2. TABLE OF CONTENTS CHAPTER 6.0: The Economic Contribution of Hospitals Chart 6.1: National Health Expenditures as a Percentage of Gross Domestic Product and Breakdown of National Health Expenditures, 2007 Chart 6.2: Number of Full-time and Part-time Hospital Employees, 1993 – 2007 Chart 6.3: Impact of Community Hospitals on U.S. Economy (in $ billions), 2007 Chart 6.4: Hospital Employment vs. Employment in Other Industries, 2008 Chart 6.5: Average Weekly Earnings of Workers, Hospitals vs. All Service-providing Industries, 1990 – 2007 Chart 6.6: Hospital Employment by Occupation Type, 2007 Chart 6.7: Percent Change in Employment, Seasonally-adjusted: Hospital vs. All Industries (Total Non-farm), 2006 – 2008 Chart 6.8: Percent of Total Regional Employment by Hospitals, 2007 Chart 6.9: Impact of Community Hospitals on U.S. Jobs (in millions), 2007 Chart 6.10: Percent of Hospital Costs by Type of Expense, 2Q08 Chart 6.11: Hospital Impact on Sectors of the U.S. Economy (in $ billions), 2007 Chart 6.12: Impact of Community Hospitals on U.S. Economy, All States, DC and Total U.S., 2007

3. Chart 6.1: National Health Expenditures as a Percentage of Gross Domestic Product and Breakdown of National Health Expenditures, 2007 Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2009. Health Care Expenditures, 16.2%

4. Chart 6.2: Number of Full-time and Part-time Hospital Employees, 1993 – 2007 Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2007, for community hospitals.

5. Chart 6.3: Impact of Community Hospitals on U.S. Economy (in $ billions), 2007 Source: Avalere Health, using BEA RIMS-II (1997/2006) multipliers applied to 2007 American Hospital Association Annual Survey data. Direct Effect Ripple Effect Total Contribution

6. Chart 6.4: Hospital Employment vs. Employment in Other Industries, 2008 (1) Source: Department of Labor, Bureau of Labor Statistics, Current Employment Statistics (CES) Survey, customized tables. Data released 2009. Link: http://www.bls.gov/ces. (1) 2008 figures reflect annual projections.

7. Chart 6.5: Average Weekly Earnings of Workers, Hospitals (1) vs. All Service-providing Industries, 1990 – 2007 Source: Department of Labor, Bureau of Labor Statistics, Current Employment Statistics (CES) Survey, customized tables. Data released 2009. Link: http://www.bls.gov/ces. (1) Includes physicians employed by hospitals.

8. Chart 6.6: Hospital Employment by Occupation Type, 2007 Source: Department of Labor, Bureau of Labor Statistics, 2007 National Industry-specific Occupational Employment and Wage. Data released February 2009. Link: http://www.bls.gov/oes/current/naics3_622000.htm.

9. Chart 6.7: Percent Change in Employment, Seasonally-adjusted: Hospital vs. All Industries (Total Non-farm), 2006 – 2008 Source: Department of Labor, Bureau of Labor Statistics. Link: http://www.bls.gov/bls/employment.htm. 200620082007

10. Chart 6.8: Percent of Total Regional Employment (1) by Hospitals, 2007 Source: Avalere Health analysis of American Hospital Association 2007 Annual Survey data and 2007 total non-farm employment data from the Bureau of Labor Statistics. (1) Does not include farm employment. New England Mid-Atlantic East North Central West North Central West South Central Mountain Pacific East South Central South Atlantic 3.2% 2.9% 3.4% 4.3% 4.6% 4.3% 3.5% 4.5% 4.7%

11. Chart 6.9: Impact of Community Hospitals on U.S. Jobs (in millions), 2007 Source: Avalere Health, using BEA RIMS-II (1997/2006) multipliers applied to 2007 American Hospital Association Annual Survey data.

12. Chart 6.10: Percent of Hospital Costs (1) by Type of Expense, 2Q08 Source: AHA analysis of Centers for Medicare and Medicaid Services data, using base year 2002 weights. (1) Does not include capital. (2) Includes postage and telephone expenses. (2)

13. Chart 6.11: Hospital Impact on Sectors of the U.S. Economy (in $ billions), 2007 Source: Avalere Health, using BEA RIMS-II (1997/2006) multipliers applied to 2007 American Hospital Association Annual Survey data. IndustryEconomic Impact Health care and social assistance $697.9 Manufacturing297.2 Real estate and rental and leasing187.9 Finance and insurance126.8 Professional, scientific and technical services82.4 Retail trade81.1 Wholesale trade65.0 Information64.9 Transportation and warehousing61.8 Administrative and waste management services61.5 Accommodation and food services51.0 Other services49.7 Management of companies and enterprises39.9 Utilities35.3 Agriculture, forestry, fishing and hunting29.1 Educational services16.0 Arts, entertainment, and recreation14.2 Mining12.5 Construction9.8 Total $1,984.0

