Dr. Julie Schoenman’s presentation for the MILI Actuarial Seminar series, “A Detailed Look at US Health Care Spending,” covers recent trends in public and private spending as well as the implications of rising spending for the federal budget outlook and for consumers.
Dr. Julie Schoenman’s presentation for the MILI Actuarial Seminar series, “A Detailed Look at US Health Care Spending,” covers recent trends in public and private spending as well as the implications of rising spending for the federal budget outlook and for consumers.
The document discusses healthcare in the United States. It covers several topics related to US healthcare, including what makes the US system different compared to other developed countries, what health insurance looks like in the US, costs associated with diabetes, and who pays for healthcare. The US system is unique in that it does not have universal healthcare coverage and relies more heavily on private insurance compared to other countries which have nationalized systems. Healthcare costs, especially for conditions like diabetes, place a large financial burden on individuals and the system.
As the impact of healthcare reform on the U.S. delivery system comes into focus, there is little doubt that it is a “game changer” for clinical engineering and biomedical equipment technology. Carol will describe and discuss the future of the CE and BMET professions under new regulations and a new payment system. She will address why medical devices will cost much more, why equipment must have longer life cycles, why CEs and BMETs will and must have more involvement in IT-related activities, how CEs’ and BMETs’ responsibilities in regulatory compliance will expand and how you can prepare for this new environment.
About Carol Davis-Smith, CCE
Career Summary
Carol Davis-Smith is a Director in Premier’s Consulting Solution Division with responsibility for the development and deployment of capital lifecycle management processes and tools to Premier staff and owners.
Education and Affiliations
Ms. Davis-Smith received a B.S. in bioengineering technology
from the University of Dayton and an M.S. in engineering from the University of Arizona. She is a certified clinical engineer and a member of the Association for the Advancement of Medical Instrumentation (AAMI). Over the past 20 years, she has presented and published papers on a variety of clinical engineering and capital contracting topics. In 2009, Ms. Davis-Smith received the AAMI Clinical Engineering Achievement Award.
This document discusses the current state of diabetes data and software. It notes that data is currently stored vertically in closed and proprietary systems, lacking standardization. This creates problems like patients not downloading their data, placing a burden on doctors to analyze it. It also notes the shortage of providers relative to the number of patients with diabetes. Software could help bridge this gap, but more patients need to use it. The document suggests we can learn from the success of standardized therapies like DPP-4 inhibitors and from open standards in information technology.
This presentation covers the key findings of the "Household Balance Sheet" section of our report on the State of Lending in America and it's Impact on U.S. Households.
This document is Ecolab's 2003 Annual Report. It provides details about Ecolab's business including its description, markets served, products/services provided, financial highlights for 2003, and stock performance. It summarizes that Ecolab had record sales of $3.8 billion in 2003, up 11% from 2002. Net income increased 32% to $277 million and diluted earnings per share grew 33% to $1.06. The CEO highlights strong financial results and growth despite economic uncertainties.
This document contains a summary and analysis of the housing market in Southwest California, including the cities of Temecula, Murrieta, Lake Elsinore, Menifee, Wildomar, and Canyon Lake. It provides data on home sales, prices, inventory levels, and market activity from 2010 to 2012. Key findings include declining home prices from 2008 to 2012, with median prices falling over 50% in some areas, as well as an increase in the percentage of short sales and bank-owned homes being sold in December 2012. Available housing inventory levels rose from 2010 to 2012 across the region.
Dr. Julie Schoenman’s presentation for the MILI Actuarial Seminar series, “A Detailed Look at US Health Care Spending,” covers recent trends in public and private spending as well as the implications of rising spending for the federal budget outlook and for consumers.
The document discusses healthcare in the United States. It covers several topics related to US healthcare, including what makes the US system different compared to other developed countries, what health insurance looks like in the US, costs associated with diabetes, and who pays for healthcare. The US system is unique in that it does not have universal healthcare coverage and relies more heavily on private insurance compared to other countries which have nationalized systems. Healthcare costs, especially for conditions like diabetes, place a large financial burden on individuals and the system.
As the impact of healthcare reform on the U.S. delivery system comes into focus, there is little doubt that it is a “game changer” for clinical engineering and biomedical equipment technology. Carol will describe and discuss the future of the CE and BMET professions under new regulations and a new payment system. She will address why medical devices will cost much more, why equipment must have longer life cycles, why CEs and BMETs will and must have more involvement in IT-related activities, how CEs’ and BMETs’ responsibilities in regulatory compliance will expand and how you can prepare for this new environment.
About Carol Davis-Smith, CCE
Career Summary
Carol Davis-Smith is a Director in Premier’s Consulting Solution Division with responsibility for the development and deployment of capital lifecycle management processes and tools to Premier staff and owners.
Education and Affiliations
Ms. Davis-Smith received a B.S. in bioengineering technology
from the University of Dayton and an M.S. in engineering from the University of Arizona. She is a certified clinical engineer and a member of the Association for the Advancement of Medical Instrumentation (AAMI). Over the past 20 years, she has presented and published papers on a variety of clinical engineering and capital contracting topics. In 2009, Ms. Davis-Smith received the AAMI Clinical Engineering Achievement Award.
This document discusses the current state of diabetes data and software. It notes that data is currently stored vertically in closed and proprietary systems, lacking standardization. This creates problems like patients not downloading their data, placing a burden on doctors to analyze it. It also notes the shortage of providers relative to the number of patients with diabetes. Software could help bridge this gap, but more patients need to use it. The document suggests we can learn from the success of standardized therapies like DPP-4 inhibitors and from open standards in information technology.
This presentation covers the key findings of the "Household Balance Sheet" section of our report on the State of Lending in America and it's Impact on U.S. Households.
This document is Ecolab's 2003 Annual Report. It provides details about Ecolab's business including its description, markets served, products/services provided, financial highlights for 2003, and stock performance. It summarizes that Ecolab had record sales of $3.8 billion in 2003, up 11% from 2002. Net income increased 32% to $277 million and diluted earnings per share grew 33% to $1.06. The CEO highlights strong financial results and growth despite economic uncertainties.
This document contains a summary and analysis of the housing market in Southwest California, including the cities of Temecula, Murrieta, Lake Elsinore, Menifee, Wildomar, and Canyon Lake. It provides data on home sales, prices, inventory levels, and market activity from 2010 to 2012. Key findings include declining home prices from 2008 to 2012, with median prices falling over 50% in some areas, as well as an increase in the percentage of short sales and bank-owned homes being sold in December 2012. Available housing inventory levels rose from 2010 to 2012 across the region.
omnicom group Q2 2007 Investor Presentationfinance22
The document provides an overview of Omnicom Group's second quarter 2007 results. It summarizes key financial metrics such as revenue growth of 10.7% year-over-year, operating income growth of 10.6%, and net income growth of 13.4%. The summary also breaks down revenue and growth by business discipline, geography, and sources of revenue growth including foreign exchange, acquisitions, and organic growth. Additional sections cover cash flow, credit profile, liquidity, acquisitions, and potential earn-out obligations.
The Walt Disney Company reported financial results for its second quarter and first six months of fiscal year 2006. Key highlights include:
- EPS for the second quarter increased 19% and 16% for the six month period compared to the prior year.
- Segment operating income increased 7% for the quarter and 4% for the six month period driven by strong results at Media Networks.
- Free cash flow more than tripled for the six month period compared to the prior year, reaching $1.7 billion.
The document discusses a decline in private residential investment and subprime/Alt-A mortgages over the past few years which has negatively impacted the housing market. It then outlines Home Depot's strategic focus on increasing returns through disciplined capital allocation, investing in existing assets like employee training and supply chain improvements, and building sustained competitive advantages. Home Depot expects another difficult year in 2008 but believes these strategic initiatives position it for stronger future growth once market conditions normalize.
This document discusses opportunities for venture capital investment in healthcare technology. It notes that the US healthcare system is fragmented and costs are rising due to an aging population with more chronic diseases. Government initiatives around electronic health records and a push for higher quality and lower costs are driving investment in areas like telehealth, home healthcare technology, and medical games. Specific opportunities mentioned include technologies to improve care coordination for chronic conditions, digital health solutions, medical devices in growing specialties like ophthalmology, and healthcare games for training and rehabilitation. Successful exits in these areas have involved companies being acquired by larger healthcare or technology firms.
- The document is the slide deck for Newmont Mining Corporation's Fourth Quarter and Year End 2006 Earnings Conference Call on February 22, 2007.
- It provides financial and operating results for Q4 2006 and full year 2006 compared to the same periods in 2005, highlighting increases in average realized gold price, equity gold sales, and income from continuing operations.
- Project development updates are given for power plant construction in Nevada, mill construction at Yanacocha in Peru, and Boddington mine development in Australia.
