Health Insurance or Groceries? Health Care Trends: Analysis of Real Changes in U.S. Health Care and Health Insurance Costs from 1998 to 2008, Zpryme

Health Care Trends
Analysis of Real Changes in U.S. Health Care and Health Insurance Costs from 1998 to 2008

Abstract:
The purpose of this report is to assess real changes in the costs of health
care and health insurance in the U.S. and in 18 major metropolitan
areas in the U.S. from 1998 to 2008. Additionally, this report identifies
age groups that have experienced the largest increases in their health
care costs and health insurance costs during this time period.

FOR MORE INFORMATION
www.zpryme.com Published: January 2010

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Table of Contents
Summary of Key Findings ............................................................................................................................................................................................................................... 2
U.S. Health Care Costs .................................................................................................................................................................................................................................... 5
U.S. Health Care Costs by Age ..................................................................................................................................................................................................................... 6
U.S. Health Insurance Costs by Age .............................................................................................................................................................................................................. 7
Health Insurance as a Percent of Total Health Care Costs ....................................................................................................................................................................... 8
U.S. Changes in Income, Health Care, and Health Insurance Costs ........................................................................................................................................................ 9
U.S. Health Care Costs as a Percent of Income ........................................................................................................................................................................................ 10
Western Metro Areas .................................................................................................................................................................................................................................... 11
Northeastern Metro Areas ............................................................................................................................................................................................................................ 12
Southern Metro Areas ................................................................................................................................................................................................................................... 13
Midwestern Metro Areas .............................................................................................................................................................................................................................. 14
U.S. Metro Area Income Changes ............................................................................................................................................................................................................... 15
U.S. Metro Area Health Care Cost Changes ............................................................................................................................................................................................ 16
Differences Between Health Care Cost and Income Changes ............................................................................................................................................................... 17
Health Care Costs as a Percent of Income by Metro Area .................................................................................................................................................................... 18
U.S. Metro Area Health Care Costs ............................................................................................................................................................................................................ 19

Disclaimer
These materials and the information contained herein are provided by Zpryme Research & Consulting, LLC and are intended to provide general information on a particular subject or subjects and is not an exhaustive treatment
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Health Care Insight

“ Clearly, getting spiraling health insurance costs under control is the key to
stabilizing health care costs for all Americans.

Some Americans have seen their incomes grow just as fast as or faster than their
health care costs. Thus the financial adversity caused by increasing health care
costs is not equally shared among all Americans.

Americans now have to make more incremental economic choices such as paying
their insurance co-payment to see a doctor or to purchase a day’s worth of
groceries for their family. In fact, Americans age 65 and above are most likely to
face such economic choices as their health care costs as a percent of their income
are almost three times higher than other Americans.

—Jason S. Rodriguez, Zpryme CEO & Director of Research


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Purpose

The purpose of this report is to assess real changes in the costs of health care and health insurance in the U.S. and in 18 major metropolitan areas in
the U.S. from 1998 to 2008. Additionally, this report analyzes the change in average annual income for U.S. consumers. Last, this report identifies age
groups that have experienced the largest increases in their health care costs and health insurance costs from 1998 to 2008.

Inflation Adjustment and Data Sources

In this analysis Zpryme standardized U.S. historical annual average income, health care costs, and health insurance costs from 1998 to 2008 using the
Consumer Price Index (CPI) for urban consumers. In this analysis all values are converted to 2008 constant dollars. Due to inflation, the purchasing
power of the dollar changes over time, so in order to compare dollar values from one year to another they need to be converted to constant dollar
values. By adjusting for inflation, we can uncover the real growth in annual average health care costs and health insurance costs from 1998 to 2008.
Data for this analysis was obtained from the U.S Bureau of Labor Statistics Consumer Expenditure Survey and Consumer Price Index.

Summary of Key Findings

 In 2008, health insurance costs accounted for 56.0% of total health care costs versus 48.0% of total health care costs in 1998.
 From 1998 to 2008, inflation adjusted health care costs for consumers age 55-64, 65-74, and 75 and up increased by $975, $905, and
$532, respectively.
 From 1998 to 2008, inflation adjusted health insurance costs for consumers age 65-74 and 75 and up increased by $855 and $798,
respectively.
 From 1998 to 2008, health insurance costs as a percent of total health care costs increased across all age groups in this analysis.
 From 1998 to 2008, among all U.S. consumers, inflation adjusted income, health care, and health insurance costs increased by 16.0%, 18.0%,
and 37.0%, respectively. Health care and health insurance costs increased the most among 55-64 year-olds.
 In 2008, health care costs as a percent of total income were highest among consumers age 65 and up.
 From 1998 to 2008, Cleveland, Seattle, San Francisco, Boston, Phoenix, and Minneapolis-St. Paul experienced the greatest increase in their
health care costs relative to their increase in income.
 After adjusting for inflation, 16 out of the 18 U.S. metro areas in this analysis experienced an increase in their health care costs from 1998 to
2008.
 All 18 U.S. metro areas in this analysis experienced an increase in their average annual income from 1998 to 2008.
 From 1998 to 2008, health care costs as a percent of total income increased for 10 of the metro areas in this analysis and decreased for 8 of
the metro areas in this analysis.


