View in EDS HTML Full Text PDF Full Text

Century‐Long Trends in the Financing and Ownership of American Health Care.

Saved in:
Bibliographic Details
Title: Century‐Long Trends in the Financing and Ownership of American Health Care.
Authors: GAFFNEY, ADAM, WOOLHANDLER, STEFFIE, HIMMELSTEIN, DAVID U.
Source: Milbank Quarterly. Jun2023, Vol. 101 Issue 2, p325-348. 24p. 4 Graphs.
Subjects: Health policy, Hospitals, Hospice care, Nonprofit organizations, Treatment programs, Substance abuse treatment, Home care services, Medical care costs, Private sector, Surgical clinics, Primary health care, Health insurance reimbursement, Health care reform, Nursing care facilities, Public sector, Hemodialysis facilities, Government aid, Pharmaceutical industry, Data analysis software, Psychiatric hospitals, Outpatient services in hospitals
Geographic Terms: United States
Abstract: Policy PointsOver the past century, the tax‐financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance.For‐profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees.US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health. A reconsideration of US health care financing and ownership appears warranted. Context: Who pays for health care—and who owns it—determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century. Methods: We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for‐profit), and private (not‐for‐profit). We used US Census data to classify physicians' employers as public, not‐for‐profit, or for‐profit entities or "self‐employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer‐sponsored insurance plans or government purchase of such plans for public employees. Findings: For‐profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not‐for‐profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer‐financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer‐financed subsidies to private expenditures accounting for much of the recent growth. Conclusions: American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted. [ABSTRACT FROM AUTHOR]
Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
Text:
  Availability: 1
Header DbId: pbh
DbLabel: Psychology and Behavioral Sciences Collection
An: 164284560
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Century‐Long Trends in the Financing and Ownership of American Health Care.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22GAFFNEY%2C+ADAM%22">GAFFNEY, ADAM</searchLink><br /><searchLink fieldCode="AR" term="%22WOOLHANDLER%2C+STEFFIE%22">WOOLHANDLER, STEFFIE</searchLink><br /><searchLink fieldCode="AR" term="%22HIMMELSTEIN%2C+DAVID+U%2E%22">HIMMELSTEIN, DAVID U.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%22Milbank+Quarterly%22">Milbank Quarterly</searchLink>. Jun2023, Vol. 101 Issue 2, p325-348. 24p. 4 Graphs.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Health+policy%22">Health policy</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Hospice+care%22">Hospice care</searchLink><br /><searchLink fieldCode="DE" term="%22Nonprofit+organizations%22">Nonprofit organizations</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+programs%22">Treatment programs</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+abuse+treatment%22">Substance abuse treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Home+care+services%22">Home care services</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+costs%22">Medical care costs</searchLink><br /><searchLink fieldCode="DE" term="%22Private+sector%22">Private sector</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+clinics%22">Surgical clinics</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+health+care%22">Primary health care</searchLink><br /><searchLink fieldCode="DE" term="%22Health+insurance+reimbursement%22">Health insurance reimbursement</searchLink><br /><searchLink fieldCode="DE" term="%22Health+care+reform%22">Health care reform</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+care+facilities%22">Nursing care facilities</searchLink><br /><searchLink fieldCode="DE" term="%22Public+sector%22">Public sector</searchLink><br /><searchLink fieldCode="DE" term="%22Hemodialysis+facilities%22">Hemodialysis facilities</searchLink><br /><searchLink fieldCode="DE" term="%22Government+aid%22">Government aid</searchLink><br /><searchLink fieldCode="DE" term="%22Pharmaceutical+industry%22">Pharmaceutical industry</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Psychiatric+hospitals%22">Psychiatric hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Outpatient+services+in+hospitals%22">Outpatient services in hospitals</searchLink>
– Name: SubjectGeographic
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Policy PointsOver the past century, the tax‐financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance.For‐profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees.US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health. A reconsideration of US health care financing and ownership appears warranted. Context: Who pays for health care—and who owns it—determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century. Methods: We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for‐profit), and private (not‐for‐profit). We used US Census data to classify physicians' employers as public, not‐for‐profit, or for‐profit entities or "self‐employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer‐sponsored insurance plans or government purchase of such plans for public employees. Findings: For‐profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not‐for‐profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer‐financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer‐financed subsidies to private expenditures accounting for much of the recent growth. Conclusions: American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=164284560
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1468-0009.12647
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 24
        StartPage: 325
    Subjects:
      – SubjectFull: Health policy
        Type: general
      – SubjectFull: Hospitals
        Type: general
      – SubjectFull: Hospice care
        Type: general
      – SubjectFull: Nonprofit organizations
        Type: general
      – SubjectFull: Treatment programs
        Type: general
      – SubjectFull: Substance abuse treatment
        Type: general
      – SubjectFull: Home care services
        Type: general
      – SubjectFull: Medical care costs
        Type: general
      – SubjectFull: Private sector
        Type: general
      – SubjectFull: Surgical clinics
        Type: general
      – SubjectFull: Primary health care
        Type: general
      – SubjectFull: Health insurance reimbursement
        Type: general
      – SubjectFull: Health care reform
        Type: general
      – SubjectFull: Nursing care facilities
        Type: general
      – SubjectFull: Public sector
        Type: general
      – SubjectFull: Hemodialysis facilities
        Type: general
      – SubjectFull: Government aid
        Type: general
      – SubjectFull: Pharmaceutical industry
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Psychiatric hospitals
        Type: general
      – SubjectFull: Outpatient services in hospitals
        Type: general
      – SubjectFull: United States
        Type: general
    Titles:
      – TitleFull: Century‐Long Trends in the Financing and Ownership of American Health Care.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: GAFFNEY, ADAM
      – PersonEntity:
          Name:
            NameFull: WOOLHANDLER, STEFFIE
      – PersonEntity:
          Name:
            NameFull: HIMMELSTEIN, DAVID U.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Text: Jun2023
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 0887378X
          Numbering:
            – Type: volume
              Value: 101
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Milbank Quarterly
              Type: main
ResultId 1