1. Stryker Corporation is a global medical technology company focused on reconstructive, medical and surgical, and neurotechnology and spine products.
2. For 2007, Stryker reported net sales of $6 billion, net earnings of $1.02 billion, and diluted earnings per share of $2.44, representing year-over-year growth of 17%, 31%, and 29%, respectively.
3. On an adjusted basis, Stryker reported net earnings from continuing operations of $999 million and adjusted diluted earnings per share from continuing operations of $2.40 for 2007, representing year-over-year growth of 21% and 20%, respectively.
This document analyzes the potential economic impact of a proposed bill (S6413) in New York that would increase the minimum wage. It finds that depending on future inflation rates, the bill could result in nearly 22,000 lost jobs in New York over 10 years and a $2.5 billion reduction in economic output. More than 70% of lost jobs would be in small businesses. The analysis models different inflation scenarios and estimates costs to employers, as well as potential secondary effects on near-minimum wage workers.
Justin R. Victoria welcomed attendees to the meeting. The document contained forward-looking statements about product research, development, pricing, and manufacturing that involve risks and uncertainties. The agenda introduced new products such as Pristiq, Aprela/Viviant, Lybrel, Torisel, Tygacil, Bifeprunox, and Methylnaltrexone for important medical indications. Robert Essner discussed Wyeth's past financial performance and new drug launches, positioning the company for continued growth. Presentations on Enbrel, Prevnar, and mid-pipeline products followed.
This document analyzes the total costs of different mortgage plans for a homebuyer. It compares an FHA fixed loan, conventional loans with 5%, 10%, and 20% down, outlining details like loan amount, interest rate, monthly payment, and total costs over time. The analysis finds that a conventional 20% down loan would result in the lowest long-term costs and allow the homeowner to reach financial independence or "Freedom Point" the soonest.
Clear Channel Communications reported financial results for the second quarter of 2002 with revenues of $2.17 billion, EBITDA of $627 million, and free cash flow of $365 million. Radio revenues increased 5% to $991 million and EBITDA increased 9% to $441 million. Outdoor revenues were $474 million and EBITDA was $145 million. Entertainment revenues declined 11% to $619 million and EBITDA declined 8% to $52 million. The company expects third quarter 2002 EBITDA to be between $570-585 million and full year EBITDA to be $2.05-$2.10 billion.
The document introduces HEcheck, a new organizational assessment tool to evaluate workplace health environments. HEcheck assesses policies, services, and facilities related to employee health across topics like smoking, nutrition, physical activity, and stress. It contains over 200 items scored dichotomously. HEcheck aims to help organizations measure and improve their support for employee health and implement health promotion programs and policies.
plains all american pipeline Annual Reports2007 finance13
- Plains All American Pipeline, L.P. (PAA) is a master limited partnership engaged in oil and gas transportation, storage, and marketing.
- In 2007, PAA achieved or exceeded its goals by delivering record financial results, successfully integrating its acquisition of Pacific Energy Partners, completing its largest capital program and acquisitions to date, and increasing distributions paid to unitholders by 14.4%.
- Looking ahead, PAA's goals for 2008 are to deliver strong operating and financial performance, successfully execute its capital program and pursue strategic acquisitions, and increase distributions year-over-year by $0.20 to $0.25 per unit.
1) The document provides financial highlights from Google's Q3 2006 earnings call, including 70% year-over-year revenue growth and plans to acquire YouTube for $1.65 billion in stock.
2) Revenue growth was driven by increased monetization and traffic, with strong growth across advertisers. Operating income and net income reached record levels.
3) Google continued focusing on innovation and user experience while also forming new partnerships with companies like Fox, eBay, and Intuit.
Target Corporation reported financial results for 2007 with total revenues growing 6.5% to $63.4 billion and diluted earnings per share increasing 3.9% to $3.33. Target opened 118 new stores in 2007, including 33 SuperTarget stores, and continued investing in technology, distribution centers, and its second Target.com fulfillment center. Looking ahead, Target will focus on driving top-line growth and managing expenses while continuing to invest in its brand and unique shopping experience.
omnicom group Q2 2006 Investor Presentationfinance22
Omnicom Group presented its financial results for the second quarter of 2006. Revenue grew 7.9% to $2.8 billion compared to the second quarter of 2005. Net income increased 8.1% to $244.1 million. Organic revenue growth accounted for 7.2% of total revenue growth. The company has a $2.4 billion credit facility expiring in 2011 and $1.1 billion in cash, providing $3.5 billion in total liquidity. Acquisition expenditures for the first half of 2006 totaled $151 million. Future earn-out obligations over the next 5 years are estimated at $405 million assuming current performance levels are maintained.
- For fiscal year 2008, Disney reported EPS of $2.28, up slightly from $2.25 the prior year. Excluding certain items, EPS rose 18% to $2.27.
- Revenue increased 7% to $37.8 billion, with growth at Media Networks, Parks and Resorts, and Consumer Products.
- Segment operating income rose 8% to $8.5 billion, with double-digit increases at Media Networks and Parks and Resorts.
- However, Studio Entertainment operating income fell 9% on weaker home entertainment, and Broadcasting lost $150 million in the quarter.
- Yahoo reported Q2'08 financial highlights, with revenue ex-TAC of $1.346 billion, an 8% increase year-over-year but flat quarter-over-quarter.
- Operating cash flow was $427 million in Q2'08, a 10% decrease year-over-year due to costs related to strategic initiatives and a 1% decrease quarter-over-quarter.
- For full-year 2008, Yahoo expects revenue of $7.35-7.85 billion, operating cash flow of $1.825-1.975 billion, and free cash flow of $900 million to $1.05 billion.
The document provides an overview of key economic and political factors that may impact the housing market in 2013, including the fiscal cliff, debt ceiling, Eurozone debt crisis, and state/federal policies. It summarizes housing market trends in Southwest California in 2012, with median home prices rising 9-30% year-over-year in areas like Lake Elsinore and Temecula. Demand remained strong with over 250 homes sold in January 2013 across the region.
Canada's VC Challenge - A statistical overview - August 2012heri
This document analyzes data on Canada's venture capital industry and identifies several challenges it faces:
1) Venture capital investment as a percentage of GDP has steadily decreased in Canada since 2000, while it remains over double the rate in the US.
2) Domestic venture capital fund activity in Canada has remained flat in recent years, while foreign funds have increased their share of investments.
3) Weak fundraising has contributed to flat or declining levels of activity from Canadian venture capital funds, reducing support for high-growth technology companies.
Medicaid spending in New York is projected to grow 36% from fiscal years 2009-2010 to 2012-2013, a rate 67% higher than the average U.S. growth. Spending per Medicaid beneficiary in New York was $7,746 in 2006, over 67% higher than the national average of $4,635. The document compares past and projected Medicaid spending growth in New York to U.S. averages and spending per beneficiary.
The report provides information on recent property sales in the suburb of Dalkeith, Western Australia. It finds that the median house price in Dalkeith is currently $2,405,000, with a 1-year return of -14% and 3-year return of -14%. Recent property sales in Dalkeith have ranged from $1,460,000 to $6,000,000.
Northern Trust had a very strong financial performance in 2005. Net income grew 16% to $584 million and total revenues increased 15% to $2.7 billion. Assets under custody reached a record high of $2.9 trillion, up 15% from 2004, and assets under management grew 8% to $618 billion. Northern Trust continued its global expansion through acquisitions and new offices while maintaining its focus on serving private clients and institutional investors worldwide.
omnicom group Q2 2007 Investor Presentationfinance22
The document provides an overview of Omnicom Group's second quarter 2007 results. It summarizes key financial metrics such as revenue growth of 10.7% year-over-year, operating income growth of 10.6%, and net income growth of 13.4%. The summary also breaks down revenue and growth by business discipline, geography, and sources of revenue growth including foreign exchange, acquisitions, and organic growth. Additional sections cover cash flow, credit profile, liquidity, acquisitions, and potential earn-out obligations.
The Walt Disney Company reported financial results for its second quarter and first six months of fiscal year 2006. Key highlights include:
- EPS for the second quarter increased 19% and 16% for the six month period compared to the prior year.
- Segment operating income increased 7% for the quarter and 4% for the six month period driven by strong results at Media Networks.
- Free cash flow more than tripled for the six month period compared to the prior year, reaching $1.7 billion.
The document discusses a decline in private residential investment and subprime/Alt-A mortgages over the past few years which has negatively impacted the housing market. It then outlines Home Depot's strategic focus on increasing returns through disciplined capital allocation, investing in existing assets like employee training and supply chain improvements, and building sustained competitive advantages. Home Depot expects another difficult year in 2008 but believes these strategic initiatives position it for stronger future growth once market conditions normalize.
