Trends and Indicators in the Changing Health Care Marketplace Section 5: Trends in the Structure of the Health Care Marketplace
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Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.1: Health Care Employment and Share of Total Non-Farm Employment, 1990-2005p
Health care employment as a proportion of all non-farm employment has increased fairly steadily since the early 1990s. In 2005p, 9.2% of all workers, or 12.3 million people, held health care jobs, up from 7.5% (8.2 million) in 1990.
Health Care Employment
Notes: Not seasonally adjusted. Health Care Employment includes those who work in ambulatory health care services (NAICS code 621), hospitals (NAICS code 622), and nursing and residential care facilities (NAICS code 623).
Source: Kaiser Family Foundation calculations using data from Bureau of Labor Statistics, Current Employment Statistics survey using the 2002 North American Industry Classification System (NAICS), at http://www.bls.gov/ces/home.htm#data.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/08/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.2: Community Hospital Beds per 100,000 Population, 1975-2003
Community hospital capacity has declined as lengths of stay decrease and use of outpatient procedures grows, although the decline appears to have leveled off since 2000. In 2003, the nation’s community hospitals housed 280 beds for every 100,000 residents, almost two-thirds the capacity that existed in 1975.
Notes: Data are for community hospitals, which represent 85% of all hospitals. Federal hospitals, long term care hospitals, psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.3: Community Hospital Beds per 100,000 Population, by State, 2003
Community hospital capacity is not evenly distributed throughout the nation. In 2003, South Dakota had 578 beds per 100,000 residents, while Washington, with 183 beds per 100,000, had about a third of this capacity. A combination of factors including population density, reimbursement levels, and managed care penetration contribute to these differences. Further, there is clear regional variation: Western and Southwestern states have lower levels and Midwestern states have higher levels of hospital capacity.
Notes: District of Columbia included. Data are for community hospitals, which represent 85% of all hospitals. Federal hospitals, long term care hospitals, psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included.
Source: Kaiser Family Foundation calculations using bed data from 2003 American Hospital Association Annual Survey, Copyright 2004 by Health Forum LLC, an affiliate of the American Hospital Association, special data request, 2005; and July 1, 2003 population data from U.S. Census Bureau at http://www.census.gov/popest/states/NST-ann-est.html.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.4: Number and Distribution of Community Hospital Beds, by Ownership Status, 1980-2003
The ownership status of community hospitals changed little over the last two decades, with the proportion of hospital beds in not-for-profit hospitals remaining constant at about 70%. Meanwhile, the share of public hospital beds declined somewhat as the proportion of investor-owned beds increased modestly.
Notes: Data are for community hospitals, which represent 85% of all hospitals. Federal hospitals, long term care hospitals, psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included.
Source: Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2002, May 2002, Exhibit 5.4, p. 51, at http://www.kff.org/insurance/3161-index.cfm, updated with KFF calculations using 2002 and 2003 American Hospital Association Annual Survey data, Copyright by Health Forum LLC, an affiliate of the American Hospital Association, special data request, 2004 and 2005.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.5: Proportion of Hospital Beds in 10 Largest Hospital Systems, 1989-2003
While HMO enrollment is concentrated in a few large firms (see Exhibit 5.11), the hospital market is still largely local and dispersed. Fewer than 20% of all hospital beds were in the 10 largest hospital systems in 2003. However, these figures mask an important market transition over the last decade as independent not-for-profit community hospitals have merged together to form large local hospital systems, often dominating certain urban health care markets.
Notes: The numerator, hospital beds in 10 largest systems, is licensed beds. The denominator, total community hospital beds, is staffed beds. This discrepancy will result in a modest overstatement of the proportion of beds in hospital systems. Excludes the U.S. Department of Veterans Affairs hospital system.
Source: Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2002, May 2002, Exhibit 5.5, p. 52, at http://www.kff.org/insurance/3161-index.cfm, updated with KFF calculations using hospital systems data from Modern Healthcare’s Health Systems Survey (2000 data from personal communication; 2001-2003 data at http://www.modernhealthcare.com/survey.cms), and community hospital beds from the American Hospital Association’s Annual Hospital Survey (2000-2003, Copyright by Health Forum LLC).
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.6: Full-Time-Equivalent Employees Working in Community Hospitals, per 100 Adjusted Admissions, 1980-2003
After increasing through the 1980s and early 1990s, community hospital staffing levels began declining in the mid-1990s, a period marked by rapid increases in managed care. In 2003, hospitals had 7.1 full-time-equivalent employees per 100 adjusted admissions, about 14% fewer than in 1990.
Notes: Adjusted admissions reflects the number of inpatient admissions, plus an estimate of the volume of outpatient services expressed in units equivalent to an inpatient admission in terms of level of effort.
Source: The Lewin Group analysis of American Hospital Association Annual Survey Data, in American Hospital Association/The Lewin Group, TrendWatch Chartbook 2005, Trends Affecting Hospitals and Health Systems, May 2005, Table 5.3, p.A-40, at http://www.hospitalconnect.com/ahapolicyforum/trendwatch/chartbook2005.html.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/08/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 5.7: Non-Federal Physicians per 100,000 Civilian Population, 1970-2003
The supply of physicians rose steadily during the 1970s, 1980s, and 1990s, fell in the early 2000s, but has been rising since then. There were 281 non-federal physicians for every 100,000 persons in 2003, fewer than the 288 in 2000, but almost twice the capacity as in 1970.
Note: Non-federal physicians are not employed by the federal government and include medical doctors and osteopaths. They represent 98% of total physicians.
Source: Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2002, May 2002, Exhibit 5.7, p. 54, at http://www.kff.org/insurance/3161-index.cfm, updated for 2001, 2002 and 2003 with KFF calculations using data from State Health Facts, at www.statehealthfacts.kff.org, based on American Medical Association, Physicians Professional Data, and U.S. Census Bureau data at http://www.census.gov/popest/national/NA-EST2004-01.html.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/02/05