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U.S. Health Care Costs
From 1998 to 2008, U.S. inflation adjusted health care costs increased from $2,514 to $2,976. During this time period, inflation adjusted health
insurance costs increased from $1,206 to $1,653. In 2008, health insurance costs accounted for 56.0% of total health care costs versus 48.0% of total
health care costs in 1998.

Annual Average U.S. Health Care and Health Insurance Costs, 1998 – 2008
(inflation adjusted to 2008 constant dollars)
$3,500

$3,000 $2,954 $2,963 $2,976
$2,934 $2,937
$2,813 $2,828
$2,653
$2,583
$2,500 $2,514 $2,532

$2,000

$1,653
$1,565 $1,604
$1,500 $1,518 $1,500
$1,465
$1,398
$1,290
$1,206 $1,193 $1,229

$1,000

$500

$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Health care Health insurance

Data: U.S Bureau of Labor Statistics: Consumer Expenditure Survey and Consumer Price Index (1998 – 2008)


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U.S. Health Care Costs by Age
As expected, higher inflation adjusted health care costs are strongly related to the age of consumers. From 1998 to 2008, inflation adjusted health
care costs for consumers age 55-64, 65-74, and 75 and up increased by $975, $905, and $532, respectively. Consumers under 25 and 25-54
experienced the smallest increases in their health care costs when compared to the other age groups in this analysis.

Annual Average U.S. Health Care Costs, 1998 – 2008
by Age Group | (inflation adjusted to 2008 constant dollars)
$5,500
$5,158
$5,000
$4,641 $4,677 $4,779
$4,553 $4,604 $4,573
$4,500 $4,513
$4,439 $4,413
$4,356 $4,295 $4,330
$4,290 $4,244
$4,173 $4,130
$4,000 $3,881 $3,944
$3,955
$3,865 $3,825
$3,874 $3,759 $3,798
$3,718
$3,599 $3,580 $3,609
$3,500
$3,286
$3,166 $3,136
$2,887 $3,052 $3,072
$3,000 $2,946 $2,944 $2,930
$2,901 $2,899
$2,821 $2,754
$2,850 $2,751
$2,579
$2,500 $2,464 $2,505 $2,439 $2,499
$2,370 $2,404
$2,230 $2,218 $2,284
$2,108
$2,000
$1,764 $1,807
$1,696 $1,718 $1,731 $1,678 $1,737
$1,565 $1,570 $1,563
$1,500 $1,512

$1,000
$831
$712 $766 $745 $776 $754
$630 $644 $639 $682
$588
$500

$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up



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U.S. Health Insurance Costs by Age
From 1998 to 2008, inflation adjusted health insurance costs for consumers age 65-74 and 75 and up increased by $855 and $798, respectively.
Consumers age 25-54 experienced the smallest increases in their health insurance costs when compared to the other age groups in this analysis.

Annual Average U.S. Health Insurance Costs, 1998 – 2008
$3,500

$3,000
$2,903 $2,929 $2,901
$2,820 $2,783
$2,593 $2,682

$2,500 $2,474 $2,491
$2,377 $2,411
$2,299 $2,310
$2,179 $2,213
$2,039 $2,138
$2,046 $2,032
$2,000 $1,985 $1,982 $2,010 $1,945
$1,840 $1,818
$1,786 $1,747 $1,790
$1,623
$1,500 $1,523
$1,445 $1,471 $1,439
$1,374 $1,415 $1,412 $1,365 $1,414 $1,399
$1,309 $1,367 $1,341
$1,298 $1,279 $1,296 $1,318
$1,243 $1,220 $1,262 $1,224
$1,217
$1,125
$1,043 $1,063
$1,000 $964 $948 $960 $943 $953 $983
$912 $906
$845
$798 $772 $800

$500
$416 $412
$366 $392 $389
$301 $305 $341 $329
$272 $264

$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up



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Health Insurance as a Percent of Total Health Care Costs
Across all age groups, from 1998 to 2008, health insurance costs accounted for a larger amount of total health care costs. As expected, health
insurance costs as a percent of total health care costs were the greatest for consumers age 65 and up. Interestingly, consumers age 55-64 paid the
least amount of health insurance costs as a percent of their total health care costs in 2008.