This document discusses opportunities for venture capital investment in healthcare technology. It notes that the US healthcare system is fragmented and costs are rising due to an aging population with more chronic diseases. Government initiatives around electronic health records and a push for higher quality and lower costs are driving investment in areas like telehealth, home healthcare technology, and medical games. Specific opportunities mentioned include technologies to improve care coordination for chronic conditions, digital health solutions, medical devices in growing specialties like ophthalmology, and healthcare games for training and rehabilitation. Successful exits in these areas have involved companies being acquired by larger healthcare or technology firms.
- The document is the slide deck for Newmont Mining Corporation's Fourth Quarter and Year End 2006 Earnings Conference Call on February 22, 2007.
- It provides financial and operating results for Q4 2006 and full year 2006 compared to the same periods in 2005, highlighting increases in average realized gold price, equity gold sales, and income from continuing operations.
- Project development updates are given for power plant construction in Nevada, mill construction at Yanacocha in Peru, and Boddington mine development in Australia.
1. Stryker Corporation is a global medical technology company focused on reconstructive, medical and surgical, and neurotechnology and spine products.
2. For 2007, Stryker reported net sales of $6 billion, net earnings of $1.02 billion, and diluted earnings per share of $2.44, representing year-over-year growth of 17%, 31%, and 29%, respectively.
3. On an adjusted basis, Stryker reported net earnings from continuing operations of $999 million and adjusted diluted earnings per share from continuing operations of $2.40 for 2007, representing year-over-year growth of 21% and 20%, respectively.
This document analyzes the potential economic impact of a proposed bill (S6413) in New York that would increase the minimum wage. It finds that depending on future inflation rates, the bill could result in nearly 22,000 lost jobs in New York over 10 years and a $2.5 billion reduction in economic output. More than 70% of lost jobs would be in small businesses. The analysis models different inflation scenarios and estimates costs to employers, as well as potential secondary effects on near-minimum wage workers.
Justin R. Victoria welcomed attendees to the meeting. The document contained forward-looking statements about product research, development, pricing, and manufacturing that involve risks and uncertainties. The agenda introduced new products such as Pristiq, Aprela/Viviant, Lybrel, Torisel, Tygacil, Bifeprunox, and Methylnaltrexone for important medical indications. Robert Essner discussed Wyeth's past financial performance and new drug launches, positioning the company for continued growth. Presentations on Enbrel, Prevnar, and mid-pipeline products followed.
This document analyzes the total costs of different mortgage plans for a homebuyer. It compares an FHA fixed loan, conventional loans with 5%, 10%, and 20% down, outlining details like loan amount, interest rate, monthly payment, and total costs over time. The analysis finds that a conventional 20% down loan would result in the lowest long-term costs and allow the homeowner to reach financial independence or "Freedom Point" the soonest.
Clear Channel Communications reported financial results for the second quarter of 2002 with revenues of $2.17 billion, EBITDA of $627 million, and free cash flow of $365 million. Radio revenues increased 5% to $991 million and EBITDA increased 9% to $441 million. Outdoor revenues were $474 million and EBITDA was $145 million. Entertainment revenues declined 11% to $619 million and EBITDA declined 8% to $52 million. The company expects third quarter 2002 EBITDA to be between $570-585 million and full year EBITDA to be $2.05-$2.10 billion.
The document introduces HEcheck, a new organizational assessment tool to evaluate workplace health environments. HEcheck assesses policies, services, and facilities related to employee health across topics like smoking, nutrition, physical activity, and stress. It contains over 200 items scored dichotomously. HEcheck aims to help organizations measure and improve their support for employee health and implement health promotion programs and policies.
plains all american pipeline Annual Reports2007 finance13
- Plains All American Pipeline, L.P. (PAA) is a master limited partnership engaged in oil and gas transportation, storage, and marketing.
- In 2007, PAA achieved or exceeded its goals by delivering record financial results, successfully integrating its acquisition of Pacific Energy Partners, completing its largest capital program and acquisitions to date, and increasing distributions paid to unitholders by 14.4%.
- Looking ahead, PAA's goals for 2008 are to deliver strong operating and financial performance, successfully execute its capital program and pursue strategic acquisitions, and increase distributions year-over-year by $0.20 to $0.25 per unit.
1) The document provides financial highlights from Google's Q3 2006 earnings call, including 70% year-over-year revenue growth and plans to acquire YouTube for $1.65 billion in stock.
2) Revenue growth was driven by increased monetization and traffic, with strong growth across advertisers. Operating income and net income reached record levels.
3) Google continued focusing on innovation and user experience while also forming new partnerships with companies like Fox, eBay, and Intuit.
Target Corporation reported financial results for 2007 with total revenues growing 6.5% to $63.4 billion and diluted earnings per share increasing 3.9% to $3.33. Target opened 118 new stores in 2007, including 33 SuperTarget stores, and continued investing in technology, distribution centers, and its second Target.com fulfillment center. Looking ahead, Target will focus on driving top-line growth and managing expenses while continuing to invest in its brand and unique shopping experience.
omnicom group Q2 2006 Investor Presentationfinance22
Omnicom Group presented its financial results for the second quarter of 2006. Revenue grew 7.9% to $2.8 billion compared to the second quarter of 2005. Net income increased 8.1% to $244.1 million. Organic revenue growth accounted for 7.2% of total revenue growth. The company has a $2.4 billion credit facility expiring in 2011 and $1.1 billion in cash, providing $3.5 billion in total liquidity. Acquisition expenditures for the first half of 2006 totaled $151 million. Future earn-out obligations over the next 5 years are estimated at $405 million assuming current performance levels are maintained.
- For fiscal year 2008, Disney reported EPS of $2.28, up slightly from $2.25 the prior year. Excluding certain items, EPS rose 18% to $2.27.
- Revenue increased 7% to $37.8 billion, with growth at Media Networks, Parks and Resorts, and Consumer Products.
- Segment operating income rose 8% to $8.5 billion, with double-digit increases at Media Networks and Parks and Resorts.
- However, Studio Entertainment operating income fell 9% on weaker home entertainment, and Broadcasting lost $150 million in the quarter.
- Yahoo reported Q2'08 financial highlights, with revenue ex-TAC of $1.346 billion, an 8% increase year-over-year but flat quarter-over-quarter.
- Operating cash flow was $427 million in Q2'08, a 10% decrease year-over-year due to costs related to strategic initiatives and a 1% decrease quarter-over-quarter.
- For full-year 2008, Yahoo expects revenue of $7.35-7.85 billion, operating cash flow of $1.825-1.975 billion, and free cash flow of $900 million to $1.05 billion.
The document provides an overview of key economic and political factors that may impact the housing market in 2013, including the fiscal cliff, debt ceiling, Eurozone debt crisis, and state/federal policies. It summarizes housing market trends in Southwest California in 2012, with median home prices rising 9-30% year-over-year in areas like Lake Elsinore and Temecula. Demand remained strong with over 250 homes sold in January 2013 across the region.
Canada's VC Challenge - A statistical overview - August 2012heri
This document analyzes data on Canada's venture capital industry and identifies several challenges it faces:
1) Venture capital investment as a percentage of GDP has steadily decreased in Canada since 2000, while it remains over double the rate in the US.
2) Domestic venture capital fund activity in Canada has remained flat in recent years, while foreign funds have increased their share of investments.
3) Weak fundraising has contributed to flat or declining levels of activity from Canadian venture capital funds, reducing support for high-growth technology companies.
Medicaid spending in New York is projected to grow 36% from fiscal years 2009-2010 to 2012-2013, a rate 67% higher than the average U.S. growth. Spending per Medicaid beneficiary in New York was $7,746 in 2006, over 67% higher than the national average of $4,635. The document compares past and projected Medicaid spending growth in New York to U.S. averages and spending per beneficiary.
The report provides information on recent property sales in the suburb of Dalkeith, Western Australia. It finds that the median house price in Dalkeith is currently $2,405,000, with a 1-year return of -14% and 3-year return of -14%. Recent property sales in Dalkeith have ranged from $1,460,000 to $6,000,000.
Northern Trust had a very strong financial performance in 2005. Net income grew 16% to $584 million and total revenues increased 15% to $2.7 billion. Assets under custody reached a record high of $2.9 trillion, up 15% from 2004, and assets under management grew 8% to $618 billion. Northern Trust continued its global expansion through acquisitions and new offices while maintaining its focus on serving private clients and institutional investors worldwide.
Please visit our online professional network and join our community of Automotive Social Media Marketing professionals at http://www.ADPsocialMarketing.com
Claude Resources Inc. Q4 2012 Conference Call and Webcast PresentationClaude Resources Inc.