14. Chart 6.12: Impact of Community Hospitals on U.S. Economy; All States, DC and Total U.S., 2007 Source: Avalere Health, using BEA RIMS-II (1997/2006) multipliers for hospital NAICS Code 622, released 2008, applied to American Hospital Association Annual Survey data for 2007. Hospital jobs are total part time and full time jobs. Hospital labor income is defined as payroll plus benefits. The percent of total employment supported by direct and indirect hospital employment is based on 2007 BLS data. *Expenditures are defined as net patient revenue + other operating revenue. State Name Number of Hospital Jobs (FT and PT) Multiplier for Employment Effect of Hospital Jobs on Total Jobs in State Economy Percent of Total (Non-farm) Employment Supported by Hospital Employment Hospital Payroll and Benefits ($ millions) Multiplier for Earnings Effect of Hospital Payroll and Benefits on Total Labor Income ($ millions) Hospital Expenditures* ($ millions) Multiplier for Output Effect of Hospital Expenditures on Total Output in State Economy ($ millions) Alabama84,3722.0128169,8248.46%$3,9351.7382$6,840$7,9952.1741$17,382 Alaska10,3731.893119,6376.18%$7541.5342$1,157$1,5131.8427$2,788 Arizona81,8512.1321174,5156.55%$4,8121.7511$8,426$10,0662.1596$21,739 Arkansas48,3581.943493,9797.81%$2,2711.6528$3,754$4,7332.0373$9,643 California488,4132.27511,111,1887.33%$29,6621.9677$58,366$59,5902.5265$150,554 Colorado64,5652.2728146,7436.30%$4,0191.9439$7,813$8,6102.4720$21,284 Connecticut64,5121.9089123,1477.25%$4,0401.7029$6,880$7,3512.1058$15,480 Delaware18,1921.908334,7167.95%$1,1191.6208$1,814$2,0861.9746$4,119 District of Columbia25,4531.564839,8295.73%$1,7291.3668$2,363$3,2681.3866$4,531 Florida274,0752.0425559,7986.96%$15,4821.7860$27,651$33,1002.2052$72,992 Georgia142,8042.1991314,0407.57%$7,4601.9466$14,522$15,2472.4931$38,012 Hawaii17,2312.152237,0855.95%$1,0991.6993$1,868$2,1182.0783$4,402 Idaho23,0812.075347,9007.31%$1,1431.6781$1,918$2,4262.0419$4,954 Illinois238,8272.2421535,4748.95%$13,3212.0074$26,741$27,5432.6107$71,907 Indiana121,9432.0684252,2278.44%$6,5111.7652$11,493$13,5852.2423$30,462 Iowa69,3621.9678136,4919.00%$3,1851.6683$5,314$6,2732.0566$12,901 Kansas50,9301.9810100,8927.32%$2,5351.6851$4,272$4,7892.1205$10,155 Kentucky79,4082.0151160,0158.56%$4,0841.7246$7,043$8,8922.1535$19,149 Louisiana83,0351.9761164,0858.54%$4,0601.6890$6,857$8,1792.0450$16,726 Maine34,0682.099471,52211.58%$1,7451.6934$2,955$3,3672.0724$6,978 Maryland88,9882.0835185,4067.10%$5,2151.7969$9,371$10,8822.2440$24,419 Massachusetts170,9212.0772355,03710.83%$9,8601.8276$18,020$20,1462.2898$46,130 Michigan202,3102.0864422,1009.90%$11,4981.7892$20,572$22,4832.2250$50,025 Minnesota109,7452.2509247,0258.92%$6,3701.8750$11,944$12,0542.3801$28,690 Mississippi57,7971.9358111,8839.71%$2,9081.6342$4,752$5,5382.0111$11,137 Missouri128,3992.1314273,6709.79%$6,5101.8270$11,894$14,7822.3078$34,114 Montana21,1892.027742,9659.70%$1,0301.6295$1,678$2,0231.9804$4,006 Nebraska41,5352.001283,1208.63%$2,0981.7151$3,598$4,3732.1184$9,264 Nevada24,1041.947346,9383.63%$1,7551.6078$2,822$3,6721.9425$7,133 New Hampshire29,1702.016458,8189.06%$1,7701.7655$3,125$3,3202.1038$6,985 New Jersey145,8102.1713316,5977.77%$8,8161.8966$16,720$16,1152.4450$39,401 New Mexico23,9202.083449,8355.91%$1,5611.6371$2,556$2,9051.9595$5,692 New York410,4481.8941777,4308.90%$27,8861.6807$46,868$49,6512.1262$105,568 North Carolina160,2512.1746348,4828.41%$8,6741.8509$16,055$17,4972.3573$41,246 North Dakota19,7021.890637,24910.41%$9481.5824$1,500$1,7411.8921$3,294 Ohio255,4722.1845558,07910.29%$13,9131.8463$25,688$28,0502.3406$65,654 Oklahoma55,8562.0911116,8007.46%$2,7281.7621$4,807$6,0822.1927$13,336 Oregon55,8362.2135123,5937.14%$3,5111.7507$6,147$6,8472.1740$14,885 Pennsylvania280,4512.1859613,03810.58%$14,3801.9220$27,638$30,8462.4662$76,072 Rhode Island21,2691.994442,4198.60%$1,4431.6867$2,434$2,5262.0518$5,183 South Carolina70,6112.1289150,3247.71%$3,6671.7830$6,538$8,4612.2809$19,299 South Dakota20,6891.894239,1899.64%$9771.5882$1,552$1,9721.9210$3,788 Tennessee135,4622.1825295,64610.57%$6,7341.8680$12,579$13,9502.4045$33,543 Texas322,6032.3308751,9237.26%$17,9861.9591$35,236$37,7772.5537$96,471 Utah39,1722.258788,4787.07%$1,8711.9017$3,558$4,1452.4405$10,116 Vermont12,9972.010526,1308.49%$8751.5910$1,392$1,4801.8782$2,780 Virginia107,8701.9699212,4935.65%$6,1291.7659$10,823$13,4202.2555$30,269 Washington94,0912.2047207,4427.08%$6,1831.8049$11,160$11,8322.2829$27,011 West Virginia42,0241.904880,04710.58%$2,0361.5673$3,191$4,1931.8522$7,766 Wisconsin108,9692.0666225,1957.81%$5,9711.7664$10,547$12,7202.2070$28,073 Wyoming8,9891.745115,6875.44%$4651.4443$672$9081.6980$1,542 U.S. 5,287,5032.804814,830,38810.80%$298,7342.4031$717,888$603,1223.2896$1,984,030