U.S. Health Insurance Costs as a Percent of Total Health Care Costs, 1998 – 2008
400%

63%
350% 59% 64%
53%
53% 54%
53% 52%
51% 49% 75 and up
300% 50% 61%
54% 57% 56% 62% 57%
54% 65 to 74
53% 49%
250% 53% 51%
51%
51% 48% 46% 47% 50%
44% 45% 55 to 64
46%
43% 45%
200%
52%
47% 48% 48% 48% 50%
46% 45 to 54
46%
43% 43% 44%
150%
54% 35 to 44
53% 53% 51% 53% 55%
47% 49% 52%
46% 48%
100%
25 to 34
54% 57%
54% 55% 55% 53% 53%
51% 51% 51% 54%
50% Under 25

46% 47% 51% 49% 54% 52% 50% 57%
42% 42% 45%
0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008



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U.S. Changes in Income, Health Care, and Health Insurance Costs
From 1998 to 2008, among all U.S. consumers, inflation adjusted income, health care, and health insurance costs increased by 16.0%, 18.0%, and
37.0%, respectively. Health care and health insurance costs increased the most among 55-64 year-olds. Consumers under 25, 65-74, and 75 and up
also experienced a significant increase in health insurance costs.

Percent Change in Annual Average Income, Health Care Costs, and Health Insurance Costs,1998 - 2008
by Age Group| (inflation adjusted to 2008 constant dollars)
60%

50% 49%

43%
42%
40%
40%
37%

34%

30% 29%
26% 27%
23% 23% 23%
23% 23%

20% 18%
16% 16% 15%
14%
12%
11%
10% 8%
6%

1%
0%
All U.S. Consumers Under 25 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and up

Income Before Taxes Health Care Health Insurance



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U.S. Health Care Costs as a Percent of Income
Among all U.S. consumers, health care costs as a percent of total income increased from 2.2% to 2.6% from 1998 to 2008. In 2008, health care costs
as a percent of total income were highest among consumers age 65 and up.

Health Care Costs as a Percent of Income,1998 - 2008
by Age Group| (inflation adjusted to 2008 constant dollars)

75 and up 8.5%
7.4%

65 to 74 6.4%
5.7%

55 to 64 2.7%
2.2%

2008
45 to 54 1.9%
1.6% 1998

35 to 44 1.7%
1.6%

25 to 34 1.6%
1.4%

Under 25 1.4%
1.2%

All U.S. 2.6%
Consumers 2.2%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0%


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Western Metro Areas
Among the 5 Western metro areas in this analysis, Seattle had the highest health care costs in 2008 ($3,373) while San Diego had the lowest
($1,840). From 1998 to 2008, inflation adjusted health care costs in Los Angeles, San Francisco, Seattle, and Phoenix increased by 19.6%, 41.2%,
55.3%, and 39.3%, respectively. During this time period, health care costs in San Diego decreased by 22.2%.

Annual Average Health Care Costs, 1998 – 2008
Los Angeles, San Francisco, San Diego, Seattle, and Phoenix Metro Areas
$4,000
$3,750
$3,500
$3,250
$3,000
$2,750
$2,500
$2,250
$2,000
$1,750
$1,500
$1,250
$1,000
$750
$500
$250
$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Los Angeles San Francisco San Diego Seattle Phoenix



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Northeastern Metro Areas
Among the 5 Northeastern metro areas in this analysis, Washington, D.C. had the highest health care costs in 2008 ($2,996) while Baltimore had the
lowest ($2,571). From 1998 to 2008, inflation adjusted health care costs in Washington, D.C., Baltimore, New York, Philadelphia, and Boston
increased by 1.3%, 21.7%, 14.4%, 20.7%, and 31.3%, respectively.

Washington, D.C., Baltimore, New York, Philidelphia, and Boston Metro Areas
$4,000
$3,750
$3,500
$3,250
$3,000
$2,750
$2,500
$2,250
$2,000
$1,750
$1,500
$1,250
$1,000
$750
$500
$250
$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Washington, D.C. Baltimore New York Philadelphia Boston



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Southern Metro Areas
Among the 4 Southern metro areas in this analysis, Houston had the highest health care costs in 2008 ($3,002) while Miami had the lowest ($1,933).
From 1998 to 2008, inflation adjusted health care costs in Miami, Dallas-Fort Worth, and Houston increased by 3.2%, 0.4%, and 17.5%, respectively.
During this time period, health care costs in Atlanta decreased by 3.6%.