Neil McMillan, President and CEO of Claude Resources Inc., presented the company's 2012 financial and operating results on March 28, 2013. Key highlights included net profit of $5.6 million, cash flow from operations of $25.8 million, gold sales increasing 16% to 48,672 ounces, and production reaching a record 49,570 ounces. The presentation also provided details on the company's financial position, debt facilities, operations at Seabee Gold Operation and exploration projects, and production and cost guidance for 2013.
Group 1 Automotive is a leading automotive retailer that has experienced significant growth since its IPO in 1997. In 2002, Group 1 achieved record financial results for the fifth consecutive year, with revenues increasing 5.5% to $4.2 billion and net income growing 21% to $67.1 million. The company attributes its success to its diverse business model across brands, geographies, and revenue streams. Group 1 aims to continue its acquisition strategy in 2003 to further augment its portfolio and leverage its operating platform.
This document summarizes internet advertising revenue results for the first two quarters of 2007. It finds that total revenue for the first half of 2007 was nearly $10 billion, a 26.4% increase from the same period in 2006. Revenue in Q2 2007 reached over $5 billion, marking 25.4% growth compared to Q2 2006. Consumer advertising continues to be the largest spending sector, accounting for 54% of Q2 2007 revenues. Search advertising remains the leading format at 40% of revenues, though display and lead generation are gaining.
Spencer Levy - Capital Markets 2.0 - Did We Speak Too Soon?Ryan Slack
The document discusses recent market trends and statistics for commercial real estate investment sales in the United States. It notes that investment sales in 2011 are on pace to reach 2003-2004 levels across various property types like apartments, hotels, industrial, office, and retail. Transaction volume is up significantly from 2010 but still below peaks seen in 2006-2007. Debt financing for commercial real estate also increased substantially in the first half of 2011 compared to the previous year. The document provides charts and data on investment sales, property types, debt financing, and the breakdown of buyers and sellers in the commercial real estate market.
Northern Trust Corporation's 2006 annual report summarizes the company's financial performance and strategic initiatives. In 2006, Northern Trust achieved record financial results with net income of $665 million, up 14% from 2005. Total revenues increased 14% to $3.06 billion. The company also made progress on key strategic priorities including expanding blended investment solutions, growing adoption of its WealthPassport technology, and completing major acquisitions and migrations of client assets. Northern Trust positioned itself for continued growth by strengthening its presence in high-growth markets like Asia-Pacific and developing new client relationships.
Q1 2010 Shareholder Presentation May 2010Monster12
- American Capital reported net earnings of $1.5 per diluted share in Q1 2010, up from a loss in Q1 2009, driven by $0.92 per share in net unrealized appreciation.
- The portfolio fair value was $5.7 billion as of March 31, 2010, generating $164 million in revenue for Q1 2010.
- Non-accrual loans decreased to $263 million or 7.0% of the total $3.8 billion loan portfolio at fair value.
Venture capital investment in life sciences in Missouri is lower than other Midwestern states like Ohio and Minnesota. In 2011, Missouri saw $168.7 million invested in 9 life sciences companies, compared to over $200 million invested in Minnesota and over $175 million invested in Ohio. The lower levels of venture funding in Missouri can make it challenging for early-stage life sciences companies in the state to access capital needed for research and development. Speakers on the panel discussed strategies for attracting more venture capital to Missouri, including increasing partnerships between investors, entrepreneurs, universities, and industry.
The Knights of Columbus 2011 Investment Review provides information about their investment strategy and performance. They focus on investing in investment grade corporates and agencies across sectors as well as high quality mortgage securities. They avoid risky investments like junk bonds, derivatives, and structured products. Over 2011, their total assets grew to $18 billion with 87.5% in bonds, 2.1% in stocks, and the remainder in real estate and other assets. Their annualized returns over various periods exceeded their peers, with strong credit ratings reflecting their conservative approach.
Google Q4 2012 Quarterly Earnings SummaryKit Seeborg
The document summarizes Google's financial results for Q4 2012. It reports that Google's consolidated revenues grew 36% year-over-year and 8% quarter-over-quarter to $14.4 billion. It also discusses strong revenue growth and cash flow. The document provides details on revenue sources and breakdowns between US vs international revenues. It includes charts showing revenue trends over time and costs like traffic acquisition costs.
- Google reported consolidated revenues of $14.4 billion for Q4 2012, up 36% year-over-year and 8% quarter-over-quarter. Including Motorola Home, revenues were $15.2 billion.
- Google properties revenues increased 18% year-over-year and 12% quarter-over-quarter. Network revenues increased 19% year-over-year and 10% quarter-over-quarter.
- Income from operations on a non-GAAP basis was $4.3 billion, with an operating margin of 30%.
This document provides information about school funding in California. It discusses how revenue limits are calculated based on average daily attendance and local property taxes. It notes that while some districts receive little state aid, categorical funding is being reduced. Charts show declining per-student funding in California compared to top performing states. The document also includes district-specific data on revenues, expenditures, ADA, sources of funding, and expenditure categories. It outlines proposed budget cuts, potential layoffs, and options to resolve a $5 million budget deficit, including school closures. API scores for the district are also shown.
- The document discusses Google's Q3 2006 earnings conference call, reporting 70% year-over-year revenue growth and 10% quarter-over-quarter growth driven by increased monetization and traffic.
- Operating income and net income reached record levels, and the company continued investing in products and infrastructure while forming new partnerships.
- Google agreed to acquire YouTube for $1.65 billion in stock, hoping to enable anyone to upload, watch and share videos worldwide.
- Google reported strong Q3 2006 financial results, with 70% year-over-year revenue growth and 10% quarter-over-quarter growth driven by increased monetization and traffic gains.
- Revenue was $2.69 billion for Q3 2006, with international revenue accounting for 56% of the total.
- Costs of revenue were 39% of total revenue, with research and development accounting for 11.6% and sales and marketing at 7.7% of revenue.
- The acquisition of YouTube for $1.65 billion in stock was announced and expected to close in October.
Diane Watson | Research to improve public confidence and views on quality in ...Sax Institute
Dr Diane Watson, (then International Visiting Health Services Research Fellow at the Sax Institute from the University of British Columbia, Canada) spoke with the HARC network in April 2009 about ways to strengthen public confidence in the hospital system through research and analysis.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
1. A Detailed Look at
U.S. Health Care Spending
Julie A. Schoenman, Ph.D.
National Institute for Health Care Management Foundation
Medical Industry Leadership Institute
Actuarial Seminar Series
October 25, 2012
2. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health Care Spending
3. Spending through Government Entitlement
Programs
4. Spending through Private Health Insurance
5. What’s Behind the High and Rising Spending?
3. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health Care Spending
3. Spending through Government Entitlement
Programs
4. Spending through Private Health Insurance
5. What’s Behind the High and Rising Spending?
4. Total National Health Spending
Continues to Increase
3 $8,402 $9,000
$8,149
National Health Expenditures (trillions) $7,911
$7,628 $8,000
2.5
Per Capita Health Spending $7,251
$6,868 2.6
$6,488 2.5 $7,000
$6,114 2.4
$5,687
2.3
2 2.2 $6,000
$5,241 2.0
$4,878
$4,601 1.9
$4,367 1.8 $5,000
$4,169
1.5 1.6
1.5 $4,000
1.4
1.3
1 1.1 1.2 $3,000
$2,000
0.5
$1,000
0 $0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
% GDP 13.7% 13.7% 13.8% 13.8% 14.5% 15.4% 15.9% 16.0% 16.1% 16.2% 16.4% 16.8% 17.9% 17.9%
NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
5. U.S. Health Spending is a Dramatic
Outlier Internationally
United States
Netherlands
17.4
France
Germany
Denmark
Switzerland
Canada
Austria
Belgium
New Zealand
Sweden
United Kingdom
Iceland
Norway
Spain Most developed
Italy
Ireland
countries spent
Slovenia
Finland
~9.5 to 12% of
Slovak Republic GDP on health
Chile
Czech Republic care in 2009
Israel
Luxembourg
Poland
Hungary
Estonia
Korea
% GDP, 2009
Mexico
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
NIHCM Foundation analysis of data from the Organisation for Economic Cooperation and Development.
6. U.S. Spends More than Expected
Based on Our Wealth
$9,000
United States
Per Capita Health Spending, 2009
$8,000
$7,000
Chile, Mexico, Poland,
$6,000 Estonia, Hungary, Switzerland Norway
Slovak Republic, Czech Luxembourg
$5,000
Republic, Korea, Israel,
$4,000 Slovenia, New Zealand
$3,000
$2,000 Spain, Italy, France, Finland, United Kingdom,
Belgium, Germany, Iceland, Sweden, Denmark,
$1,000 Canada, Austria, Ireland, Netherlands
$0
$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000
Per Capita GDP, 2009
NIHCM Foundation analysis of data from the Organisation for Economic Cooperation and Development.
