DISEASE TRENDS

Disease Trends and the Delivery of Health Care Services

Disease Trends and the Delivery of Health Care Services

Introduction

Government policies, reimbursement trends, insurance changes, and the economy all affect the healthcare delivery system. For at least the past two decades, there has been widespread concern with rising healthcare costs and lack of universal access to insurance.

Total and inflation-adjusted national health expenditures rose steadily between 2004 and 2010, as did per capita national health expenditures, and expenditures as a percentage of gross domestic product.

The nationwide number of Medicaid enrollees nearly doubled between 1990 and 2003, increasing burdens for state and local governments.

The annual percent change in cost of health insurance premiums has risen yearly since 1998 and has been in the double digits since 2001.

More than 45 million Americans lacked health insurance coverage in 2004, 6 million more than in 2000.

As a result, cost containment has been a major focus for federal, state and private payers. Strategies have included efforts to reduce use rates, particularly of high intensity, high cost services, channel patients to lower cost “preferred” providers, and reduce reimbursement. In addition to these underlying financial factors, three “megatrends” that began in previous decades will continue to affect healthcare use rates in the foreseeable future:

Changes in Demographics

Advances in Clinical Technology

Changes in Health Care Organization and Delivery.[1]

Changes In Demographics

Population size and composition are important starting points in projecting use rates and demand for health care capacity. Recent history and projected trends indicate that New York State's population is growing modestly and unevenly. Specifically, New York City is growing due to a surge of immigration while other regions demonstrate stable or declining populations. Population and Immigration Trends 1990 - 2000 - In the 1990s, New York State's total population grew from 17,990,455 to 18,976,457, an increase of 5.5%. In contrast, the total population of the United States grew by more than twice that rate, increasing 13.2% over the same period.5 New York experienced the smallest rate of growth among the five most populous states in the nation. (Figure 1)

During the 1990s, some NY regions grew while others declined. Fully 69.5% of the state's growth occurred in New York City whose population increased 9.4%. There was also greater than average growth in the Hudson Valley. Populations declined in the southern tier counties of Chautauqua, Cattaraugus, Allegany, Steuben, Chemung, Tioga and Broome. Upstate counties and cities including Clinton (Plattsburg), Erie (Buffalo), Onondaga (Syracuse), Rensselaer (Troy), and Schenectady counties all showed declines.

The growth that occurred in the New York City metropolitan region is largely attributable to new immigrants who transformed what would have been a statewide population decline of more than a half million into an increase of nearly one million. According to the New York City Department of City Planning, New York City's 2000 foreign-born population of 2.87 million was an all-time high, and represented 36% of the city's population of 8 million. Overall, immigrants and their U.S. born offspring account for approximately 55% of the city's ...