Atlanta, Miami, Dallas-Ft Worth, and Houston Metro Areas
$4,000
$3,750
$3,500
$3,250
$3,000
$2,750
$2,500
$2,250
$2,000
$1,750
$1,500
$1,250
$1,000
$750
$500
$250
$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Atlanta Miami Dallas- Fort Worth Houston



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Midwestern Metro Areas
Among the 4 Midwestern metro areas in this analysis, Minneapolis-St. Paul had the highest health care costs in 2008 ($3,365) while Detroit had the
lowest ($2,432). From 1998 to 2008, inflation adjusted health care costs in Chicago, Detroit, Minneapolis-St. Paul, and Cleveland increased by
27.1%, 14.8%, 16.6%, and 82.1%, respectively.

Chicago, Detroit, Minneapolis-St.Paul, and Cleveland Metro Areas
$4,000
$3,750
$3,500
$3,250
$3,000
$2,750
$2,500
$2,250
$2,000
$1,750
$1,500
$1,250
$1,000
$750
$500
$250
$0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Chicago Detroit Minneapolis-St.Paul Cleveland



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U.S. Metro Area Income Changes
After adjusting for inflation, all 18 U.S. metro areas in this analysis experienced an increase in their average annual income before taxes from 1998
to 2008. During this time period, Chicago, Baltimore, Washington, D.C., and Houston experienced the greatest increase in income. Minneapolis-St.
Paul, Miami, Dallas-Fort Worth, and Detroit incomes increased the least among the 18 metro areas.

Percent Change in Annual Average Income, 1998 - 2008
by U.S. Metro Area | (inflation adjusted to 2008 constant dollars)
Chicago 35.7%
Baltimore 35.6%
Washington, D.C. 27.5%
Houston 25.5%
New York 22.4%
San Francisco 22.2%
Phoenix 21.7%
Seattle 16.1%
Boston 13.5%
Cleveland 13.0%
Los Angeles 12.8%
San Diego 12.0%
Philadelphia 11.7%
Atlanta 10.4%
Detroit 3.7%
Dallas- Fort Worth 2.7%
Miami 1.6%
Minneapolis-St.Paul 1.0%

0% 5% 10% 15% 20% 25% 30% 35% 40%



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U.S. Metro Area Health Care Cost Changes
After adjusting for inflation, 16 out of the 18 U.S. metro areas in this analysis experienced an increase in their health care costs from 1998 to 2008.
During this time period, Cleveland, Seattle, San Francisco, Phoenix, and Boston experienced the greatest increase in their health care costs. Only
Atlanta and San Diego experienced a decrease in their health care costs during this time period.

Percent Change in Annual Average Health Care Costs, 1998 - 2008
by U.S. Metro Area | (inflation adjusted to 2008 constant dollars)
Cleveland 82.1%
Seattle 55.3%
San Francisco 41.2%
Phoenix 39.3%
Boston 31.3%
Chicago 27.4%
Baltimore 21.7%
Philadelphia 20.7%
Los Angeles 19.6%
Houston 17.5%
Detroit 14.8%
New York 14.4%
Miami 3.2%
Atlanta -3.6%
San Diego -22.2%

-40% -20% 0% 20% 40% 60% 80% 100%



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Differences Between Health Care Cost and Income Changes
From 1998 to 2008, Cleveland, Seattle, San Francisco, Boston, Phoenix, and Minneapolis-St. Paul experienced the greatest increase in their health
care costs relative to their increase in income. On the other hand, San Diego, Washington, D.C., Atlanta, and Baltimore experienced the greatest
increase in their incomes relative to their increase in health care costs.

Net Percentage Point Difference Between Change in Health Care Costs and Change in Income, 1998 - 2008
by Metro Area | (infaltion adjusted to 2008 costant dollars)
Cleveland 69.1
Seattle 39.2
San Francisco 19.0
Boston 17.8
Phoenix 17.6
Minneapolis-St.Paul 15.7
Detroit 11.1
Philadelphia 9.0
Los Angeles 6.8
Miami 1.6
Dallas- Fort Worth -2.3
Houston -8.0
New York -8.1
Chicago -8.3
Baltimore -14.0
Atlanta -14.0
Washington, D.C. -26.2
San Diego -34.3

-40.0 -20.0 0.0 20.0 40.0 60.0 80.0



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Health Care Costs as a Percent of Income by Metro Area
From 1998 to 2008, health care costs as a percent of total income increased in 10 out of the 18 metro areas in this analysis. In 2008, health care costs
as a percent of income were highest for consumers in Cleveland and Minneapolis-St. Paul and lowest for consumers in San Diego and Washington, D.C.