7. What Does $8,400 Per Person Buy?
Public Health, Investment, $483 16% of spending
Administration, $267 ($1,320) is not
$570 related to personal
health care services
Rx, DME & Hospital Care,
Other Medical $2,637
Products, $1,106
84% of spending
Home Health & ($7,080) is for
LTC, $1,107 MD & Clinical personal health
Services, $1,670
Dentists & care services
Other Health
Professionals,
$560
NIHCM Foundation analysis of data from the 2010 National Health Expenditure Accounts.
8. Health Spending Growth has Slowed,
But Usually Outpaces GDP Growth
16
Health Spending
14 GDP
12
Percent Change from Previous Year
Lowest growth rates in history of
10 National Health Expenditure Accounts
8
6
4
2
0
1961 1966 1971 1976 1981 1986 1991 1996 2001 2006
-2
-4
NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
9. Historically, Health Spending Has Grown
1.0 - 2.5 Percentage Points Faster than GDP
Pct. Points
3.0
1975-2008 1980-2008 1985-2008 1990-2008
2.5
Average Annual Rate of
2.5
“Excess” Cost Growth
2.0 2.2
2.0
1.9 1.9 1.9
1.8 1.8 1.8
1.5 1.7 1.7
1.5
1.4 1.4
1.0 1.2
1.0
0.5
0.0
Medicare Medicaid All Other All Health Spending
HealthSpending
NIHCM Foundation analysis of information presented in CBO’s “The Long-Term Budget Outlook.” Revised August 2011.
10. The Recent Slowdown in Spending
Temporary Blip or Systemic Change?
• Continuation of slowdown underway since 2002
• Factors related to recent slowing in spending:
o Recession
ü Massive loss of jobs and employer-sponsored insurance
ü Declining real income, substantial loss of wealth, people more cautious about spending
ü Reduced demand for health care services, even among those with insurance
o Drugs – ongoing shift to generics, expiring drug patents, fewer new drugs coming on line
o Medicare – provider payment cuts, stabilization in Part D enrollment
o Medicaid – provider payment cuts, higher drug rebates, benefit restrictions
o Ongoing shift to policies with more cost-sharing, employees paying higher share of rising
premiums
• Factors likely to affect future spending:
o Economic recovery, pent-up demand for health care, higher need due to delayed care
o ACA - 2014 coverage expansions and other industry changes
o Aging population
o Delivery/payment system changes emphasizing paying for value, informed consumers
o Ongoing consolidation among providers
Sources: Martin et al. “Growth in US Health Spending Remained Slow in 2010; Health Share of GDP Was Unchanged from 2009.” Health
Affairs, 31(1):208-19, Jan. 2012 & McKinsey Center for U.S. Health System Reform. “Accounting for the Cost of U.S. Health Care.” Dec. 2011.
11. 2011 Uptick
Return to Higher Spending Growth, or Not?
Altarum analysis of monthly health spending data from the Bureau of Economic Analysis.
12. A Growing Share of National Health
Spending is From Public Sources
100%
Other Private Revenues
90%
80% Private
Households
70%
Private Sources
Sources = 55%
60% = 68%
50% Private Business
40%
30%
Public Federal Government Public
20% Sources Sources
= 32% = 45%
10%
State and Local Government
0%
1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
13. A Closer Look at Public & Private
Health Care Spending, 2010
Private Sources (55%) Public Sources (45%)
Total Spending by Private Sources $1,430 B Total Spending by Public Sources $1,164 B
Private Business (20.6%) Federal Government (28.6%)
Private Health Insurance Premiums $414.1 Private Health Insurance Premiums $28.5
Medicare Payroll Taxes $79.7 Medicare Payroll Tax $4.0
Workers Compensation, Disability Direct Medicare Program Spending $254.0
Insurance & Worksite Health $40.7
Direct Medicaid Program Spending $278.1
Households (28.0%) All Other Health Spending $178.0
Private Health Insurance Premiums $263.1
State/Local Government (16.2%)
Medicare Payroll Taxes and Premiums $162.8
Private Health Insurance Premiums $134.1
Out of Pocket Spending $299.7
Medicare Payroll Tax $11.4
Other Private Sources (6.6%) Direct Medicaid Program Spending $135.9
Philanthropy, Investment, Etc. $169.9 All Other Health Spending $139.6
Source: NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
14. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health
Care Spending
3. Spending through Government Entitlement
Programs
4. Spending through Private Health Insurance
5. What’s Behind the High and Rising Spending?
15. A Word about Data Sources
National Health Expenditure Accounts Medical Expenditure Panel Survey
(NHEA) (MEPS)
Synthetic database derived from myriad Annual survey of households about
secondary sources their health spending
Covers total US population, including Covers civilian, non-institutionalized
military, nursing home residents, etc. population
Includes expenditures beyond personal Designed to capture payments from all
health care services (e.g., public health, sources (public, private, self-pay) for
research, investments in infrastructure, personal health care services
administration)
Latest available year is 2010 Latest available year is 2009
Total spending reported = $2.594T Total spending reported = $1.259T
16. Relatively Few People Account
for Most Personal Health Spending
100 100.0
90 Top 1% of spenders account for >20% of spending ($275 billion)
Cumulative Percent of Total Spending
80 78.2
70 Top 5% of spenders account for almost half of spending ($623 billion)
60
50 Total Personal Health Care Spending
50.5
= $1.259 Trillion
40
34.8
$36 Billion $1,223 Billion
30
18.8
20
10.4
10 5.6
1.3 2.9
0.0 0.1 0.4 95 99
0 15.4
0 10 20 30 40 50 60 70 80 90 100
Percent of Civilian Non-Institutionalized Population Ordered by Health Care Spending
NIHCM Foundation analysis of data from the 2009 Medical Expenditure Panel Survey.
17. Greatest Potential for Savings
Focus on High Spenders
$100,000
Total spending by top 1% $90,061
$90,000 = $275 billion
$80,000
Mean Annual Expenditure
$70,000 Total spending by top 5%
= $623 billion
$60,000
Total spending by top 10%
$50,000 = $821 billion
Total spending $40,682
$40,000 by bottom 50%
$30,000 = $36 billion $26,767
$20,000
$12,265
$10,000
$7,980
$236
$0
Lowest 50% Top 50% Top 30% Top 10% Top 5% Top 1%
30.7M pop. 15.3M pop. 3.06M pop.
Percent of Civilian Non-Institutionalized Population Ordered by Health Care Spending
NIHCM Foundation analysis of data from the 2009 Medical Expenditure Panel Survey.
18. High Spenders are Older
100% 1.4
2.7
90% 7.0
21.1 24.8
12.5
80% 75+
70% 14.0 17.1 65-74
15.1
55-64
60%
45-54
50% 27.8 22.1
26.1 35-44
40% 19-34
30% 16.2 0-18
13.2
20% 8.7
34.5 7.3
10% 8.5 5.9
6.3 7.6
0%
Lowest 50% Top 5% Top 1%
NIHCM Foundation analysis of data from the 2009 Medical Expenditure Panel Survey.
19. High Spenders
Report Worse Health
100% 0.8
4.3
90% 18.5
26.0
22.1
80%
70% 25.2
Poor
60% 31.4
32.3 Fair
50%
Good
40% 28.9
Very Good
30% 23.4
Excellent
20% 40.4
19.9
10% 13.4
7.5 5.8
0%
Lowest 50% Top 5% Top 1%
NIHCM Foundation analysis of data from the 2009 Medical Expenditure Panel Survey.
20. High Spenders Have More Chronic
Conditions & Functional Limits
100% 1.9 1.3
3.4
90% 8.2
31.5
80%
Functional limitation only
70% 36.5
Chronic condition, help with
60%
ADLs
50% 28.9
Chronic condition, functional
limitation
40%
Chronic condition only
30%
50.0 30.9
20% No chronic condition, no
functional limitation
10%
7.4
0%
Other 95% Top 5% Spenders
NIHCM Foundation analysis of data contained in The Lewin Group, "Individuals Living in the Community with Chronic
Conditions and Functional Limitations: A Closer Look," January 2010.
21. Considerable Persistence in
Spending Patterns Over Two Years
80%
73.9% 75.0%
Percent with Same Ranking in 2009
70%
63.1%
60% 54.4%
50% 44.8%
40%
38.0%
30%
20.0%
20%
10%
0%
Bottom 50% Top 50% Top 30% Top 20% Top 10% Top 5% Top 1%
Percentile Rank by Health Care Spending, 2008
Source: Cohen SB and Yu W. "The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S.
