.70.60.60.7
 Other Professional Expenses—7.6012.52.32.11.81.71.61.51.61.82.12.53.03.13.23.23.1
  AutomobileCPI(U)-Private Transportation1.3002.31.70.7-0.6-1.1-1.8-2.2-2.0-1.00.21.73.33.53.43.02.4
  All OtherCPI(U)-All Items less Food/Energy6.3012.62.52.42.32.22.32.32.32.42.42.62.93.13.23.33.3

For data sources used to estimate the Input Price Index relative weights and choice of price proxies, refer to the November 2, 1998, Federal Register.

Category weights may not sum to total because of rounding.

Series are adjusted for productivity using 10-year moving average of output per hour for the non-farm business sector. All series in the compensation portion of the MEI are adjusted for productivity so both economywide productivity and physician practice productivity are not included in the update.

NOTES: A dash (—) in the Price/Wage Variable column denotes a total or subtotal produced by adding two or more categories. HCFA is Health Care Financing Administration. CY is calendar year. Q designates quarter of year. AHE is average hourly earnings. ECI is Employment Cost Index. W/S is wages and salaries. CPI(U) represents Consumer Price Index for all urban consumers. PPI is Producer Price Index. The four-quarter moving-average percent change for the quarter indicated by the column heading is the rate of change in the average index level for four quarters ending in that quarter over the same period of the previous year. The four-quarter moving-average index level for the quarter indicated by the column heading is computed by summing the index level for that quarter and the prior three quarters and dividing by 4. The process is repeated to compute the four-quarter moving-average index level for the same quarter a year ago. The average index level for the quarter indicated by the column heading is divided by the average index level of the same quarter a year ago, and the quotient is subtracted from 1 and multiplied by 100 to determine the four-quarter moving-average percent change in the index.

SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the National Health Statistics Group. Second quarter 1999 forecasts were produced under contract to HCFA by Standard & Poor's DRI.

  8 in total

1.  Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1999--HCFA. Final rule with comment period.

Authors: 
Journal:  Fed Regist       Date:  1998-11-02

2.  Medicare program; schedules of per-visit and per-beneficiary limitations on home health agency costs for cost reporting periods beginning on or after October 1, 1998--HCFA. Notice with comment period.

Authors: 
Journal:  Fed Regist       Date:  1998-08-11

3.  Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1999 rates--HCFA. Final rule.

Authors: 
Journal:  Fed Regist       Date:  1998-07-31

4.  Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1998 rates--HCFA. Final rule with comment period.

Authors: 
Journal:  Fed Regist       Date:  1997-08-29

5.  Medicare program: schedule of limits for skilled nursing facility inpatient routine service costs--HCFA. Final notice with comment period.

Authors: 
Journal:  Fed Regist       Date:  1994-01-06

6.  Medicare program; revision of the Medicare Economic Index--HCFA. Final rule.

Authors: 
Journal:  Fed Regist       Date:  1992-11-25

7.  National health expenditures in 1997: more slow growth.

Authors:  K Levit; C Cowan; B Braden; J Stiller; A Sensenig; H Lazenby
Journal:  Health Aff (Millwood)       Date:  1998 Nov-Dec       Impact factor: 6.301

8.  National health expenditures, 1997.

Authors:  B R Braden; C A Cowan; H C Lazenby; A B Martin; P A McDonnell; A L Sensenig; J M Stiller; L S Whittle; C S Donham; A M Long; M W Stewart
Journal:  Health Care Financ Rev       Date:  1998
  8 in total

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