Health Care Costs as a Percent of Income,1998 - 2008
by Metro Area| (inflation adjusted to 2008 constant dollars)
Cleveland 5.8%
3.6%

4.1%

Seattle 4.5%
3.4%

Phoenix 4.5%
3.9%
4.3%
Chicago 4.6%
4.3%

Detroit 4.1%
3.7%
4.0% 2008
Houston 4.2%

Boston 3.9%
3.4% 1998
San Francisco 3.7%
3.2%

Philadelphia 3.6%
3.4%

New York 3.4%
3.7%

Atlanta 3.4%
3.9%

Los Angeles 3.4%
3.2%
3.3%
Miami 3.2%

Baltimore 3.1%
3.5%

3.6%

San Diego 2.7%
3.8%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%



Special Report

U.S. Metro Area Health Care Costs
Table 1. below shows that Cleveland and Seattle have experienced the largest net increases in their health care costs from 1998 to 2008. During this
time period annual average health care costs in Cleveland increased from $2,005 to $3,651 and from $2,171 to $3,373 in Seattle. In 2008, Miami
and San Diego paid the least in health care costs among the 18 metro areas in this analysis.

Table 1. Annual Average Health Care Costs, 1998 – 2008 by Metro Area
Net Change % Change
Metro Area 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1998 - 2008 1998 - 2008

Los Angeles $2,100 $2,271 $2,292 $2,316 $2,431 $2,570 $2,632 $2,508 $2,473 $2,413 $2,512 $412 19.6%
San Francisco $2,352 $2,316 $2,538 $2,638 $2,812 $3,020 $3,163 $3,057 $3,012 $3,348 $3,321 $969 41.2%
San Diego $2,366 $2,391 $2,409 $2,153 $2,255 $2,663 $2,969 $3,349 $3,653 $2,713 $1,840 -$526 -22.2%
Seattle $2,171 $2,495 $3,143 $3,014 $2,784 $3,195 $3,410 $3,208 $3,085 $3,247 $3,373 $1,202 55.3%
Phoenix $2,293 $2,594 $2,711 $2,493 $2,682 $2,986 $2,974 $3,186 $3,347 $3,175 $3,195 $902 39.3%
Washington, D.C. $2,959 $2,846 $2,778 $2,778 $2,634 $2,679 $2,757 $2,767 $2,675 $2,742 $2,996 $37 1.3%
Baltimore $2,113 $2,043 $2,304 $2,292 $2,202 $2,467 $2,367 $2,442 $2,724 $2,524 $2,571 $458 21.7%
New York $2,474 $2,408 $2,451 $2,587 $2,725 $2,616 $2,535 $2,659 $2,784 $2,777 $2,829 $355 14.4%
Philadelphia $2,222 $2,302 $2,224 $2,338 $2,475 $2,502 $2,423 $2,485 $2,337 $2,259 $2,682 $460 20.7%
Boston $2,236 $2,179 $2,176 $2,411 $2,461 $2,349 $2,592 $2,893 $2,984 $2,917 $2,936 $700 31.3%
Atlanta $2,473 $2,371 $2,388 $2,362 $2,406 $2,227 $2,006 $2,025 $2,154 $2,445 $2,383 -$90 -3.6%
Miami $1,873 $1,914 $2,183 $2,292 $2,357 $2,410 $2,193 $2,208 $2,339 $2,250 $1,933 $60 3.2%
Dallas- Fort Worth $2,776 $2,776 $2,454 $2,507 $2,911 $3,316 $3,491 $3,337 $3,284 $3,081 $2,787 $11 0.4%
Houston $2,556 $2,480 $2,744 $2,985 $2,931 $2,919 $3,011 $3,243 $3,480 $3,419 $3,002 $446 17.5%
Chicago $2,610 $2,521 $2,542 $2,597 $2,699 $2,881 $3,082 $3,233 $3,074 $3,136 $3,324 $714 27.4%
Detroit $2,119 $2,198 $2,048 $2,328 $2,579 $2,340 $2,285 $2,493 $2,509 $2,396 $2,432 $313 14.8%
Minneapolis-St.Paul $2,885 $2,923 $2,918 $2,740 $2,749 $3,015 $3,337 $3,417 $3,548 $3,847 $3,365 $480 16.6%
Cleveland $2,005 $2,147 $2,213 $2,140 $2,309 $2,382 $2,463 $2,866 $3,241 $3,419 $3,651 $1,646 82.1%



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