Population, 2008-2009." Agency for Healthcare Research and Quality, Statistical Brief #354. January 2012.
22. Persistent High Spenders:
Older People & Those Whose Health Remains a Problem
Age (end of 2009) Health Status (end of 2008)
100 100 6.1
90 19.2 90
13.2 24.8
80 42.9 80
70 70
26.4 65+ 27.3 Excellent
60 45-64 60 30.9 Very Good
50 30-44 50 Good
27 18-29 40 Fair
40
40.1 29.6
0-17 Poor
30 30 26.9
20 16.6 20
10 10.6 3.1 10 23.9 14.1
3.4 10.9 3.3
0 0
Top 10% in both years Top 10% in 2008, Top 10% in both years Top 10% in 2008,
Bottom 75% in 2009 Bottom 75% in 2009
Of top 10% of spenders in 2008:
44.8% remained in top 10% and 25.4% moved to the bottom 75% in 2009
Source: Cohen SB and Yu W. "The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S.
Population, 2008-2009." Agency for Healthcare Research and Quality, Statistical Brief #354. January 2012.
23. Long-Term Persistence of High Spending
Among Medicare Beneficiaries
100
90
Bottom 75% Top 25%
80
Died by Jan. 1 Not in FFS
70
60
50
40
30
20
10
0
1993 1994 1995 1996 1997 1998 1999 2000 2001
Source: Congressional Budget Office. “High-Cost Medicare Beneficiaries.” May 2005.
24. Challenges of Controlling
Costs Among High Spenders
• Chronic health problems and persistence in high spending imply a role for disease
management. But…
• many of the same chronic problems are also highly prevalent in lower-spending groups,
especially among the elderly
• accurate prospective targeting of those who can most benefit from disease management can
be tricky
• Managing high spending at the end of life can be problematic
• not all with high spending will die soon
• predicting timing of death and distinguishing between care that could extend life in a
meaningful way and care that does little good is often very difficult
• societal reluctance to discuss end of life care, fears of rationing
• Not all high spending is predictable or persistent.
• hard to control the random events
• may be able to manage some episodes more efficiently (e.g., clinical pathways for cancer)
25. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health Care Spending
3. Spending through Government
Entitlement Programs
4. Spending through Private Health Insurance
5. What’s Behind the High and Rising Spending?
26. Government Health Entitlement Programs
36 Percent of National Health Spending in 2010
Investment, 6%
Public Health, 3%
Other Third Party
Payers & Programs, Out of Pocket,
7% 12%
DOD & VA, 3%
Medicaid & CHIP = Private Health
$413.1B, 16% Insurance, 33%
Medicare = $524.6B,
20% 2010 Total Spending = $2.594 T
NIHCM Foundation analysis of data from the 2010 National Health Expenditure Accounts.
27. Government Health Entitlement Programs
21 Percent of U.S. Federal Spending in 2011
Federal Revenues Federal Spending ($3.598T)
($2.302T, excluding borrowing) 6% Net Interest
18%
Non-Defense
Discretionary
19% Defense
6% Discretionary
Other Revenue
15% Other Mandatory
23% Spending
Payroll Taxes
Social Security
5% 20%
Corporate Income
Taxes Medicaid & Other
30% 8% Health Entitlements
Individual Income 21% 13% Medicare
Taxes
Borrowing (Deficit)
36%
NIHCM Foundation analysis of data from CBO’s “The Budget and Economic Outlook: Fiscal Years 2012 to 2022,” Jan. 2012.
28. Structure of the Medicare Program
PART A • Hospital Insurance (HI) Trust Fund
Inpatient & • Mandatory program
Post-Acute Care • Eligible if > 40 quarters of covered employment (self/spouse)
• Payroll tax, SS income tax if high income, premiums if
buying into program, interest on Trust Fund reserves
PART B • Supplemental Medical Insurance (SMI) Trust Fund
Physician & • Voluntary programs
Outpatient Care • Premiums from enrollees (~25% of program costs)
• Fees on manufacturers/importers of brand name drugs (B)
PART D • Transfers from state Medicaid programs (D)
Outpatient Rx • General revenues (balance SMI Trust Fund each year)
PART C • Capitated arrangements with private health plans
Managed Care • Financed from both trust funds
29. Current Claims on the Part A Trust
Fund Require General Revenues
% of Taxable Payroll
7%
A Pay-As-We-Go System
Part A Expenditures
Part A Operating Deficit: Baby boomers retiring
6% ~10,000/day
Covered by Redemption of
Trust Fund Assets, Requiring
5% General Revenues
Part A Income
4%
2024: Part A Trust Fund Exhausted
3%
2%
Periods of Operating Surplus:
Trust Fund Assets Accumulate
1%
and are Lent to the Federal
Government, Earning Interest
0%
1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080
Source: A Summary of the 2012 Annual Reports, Social Security and Medicare Boards of Trustees, www.ssa.gov/OACT/TRSUM
30. The Big Picture for Medicare:
Dedicated Revenue < Expenditures
%GDP
historical projected
7% Total Medicare Expenditures
Part A Trust
Fund Deficit
6% Part A
Trust
Fund
Non-interest program income
5% exhausted
4% General Revenue Transfers to Parts B & D
3%
Premiums, State Transfers, & Drug Fees
2%
1% Tax on SS
Payroll Tax Benefits
0%
1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080
Source: A Summary of the 2012 Annual Reports, Social Security and Medicare Boards of Trustees, www.ssa.gov/OACT/TRSUM
31. A Beneficiary Lifetime Perspective:
Payroll Contributions < Expected Benefits
$400,000
Medicare Expected Benefits (Net of $357,000 $357,000
$350,000 Premiums), Lifetime
$300,000 Medicare Payroll Taxes, Lifetime
$250,000
$200,000 Female $188,000
Male $170,000
$150,000
$119,000
$100,000
$60,000 $60,000
$50,000
$0
Single, Average Wage
Single, Average Wage One-Earner Couple, Average Wage
One-Earner Couple, Two-Earner Couple, Average Wage
Two-Earner Couple,
Average Wage Average Wages
Source: Steuerle CE and Rennane S. "Social Security and Medicare Taxes and Benefits Over a Lifetime.” Washington, DC: The
Urban Institute. June 2011.
32. But the Public Perception is Very
Different from Reality
Thinking about Medicare, do you believe that over the course of your
career you [will] have paid…
Not enough, others will support me Enough to support myself More than I'll receive
56+ 32% 34% 34%
36-55 21% 30% 49%
18-35 13% 29% 58%
All Ages (18+) 21% 31% 49%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: Stony Brook Poll, December 2010. http://tinyurl.com/9qteyxm
33. Structure of the Medicaid Program
• Covers ~60 million low-income individuals
• Jointly financed by states and federal government
• Voluntary program for states, all now participate
• Categorical eligibility: children, pregnant women, parents with dependent
children, people with disabilities, seniors (income thresholds vary by category)
• States run their programs; must meet federal standards but can deviate with a
waiver or exceed standards using own funds
• Very few states have expanded to cover “childless adults”
• ACA removed categorical eligibility and expanded eligibility to all non-elderly
persons under 138% FPL
• Supreme Court decision makes this expansion optional for states
34. Medicaid
Enrollment vs. Spending, FY 2009
100%
90% 15%
1/4
80% 10% 43% $15,453 per enrollee
70% 2/3
60% 26%
50% $13,186 Disabled
23%
40%
Elderly
30% 14% $2,926
49%
20% Adults (<65)
10% 21% $2,313
Children
0%
Enrollees Spending
~15% of enrollees ~40% of spending
are dual eligibles is for dual eligibles
Source: Kaiser Family Foundation, “The Medicaid Program at a Glance.” September 2012.
35. Medicaid Spending is a Large and
Growing State & Federal Burden
Total State Expenditures, FY2011 (estimated) Total Medicaid Spending ($billions)
450
400 Federal Spending 273
State Spending 251
350
201
Medicaid 191
All Other 300 181
Spending
24% 176 182 63-64%
34% 162 ARRA
250
148
200 130
118 56-57%
K-12 150
Education 150 158 147 156
133 137 142
20% 100
112 122
Public 89 98
Assistance Higher 50
2% Education
10% 0
Corrections Transport
3% 2000 2002 2004 2006 2008 2010
7%
NIHCM Foundation depiction of data from National Association of State Budget Officers. “State Expenditure Report.” Dec. 2011.
