1. International Variations in Health Care Expenditure Todd Gilmer, PhD Professor of Health Policy and Economics Department of Family and Preventive Medicine 1

2. Increasing Health Care Expenditures 2

3. National Health Expenditures as a Percentage of GDP, 1960-2017 2009 17.3% 2009 $2.5 trillion SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. 9/2010 2019 19.3% 3

4. Why might this be a problem? Crowd out of public funds and opportunity costs facing federal and state governments Increasing rate of uninsured Increasing burden on the poor Some spending may be wasteful – International variations 4

5. Distribution of National Health Expenditures, by Type of Service, 2008 Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).http://www.cms.hhs.gov/NationalHealthExpendData/ 5

8. The Burden Of Public Spending, As Percentage Of Income, Nationally And By Income Quintile, 2004. Ketsche P et al. Health Aff 2011;30:1637-1646 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

9. The Burden Of Medicare Versus Medicaid/Children’s Health Insurance Program (CHIP) Spending, As Percentage Of Income, Nationally And By Income Quintile, 2004. Ketsche P et al. Health Aff 2011;30:1637-1646 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

10. The Burden Of Premiums, As Percentage Of Income, Nationally And By Income Quintile, 2004. Ketsche P et al. Health Aff 2011;30:1637-1646 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

11. Federal and State Revenues and Expenditures 11

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16. Cross Country Variation in Health Care Expenditures 16

17. Publication: R. E. Leu, F. F. H. Rutten, W. Brouwer et al., The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets, The Commonwealth Fund, January 2009 US Switzerland UK OECD Mean Organization of Economic Cooperation and Development 17

18. Health Care Costs in US vs. OECD Compare US and OECD countries on health care spending, workforce, treatment intensity, and outcomes Source: Anderson et al. “ It’s the prices, stupid: Why the United States is so different from other countries. ” Health Affairs. 22(3)

19. Total Spending in 2000 (US$ PPP)

20. Percent of GDP, 2000

21. % Private Spending

22. Population Age 65+

23. Workforce (per 1,000 in 2000)

24. Coronary Angioplasties (per 100,000, 1999)

25. Life Expectancy at Birth (2000-2005, UN)

26. Physician Fees, US vs. Other Countries Compare 6 countries on physician fees for primary care and orthopedic surgery Source: Laugesen and Glied. “ Higher fees paid to US physicians drive higher spending for physician services compared to other countries. ” Health Affairs. 30(9)