Health Care Indicators Carolyn S. Donham, Brenda T. Maple, and Suzanne W. Letsch

This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data. INTRODUCTION This article presents statistics on health care utilization, prices, expenses, employment, and work hours, as well as on national economic activity. Some of these statistics are based on sample surveys conducted monthly or quarterly by government agencies or private organizations, and are available 1 to 3 months after the completion of the period. They provide the first glimpse at changes occurring within the general economy and the health care sector. The accompanying tables report selected quarterly statistics for 1990 through the first quarter of 1993, and the calendar year aggregation of quarterly information in the past 3 years. Additional tables show change from the same period

1 year earlier. For quarterly information, this calculation permits analysis of quarterly data to focus on the direction and magnitude of changes, without interference introduced by seasonal fluctuations. In the national health accounts, indicators such as these play an important role in the estimation of the latest historical year of health care expenditures. Information that is more comprehensive tends to lag behind the close of a calendar year by 9 to 12 months or more. Therefore, we rely extensively on indicators such as these to anticipate and predict changes in health care sector expenditures for the most recent year. Other indicators help to identify specific reasons (e.g., increases in price inflation or declines in utilization) for expenditure change. In the following sections, we will identify important indicators of health care and national economic activity and their sources. We then describe what these indicators tell us about general economic and health sector activity during the most recent quarter.

The authors are with the Office of the Actuary, Health Care Financing Administration (HCFA), and the opinions expressed are those of the authors and do not necessarily reflect HCFA's views or policy position. HEALTH CARE FINANCING REVIEW/Fall 1993/volume 15, Number 1

COMMUNITY HOSPITAL STATISTICS Since 1963, the American Hospital Association (AHA), in cooperation with member hospitals, has been collecting data on the operation of community hospitals through its National Hospital Panel Survey. Community hospitals, which comprised more than 80 percent of all hospital facilities in the United States in 1991, include all non-Federal, short-term 147

general, and other special hospitals open to the public. They exclude hospital units of institutions; psychiatric facilities; tuberculosis, other respiratory, and chronic disease hospitals; institutions for the mentally retarded; and alcoholism and chemical dependency hospitals. The survey samples approximately onethird of all U.S. community hospitals. The sample is designed to produce estimates of community hospital indicators by bed size and region (American Hospital Association, 1963-93). In Tables 1 and 2, statistics covering expenses, utilization, beds, and personnel depict trends in the operation of community hospitals annually from 1990 to 1992 and quarterly for selected quarters from 1990 through 1993. Figure 1 shows changes from the same quarter 1 year earlier in various measures of hospital utilization for 1984 through the first quarter of 1993. For purposes of national health expenditures (NHE), survey statistics on revenues (not shown on Table 1) are analyzed in estimating the growth in the largest component of health care costs—community hospital expenditures. This one segment of NHE accounted for 33 percent of all health spending in 1991 (Letsch et al., 1992). The survey also identifies important factors influencing expenditure growth patterns, such as changes in the number of beds in operation, number of admissions, length of stay, use of outpatient facilities, and number of surgeries. PRIVATE HEALTH SECTOR: EMPLOYMENT, HOURS, AND EARNINGS The U.S. Bureau of Labor Statistics (BLS) collects monthly information on employment for all workers, and earnings 148

and work hours for non-supervisory workers in a sample of 370,000 establishments. Data are collected through cooperative agreements with State agencies that also use this information to create State and local area statistics. The survey is designed to collect industry-specific information on wage and salary jobs in nonagricultural industries. It excludes statistics on self-employed persons and on those employed in the military (U.S. Department of Labor, 1993a). Employment in this survey is defined as number of jobs. Persons holding multiple jobs would be counted multiple times. Approximately 5 percent of the population hold more than one job at any point in time. (Other surveys that are householdbased, such as the Current Population Survey [CPS], also record employment. In the CPS, however, each person's employment status is counted only once, either as employed, unemployed, or not in the labor force.) Once each year, monthly establishment-based employment statistics are adjusted to benchmarks created from annual establishment census information, resulting in revisions to previously published employment estimates. Tables 3 and 4 and Figure 2 present statistics on employment, average hourly earnings, and average weekly hours in private (non-government) health service establishments. Similar statistics for the private non-agricultural sector, included on these tables, provide a basis for comparing the economy as a whole with the health sector in employment, earnings, and work hours. Table 5 summarizes business activity in the health sector and the overall economy by measuring change in the implied non-supervisory work hours and payroll. Implied work hours are the product of the number of non-supervisory HEALTH CARE F I N A N C I N G REVIEW/Fall 1993/Volume 15, Number 1

employees and average weekly hours. Implied non-supervisory payrolls are calculated by multiplying implied work hours by average hourly earnings. Figure 3 shows changes from the same quarter 1 year earlier in non-supervisory payroll for 1984 through the first quarter of 1993. For purposes of NHE, changes in work hours by industry combined with changes in prices (discussed in a later section) can be used to gauge the direction and magnitude of expenditure change in specific industries. We use these composite indicators in the estimation of growth in physician and dental expenditures for the most recent period. We study the historical relationship of changes in this indicator to changes in expenditures, and estimate this relationship for the most recent period. PRICES Consumer Prices BLS publishes monthly information on changes in prices paid by consumers for a fixed market basket of goods and services. Tables 6 and 7 and Figure 4 present information on the consumer price index (CPI) for all urban consumers that measures changes in prices faced by 80 percent of the non-institutionalized population in the United States. (The more restrictive wage earner CPI gauges prices faced by wage earners and clerical workers. These workers account for 32 percent of the non-institutionalized population [U.S. Department of Labor, 1993b].) The index reflects changes in prices charged for the same quality and quantity of goods or services purchased in the base period. For most items, the base period of 1982-84 is used to define the share HEALTH CARE FINANCING REVIEW/Fall 1993/Volume15,Number1

