May 2, 2023 4 min read

Healthcare Stats & Benchmarks

Everything in healthcare is framed through benchmarks, or specific stats - from finance to utilization numbers. All of these numbers have been aggregated from various sources with a link to the original. This list, in terms of data points and sections changes fairy frequently. I want a list of ballpark figures used as a starting point to dive into specifics.

Health Spending & Growth

CMS National Health Expend Data

3.8 trillion - total healthcare spending in 2019
17.7% - US Economy devoted to health care
4.6% - Annual growth rate
20% of healthcare contributes to a persons health status (WHO)
20% genetics impact person health status
60% SDOH impact health status

Medical Debt

KFF Hospital Charity Care : How it works and why it matters (2022)

41% - adults all income have some form of medical debt57% - with income below 40k have some level of debt
$195B - estimated total medical debt
50% - cite emergency care as the source of debt
35% - hospitalizations as source of unpaid bills

Hospital Spending

RAND Impact of Policy Options for Reducing Hospital Prices

33% - Percent of hospital spending relative to all national health expenditures.
$1.2T - 2018 total hospital spending
40% - Of hospital spend covered by private insurers
$61B to $236B - Estimated savings by price capping hospitals at 100 to 150% of Medicare rates a 1.7% to 6.5% reduction in national spending

Health Insurance Coverage

HFMA CHFP

11%- Expenditures paid out-of-pocket by patient
55%- Financed Commercial
45%- Financed Public (Medicare, Medicaid)
50%- American's Healthcare through Employer
20%- Low income adults, children and disabled (CHIP or Medicaid)
6%- Individual market through ACA (Exchange)
9%- Uninsured
20%- Workers with HDHPs
90%- Patients with health insurance post ACA
85% - Patients with an Exchange plan who are eligibile for premium subsidies

Employer Health Benefits

KFF - 2022 Employer Health Benefits Survey
PDF Employer Health Benefits 2022 Annual Survey
KFF Summary of Findings Tables 2022

$22,463 - Average Premium Contribution Family Coverage - 2022
$16,357 - Employer contribution on $22,463
$6,106 - Worker contribution on $22,643
20% - Total premium increase from 2017 to 2022
7% - Increase in worker contribution 2017 to 2022
17% - Overall inflation from 2017 to 2022
22% - Workers earning increase from 2017 to 2022

Utilization

Emergency Department Visits

2020 National Hospital Ambulatory Medical Care Survey : 2020 Emergency Department Summary Tables. Per 100 (standard error). Data from IQVIA database. Page 1 contains study design. Contains additional stats on wait times, mode of arrival, expected source of payment and principal reason for visits.

40.5 (3.5) - All visits
63.2 (6.5) - 75 and over visits
42.3 (2.8) - Female visits
38.6 (3.2) - Male visits
37.1 (3.3) - Private Residence (location)
215.4 (27.4) - Nursing home (location)
339.4 (48.8) - Homeless
38.7 (3.5) - White
67.7 (8.0) - Black
34.1 (5.5) - Hispanic or Latino

Hospitals Financial Benchmarks

From Becker's 83 Hospital Benchmark 2022 - Data source appears to be Moody's investor service "Not For Profit and Public Healthcare - US Medians" report in 2020 based on financial statements from 130 freestanding hospitals (40% of all Moody's rated not profit healthcare entities. Definitive reported in 2022 that 2021 OM's for instance were primarily negative. Median values. Beckers 40 Hospital Benchmarks.

0.5% - Operation Margin
3.7% - Excess Margin
6.7% - Operating Cash Flow Margin
2.9% - Return on Assets
246.9 - Days Cash on Hand
44.6 - Accounts receivable days
11.9 - Average age of plant years
33.9% - Total Debt to Cap
32.3% - Total Debt to Operating Revenue
4.7 - Annual Debt Service Coverage
4.5% - Operating Margin in AA+ Rating
3.2% - Operating Margin in AA Rating
50 - AR days rate considered problematic
30 - 70 - AR days range
5.7 - Days for high performance DNFB
7.1 - Days for median performance DNFB
11.6 Days for low performance DNFB

Expense Per Inpatient Day

From 2022 Becker Review based on Kaiser State Health Facts from 2020 and 2019 data. See a state location breakdown on 2021 KFF Hospital Adjusted Expenses per Inpatient Day. From the KFF notes, these are estimated hospital cost, not cost to patient or payer (actual charges).

Includes all operating and non-operating expenses for registered US community hospitals, defined as nonfederal short-term general and other special hospitals whose facilities and services are available to the public. Adjusted expenses per inpatient day include expenses incurred for both inpatient and outpatient care; inpatient days are adjusted higher to reflect an estimate of the volume of outpatient services. It is important to note that these figures are only an estimate of expenses incurred by the hospital to provide a day of inpatient care and are not a substitute for either actual charges or reimbursement for care provided.

$2,883 - United States
$2,866 - Idaho
$2,244 - Montana
$3,861 - Oregon

Value Based Payments

Maryland Global Budget vs. Pioneer vs. MSSP
Meaningful Value-Based Payment Reform, Par 1: Maryland Leads the Way Data came from Exhibit 1: Comparison of per-beneficiary Medicare savings comparing Maryland's All-Payer pricing vs. Pioneer ACO vs. MSSP.

$295 - $252 savings PMPY Medicare for Maryland Jan 2014 to June 2018
$88 savings PMPY Medicare for Pioneer ACO 2016
$106 savings PMPY Medicare for MSSP

APM LAN Measurement Effort
From the 2022 HCP-LAN APM Measurement Guide aggregated payments in CY 2021. Describes the percentages of at risk payments in Category 1 to 4. Focus here though is percentage of contracts across all lines of business with upside or downside risk.

All Lines of Business

19.6% - Payments at risk in a Cat 3B(APM on FFS Upside Downside for Appropriate Care) or Cat 4 Population based payment.
12.2% - Cat3B - APM Upside & Downside for Appropriate Care
2.1% - Cat4A - Condition-specific population based payment
4.5%- Cat4B - Comprehensive Population based payment
0.8% - Cat4C - Integrated Finance & Delivery System