36. Mandatory Federal Health Spending
Projected to More Than Double in 10 Years
$ billions Exchanges
Medicaid
$1,800 Medicare (net offsetting receipts) 6.7% 7.0%
6.2% 6.4%
Other Mandatory Health Spending (net) 6.1%
$1,600 Percent of GDP 5.8% 5.8% 123
6.0%
118
$1,400 5.8%
5.5% 111
5.1% 5.3% 101 107 592
5.0%
$1,200 4.9% 91
4.7% 75 549
$1,000 46 514 4.0%
479
24 446
1 382 416
$800 3.0%
341
305
$600 275 253 267
899 2.0%
$400 750 806
632 696
539 589 608
480 466 494 514 1.0%
$200
45
$0 0.0%
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
actual
NIHCM analysis of data from CBO’s “An Update to the Budget and Economic Outlook: Fiscal Years 2012 to 2022,” Aug. 2012.
37. And That’s the Good News
• CBO’s baseline projections assume current laws remain in place
and will be implemented as written, most notably:
• Deep cuts in Medicare physician payment rates under the SGR
formula
• 2% reductions in Medicare payment rates under Budget Control Act
sequestration
• Cuts in Medicare provider payment updates under the ACA
• Overriding any of these cuts will increase Medicare spending
• Other big unknowns:
• extent to which states will expand Medicaid (implications for Federal
match)
• extent to which people will seek subsidized coverage in the exchanges
38. Faster Growth in Health Entitlement Spending
Will Dramatically Worsen Projected Deficit
10 historical projected
Primary Surplus (+) or Deficit (-) as % of GDP
5
0
Growth at GDP
-5
-10 GDP + 1%
-15
GDP + 2%
-20 (~Historical Average)
-25
2000 2010 2020 2030 2040 2050 2060 2070 2080
Source: “2011 Fiscal Report of the U.S. Government.” Supplemental Information, Chart 5,
http://www.fms.treas.gov/finrep11/supp_info/fr_supplement_info_alternative.html#chart5
39. Triangle of Painful Choices
Tradeoffs Needed to Balance Budget by 2035
Health Spending Growth Relative to Potential GDP
10%
-4% -3% -2% -1% 0% +1%
A
9% B
Defense & Other Non-Health
8%
Spending as % of GDP
D
7%
6%
5%
4%
3%
C
2%
18% 19% 20% 21% 22% 23% 24% 25%
Tax Revenue as % of GDP
Source: Roehrig, C. Altarum Center for Sustainable Health Spending. As presented in The Incidental Economist Blog, Aug. 15, 2012.
40. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health Care Spending
3. Spending through Government Entitlement
Programs
4. Spending through Private Health
Insurance
5. What’s Behind the High and Rising Spending?
41. Private Health Insurance Premiums
One-Third of National Health Spending, 2010
Investment, 6%
Public Health, 3%
Other Third Party
Payers & Programs,
7% Out of Pocket,
12%
DOD & VA, 3%
Private Health
Medicaid & CHIP, Insurance = $848.7B,
16% 33%
Medicare, 20% 2010 Total Spending = $2.594 T
NIHCM Foundation analysis of data from the 2010 National Health Expenditure Accounts.
42. Private Health Insurance Markets
Employer-Based or Group Market Individual or Non-Group Market
• Coverage purchased by employer for • Coverage purchased directly from insurer
workers, dependents and, perhaps, retirees.
• Individual/family is own risk pool. Health
• Risks pooled by employer group. underwriting and pre-existing conditions
can make coverage expensive or unavailable.
• Employers and employees generally
contribute to premium • Purchaser pays full premium.
• Premiums excluded from taxes in most • Preferential tax treatment of premiums only
cases. Value of tax exclusions = $145 billion for self-employed
in 2011.
• Most people purchasing coverage in this
• Small, medium, large group based on market do not have access to employer-
number of employees based coverage
• self-employed
• 60 percent of workers with employer-based • employed but not offered coverage
coverage were in “self-insured” plans (2012) • non-dependent students
• Larger employers most likely to self insure, • early retirees
but growing trend among smaller employers • between jobs
43. Private Coverage is Dominated by
Employment-Based Insurance
100% Govt. employer
90% contributions
(20.4%)
80%
70% Private
60% employer
89.2% 94.9% contributions
50% (52.0%)
40%
Employer-
30% Based
Employee
20% contributions Coverage
(27.6%) Individual
10%
10.8% Market
5.1%
0%
Enrollees Premiums
174.4M (2011) $839.8B (2010)
Sources: Fronstin P. “Sources of Heath Insurance…” EBRI Issue Brief 376, Sept. 2012; NIHCM analysis of data from the 2010
National Health Expenditure Accounts, Sponsor Highlights.
44. Private-Sector Workers Paying an
Increasing Share of Increasing Premiums
Employment-Based Coverage
Individual Policy Family Policy
16000 150% 16000 146% 150%
142%
14000
$15022
14000
122%
12000 12000 114%
97%
100% 100%
10000 10000
8000 87%
8000 $6772
6000 $5222 6000
50% 50%
4000 4000
$2655
2000 2000
0 0% 0 0%
2000 2002 2004 2006 2008 2010 2000 2002 2004 2006 2008 2010
Employee (EE) Contribution to Premium Employer (ER) Contribution to Premium
Cumulative Pct. Change, EE Contribution Cumulative Pct. Change, ER Contribution
Cumulative Pct. Change, Total Premium
Source: NIHCM analysis of data from the Medical Expenditure Panel Survey, Insurance Component. Data not available for 2007.
45. And Facing Higher Out-of-Pocket Costs
via Deductibles
Average Deductible for those with a Deductible - Individual Policy
78% 78%
$2,500 Average Deductible for those with a Deductible - Family Policy 74%
80%
Percent of Enrollees with a Deductible 71% $2,220
70%
$1,975
$2,000 59% 66%
64% $1,761 60%
52% $1,658
48%
50%
$1,500 $1,351
$1,232
$1,143 $1,123 40%
$1,079 $1,025
$958 $917
$1,000 $869 30%
$714
$652
$573
$518 20%
$446
$500
10%
$0 0%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: NIHCM analysis of data from the Medical Expenditure Panel Survey, Insurance Component. Data not available for 2007.
46. Health Spending by American Families
More Than Doubled in Past Decade
Family of Four, Employer-Based PPO Coverage
$21,000 $20,728
Employee Out-of-Pocket Costs $19,393
$18,074 3470
Employee Contribution to Premium
$16,771 3280
Employer Contribution to Premium $15,609 3005
$14,500 2820
2675 5114
$14,000 $13,382 4728
$12,214 2420 4325
$11,192 2210 4004
$10,168 2035 3492
1920 3171
$9,235 2810
1760
1580 2666
2522
$7,000 2354
2055
11385 12144
9947 10744
8909 9442
7513 8362
6054 6750
5600
$0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Source: NIHCM Foundation analysis of data presented in the annual Milliman Medical Index reports, 2005-2012. Values for
component parts for 2002-2005 were estimated using component growth rates reported by Milliman.
47. Premiums and Deductibles Also Continue
to Rise in the Non-Group Market
Individual Policy Family Policy
4968
$5,000 80% $5,000 80%
4596 4704
71% 4392 4428 69%
$4,500 $4,500
70% 70%
4128
$4,000 $4,000 3888
60% 3879 60%
$3,500 $3,500
2935 50% 50%
$3,000 $3,000 3128
2632 3531
2760
$2,500 40% $2,500 2610 40%
2084 2486
1972 2326 2294
$2,000 1864 2196 $2,000 28%
1721 2004 30% 30%
1896 1908
1728 1776 1932 $1,500
$1,500 27%
20% 20%
$1,000 $1,000
10% 10%
$500 $500
$0 0% $0 0%
2005 2006 2007 2008 2009 2010 2011 2005 2006 2007 2008 2009 2010 2011
Mean Annual Premium Mean Deductible
Cumulative Pct. Change - Premium Cumulative Pct. Change - Deductible
NIHCM Foundation analysis of data contained in eHealthInsurance reports “The Costs and Benefits of Individual and Family
Health Insurance Plans” (Nov. 2008 and Nov. 2011) and “2009 Summer Cost Report for Individual and Family Policy Holders.”
48. High-Deductible Health Plans
are Becoming Much More Prevalent
Health Plan Enrollment by Plan Type for Covered Workers
2005
2006
Conventional
2007
2008 HMO
2009 PPO
2010 POS
2011
HDHP/SO
2012
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Health Plan Enrollment by Plan Type for Privately Insured Individuals
2005
2006
2007 Traditional
2008 HDHP
2009
CDHP
2010
2011
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Sources: Kaiser Family Foundation/Health Research & Educational Trust. “Employer Health Benefits, 2012 Annual Survey.” Sept.
2012 (top graph); Employee Benefit Research Institute. “Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care
Survey.” EBRI Brief No. 365, Dec. 2011 (bottom graph).
