Health Care Utilization and Health Care Resources in the USA

Main Category: Nursing / Midwifery
Article Date: 28 Feb 2004 - 0:00 PDT

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National Center for Health Statistics

Major changes continue to occur in the delivery of health care in the United States, driven in part by changes in payment policies intended to rein in rising costs and by advances in technology that have allowed more complex treatments to be performed on an ambulatory basis.

Use of hospital inpatient services has decreased while use of services such as outpatient surgery, home health care, and hospice care, has increased.

Between 1980 and 2000 the percent of all office visits to primary care physicians declined, while the percent of visits to specialty physicians increased. In 2000, 49 percent of all visits to physicians' offices were made to specialists, up from 43 percent in 1980.

In 2001, 63 percent of all surgical operations in community hospitals were performed on outpatients, up from 51 percent in 1990 and 16 percent in 1980.

Between 1985 and 2001 the hospital discharge rate declined 24 percent, from 151 to 115 discharges per 1,000 population, while average length of stay declined 1.7 days, from 6.6 to 4.9 days (data are age adjusted).

Between 1995 and 2001, total registered nurse graduates per year declined from 97,000 to 69,000, allopathic medicine graduates remained stable at 16,000 per year, and osteopathic medicine graduates increased from 1,800 to 2,600 per year.

Between 1990 and 2001 the number of community hospital beds declined from about 927,000 to about 826,000. Community hospital occupancy, estimated at 64.5 percent in 2001, increased slightly from 62.5 percent in 1998, after declining from about 67 percent in 1990.

Between 1996 and 2000 use of home health care by persons 65 years of age and over declined from 547 to 277 per 10,000 population, after increasing steadily between 1992 and 1996.

The recent decline resulted in part from the Balanced Budget Act of 1997, which imposed stricter limits on the use of home health services funded by Medicare and interim limits on Medicare payments to home health agencies from October 1997 until a prospective payment system was implemented for Medicare home health agencies in October 2000 (data are age adjusted).

Between 1994 and 2000 use of hospice care by persons 65 years of age and over increased by 83 percent to 25 patients per 10,000 population. Among persons age 65 and over, use of hospice services is slightly higher for males than for females (27 compared with 23 patients per 10,000 in 2000). Cancer is the most common diagnosis among hospice patients (data are age adjusted).

In 1999 there were 1.5 million nursing home residents 65 years of age and over. More than one-half of the residents 65 years and over were at least 85 years of age and three-fourths were female. Between the mid-1970s and 1999, nursing home utilization rates increased for the black population and decreased for the white population.

In 2001 there were 1.8 million nursing home beds in facilities certified for use by Medicare and Medicaid beneficiaries. Between 1995 and 2001 nursing home bed occupancy in those facilities was relatively stable, estimated at 83 percent in 2001.