49. HSA-Qualified HDHP Enrollment Rising
Especially in the Large Group Market
2005 1.0
Individual
2006 Small Group
2007 Large Group
2008 Group, Size Not Known
2009 Market Not Known
2010
2011
2012 13.5
0 2 4 6 8 10 12 14 million
2005 64% 17% 19%
2006 42% 25% 33%
2007 26% 25% 49%
Individual
2008 25% 30% 46%
Small Group
2009 23% 30% 47%
Large Group
2010 21% 30% 50%
2011 21% 24% 55%
2012 18% 22% 59%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: America’s Health Insurance Plans. “January 2012 Census Shows 13.5 Million People Covered by HSA/HDHPs.” May 2012.
50. Health Care Premiums Growing
Quickly as a Share of Personal Income
• Employee share of premium up 63%.
• Per-person deductibles doubled.
Source: Schoen C, Fryer AK, Collins SR and Radley DC. “State Trends in Premiums and Deductibles, 2003-2010: The Need
for Action to Address Rising Costs.” The Commonwealth Fund, November 2011.
51. Insurance Premiums Pay for
Health Care Services for Enrollees
Net Cost
of
Personal Health Care Services (88%) Insurance
34 28 14 9 3 12
Physician & Clinical Rx &
Hospital Care Services DME
Dental & Other
Professional
Total Private Insurance Premium Revenue = $848.7B Services
Home Health & Other
LTC Facilities & Services
NIHCM Foundation analysis of data from the 2010 National Health Expenditure Accounts.
52. Net Cost of Health Insurance
• Defined by NHEA framework as the difference between premiums collected
and benefits paid out
• All administrative costs
• Claims processing
• Sales and marketing
• Member enrollment and customer service
• Actuarial analysis and underwriting
• Product development and provider contracting
• Medical management
• Quality improvement
• Wellness programs
• Rate credits to policyholders and dividends to stockholders
• Taxes to government
• Additions to reserves
• Profits (or losses)
53. Private Health Insurance Spending Rose
Almost 15 Percent in Five Years
$900
14.7% increase
$848.7 billion
$800
$740.2 billion 102.7 Net Cost of Insurance
[-------- Personal Health Care Spending ---------]
23.5
$700 99.6 75.8 Home Health & Other LTC
$ Billions
19.5 Facilities & Services
$600 66.3 121.4 Dental & Other Professional
Services
88% of Premiums
$500 106.0
Prescription Drugs & DME
$400 239.4
Physician & Clinical Services
211.4
$300
Hospital Care
$200
285.8
$100 237.5
$0
2006 2010
Source: NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
54. Higher Spending for Hospital & Physician Services
Drove More than 70 Percent of the Premium Growth
$120 3% of net
4% of net
9% of net change
change
14% of net change
$3.1
2006 to 2010 Change ($ Billions)
$100 change $9.5 $4.0
26% of net
$80 change $15.4
$60 45% of net $28.0
change $108.5
$40
97 percent of change in premiums
$20
$48.3 was due to growth in insurers’
spending for health care services
$0
Hospital Care Physician & Prescription Dental & Other Home Health & Net Cost of Total Change in
Clinical Services Drugs & DME Professional Other LTC Health Insurance Premiums
Services Facilities &
2006-2010 Services
% Change 20.3% 13.2% 14.5% 14.3% 20.5% 3.1% 14.7%
Source: NIHCM Foundation analysis of data from the National Health Expenditure Accounts.
55. What We Will Cover Today
1. Big Picture Orientation
2. Distribution of Personal Health Care Spending
3. Spending through Government Entitlement
Programs
4. Spending through Private Health Insurance
5. What’s Behind the High and
Rising Spending?
56. Deconstructing the
Rising Health Spending
Spending increases may be driven by:
• unit price effect - rising prices per unit of service
• volume or utilization effect - higher volume of
services, due to
• more users of services and/or
• more services used per capita
• intensity or service mix effect - shift to more
expensive mix of services or to more expensive
providers
57. It Really is the Prices (Stupid)
Evidence from Massachusetts, 2007-2009
Decomposition of Spending Growth for Privately Insured Patients
Change in Total Number of Stays/ Shift to More
Spending Pure Price Effect Services Expensive Providers Service Mix
7.3%
6.5% 6.4%
Inpatient 5.7%
Stays 1.0% 1.1%
0.2% 0.3%
9.4% -0.5%
-2.1%
Hospital 4.6% 5.1% 5.5%
3.9%
Outpatient
Care 0.1% 0.1% 0.3% 0.2%
-1.3%
2007-2008 2008-2009
Source: Massachusetts Division of Health Care Finance and Policy. “Massachusetts Health Care Cost Trends: Trends in Health
Expenditures.” June 2011.
58. It Really is the Prices (Stupid)
Evidence from Several National Payers, 2010-2011
Per Capita Spending Unit Price Utilization Intensity
9.6
10.0
Percent change, 2010-2011
5.9 7.2
5.0 6.2
3.5 3.7
4.9 4.5
2.1 1.6
1.0 1.2
0.0
-0.6 -0.3 -0.4
-5.0 -4.2
Inpatient Care Outpatient Visits Other Outpatient Professional Procedures
Source: Health Care Cost Institute, “Health Care Cost and Utilization Report: 2011,” September 2012.
59. U.S. Pays More for Hospital Services
Select Countries & Services
(US$, 2007)
$34,358
$35,000
Australia
$30,000
Canada
$25,000 France
Sweden
$20,000 United States $21,218
$17,406
$15,000
$11,162
$10,000 $7,962 $8,917
$4,451 $4,558
$5,000 $3,093
$2,591
$0
Normal Delivery Appendectomy CABG Hip Replacement Hernia Repair
Source: Koechlin F, Lorenzoni L and Schreyer P. “Comparing Price Levels of Hospital Services Across Countries.” OECD
Health Working Papers No. 53, July 2010.
60. U.S. Pays More for Hospital Services
Composite Index, 29 Inpatient Services
Comparative Price Levels, Hospital Services, 2007
United States 164
Italy 140
Australia 123
France 121 U.S. hospital
Sweden 114 prices 64%
Canada 113 higher than
Finland 98 OECD average
Portugal 85
Israel 62
Slovenia 59
Korea 57 OECD Average
0 20 40 60 80 100 120 140 160 180
Source: Koechlin F, Lorenzoni L and Schreyer P. “Comparing Price Levels of Hospital Services Across Countries.” OECD
Health Working Papers No. 53, July 2010.
61. U.S. Pays Physicians More for the Same Services
Especially Private Payers and Specialty Care
Primary Care - Office Visit Fees Specialty Care – Hip Replacement
$140 133 $4,500
129
3,996
$4,000
$120
104 $3,500
$100
$3,000
$80 $2,500
66 2,160
59 60 1,943
$60 $2,000
1,634
46 45
$1,500 1,251 1,340
$40 34 32 34 1,046
$1,000 674 1,181
$20
$500 652
$0 $0
Public Payers Private Payers Public Payers Private Payers
Australia Canada France Germany UK US Australia Canada France Germany UK US
Source: Laugesen MJ and Glied SA. “Higher Fees Paid to US Physicians Drive Higher Spending for Physician Services Compared
to Other Countries.” Health Affairs, 30(9):1647-56. September 2011.
62. U.S. Physicians Earn More
Particularly Specialists
$500,000
Australia Canada France Germany UK US
442,450
$450,000
$400,000
$350,000 324,138
$300,000
$250,000
208,634
186,582 187,609 202,771
$200,000
159,532 154,380
$150,000 125,104 131,809
92,844 95,585
$100,000
$50,000
$0
Primary Care Physicians Orthopedic Surgeons
Source: Laugesen MJ and Glied SA. “Higher Fees Paid to US Physicians Drive Higher Spending for Physician Services Compared
to Other Countries.” Health Affairs, 30(9):1647-56. September 2011.
63. Summary and Implications
• Health care spending is a heavy and increasingly
unmanageable burden to federal and state governments,
employers and individuals.
• Recent slowing in health spending growth offers a ray of
hope. But is the slowdown sustainable?
• Real and sustained gains in efficiency and value will be needed to offset
the demographic and other pressures driving health spending upward.
• The highly concentrated nature of personal health care
expenditures suggests a strategy for controlling spending.
But there are real challenges in managing the care of high
spending patients.
64. Summary and Implications
(continued)
• Private premium increases are driven by underlying increases
in spending for medical care for enrollees. Controlling
spending for hospital and physician/clinical services will be
essential to moderating growth in private premiums.
• We pay more than other countries for the same services, and
rising prices have been the dominant factor behind our
growing spending. Attention to these high prices is
warranted.
• Sizing the challenge is the easy part. Finding real solutions
is much harder.
65. For more information or
additional hard copies of our publications,
please contact me or visit our website:
jschoenman@nihcm.org
202-296-4192
www.nihcm.org