of consumer expenditures purchasing specific services and products. Those shares or weights remain constant in all years, even though consumption patterns of the household may change over time. This type of index is called a fixed weight or Laspeyres index. CPIs for health care goods and services depict price changes for out-of-pocket expenditures made directly by consumers. The composite CPI for medical care weights together product-specific or service-specific CPIs in proportion to household out-of-pocket expenditures for these items. For example, the composite medical care CPI measures inflation for the 3 percent of hospital expenditures that are made out-of-pocket by consumers; the remaining 97 percent of the costs of hospital care paid by private health insurers, Medicare, Medicaid, and other payers are not weighted into the CPI for medical care. In addition, some medical care sector indexes measure changes in list or charged prices, rather than in the prices actually received by providers after discounts are deducted. In several health care areas, received or transaction prices are difficult to capture, although BLS is making advances in this area. In the NHE, a combination of CPIs for selected medical care items, input price indexes for nursing homes, and the CPI for hospital and related services, adjusted by the Health Care Financing Administration (HCFA) to provide transaction price changes, are used as measures of inflation for the health industry. The indexes are used to develop a fixed-weight price index for personal health care to depict price changes affecting the entire health care industry more accurately than does the overall CPI medical care index (Letsch, 1993). 149

Background on Input Price Indexes In 1979, HCFA developed the Medicare hospital input price index (hospital market basket), which was designed to measure the pure price changes associated with expenditure changes for hospital services. In the early 1980s, the skilled nursing facility (SNF) and home health agency (HHA) input price indexes, often referred to as "market baskets," were developed to price a consistent set of goods and services over time. Also, in the early 1980s, the original Medicare hospital input price index was revised for use in updating payment rates for the prospective payment system (PPS). All of these indexes have played an important role in helping to set Medicare payment percent increases, and in understanding the contribution of input price increases to growing health expenditures. The input price indexes, or market baskets, are Laspeyres or fixed-weight indexes that are constructed in two steps. First, a base period is selected. For example, for the PPS hospital input price index, the base period is 1987. Cost categories, such as food, fuel, and labor, are identified and their 1987 expenditure amounts determined. The proportion or share of total expenditures included in specific spending categories is calculated. These proportions are called cost or expenditure weights. There are 28 expenditure categories in the 1987-based PPS hospital input price index. Second, a price proxy is selected to match each expenditure category: Its purpose is to measure the rate of price increase of the goods or services in that category. The price proxy index for each spending category is multiplied by the expenditure weight for that category. The 150

sum of these products (weights multiplied by the price index) over all cost categories yields the composite input price index for any given time period, usually a fiscal year or a calendar year. The percent change in the input price index is an estimate of price change over time for a fixed quantity of goods and services purchased by a provider. The input price indexes are estimated on a historical basis and forecasted over several years. The HCFA-chosen price proxies are forecasted under contract with Data Resources, Inc./McGraw-Hill (DRI). Following every calendar year quarter, in March, June, September, and December, DRI updates its macroeconomic forecasts of wages and prices based on updated historical information and revised forecast assumptions. Some of the data in Tables 8 through 13 are forecasted, and are expected to change as more recent historical data become available and subsequent quarterly forecasts are received. The methodology and price proxy definitions used in the input price indexes are described in the Federal Register notices that accompany the revisions of the PPS, HHA, and SNF cost limits. A description of the current structure of the PPS input price index was published in the September 4, 1990 Federal Register. The most recent PPS update for payment rates was published in the September 1, 1992 Federal Register. The latest HHA regulatory input price index was published in the July 1, 1992 Federal Register, and the latest SNF input price index was published in the October 7, 1992 Federal Register. Periodically, the input price indexes are revised to a new base year so that cost weights will reflect changes in the mix of goods and services that are purchased. HEALTH CARE FINANCING REVIEW/Fall 1993/Volume 15, Number 1

Each revision allows for new base weights, a new base year, and changes to certain price variables used for price proxies. Each input price index is presented in two tables: The first is a percent-change table, and the second provides the actual index numbers from which the percentages were computed. The hospital input price index for PPS is in Tables 8 and 9. Figure 5 shows a comparison in the growth of the PPS input price index with the CPI all items. The SNF input price index is in Tables 10 and 11. The HHA input price index is in Tables 12 and 13. NATIONAL ECONOMIC INDICATORS National economic indicators provide a context for understanding health-specific indicators and how change in the health sector relates to change in the economy as a whole. Tables 14 and 15 and Figure 6 present national indicators of output, employment, and inflation. Gross domestic product (GDP) measures the U.S. economy as the value of output produced within the geographic boundaries of the United States by U.S. or foreign citizens or companies. Constant dollar or "real" GDP removes the effects of prices from the valuation of goods and services produced, so that the growth of real GDP reflects changes in the "physical" output of the economy (U.S. Department of Commerce, 1993). First Quarter Indicators Growth in operating expenses for community hospitals slowed considerably in the first quarter of 1993, increasing 7.5 percent. This is down from a 9.4-percent annual growth in operating expenses for 1992. The deceleration continued steadily HEALTH CARE FINANCING REVIEW/Fall 1993/volume 15, Number 1

throughout 1992, but appears to have leveled off in the first quarter of 1993. All measures of utilization—admissions, inpatient days, surgical operations, and outpatient visits—grew more slowly or decelerated faster than they had during the first quarter of 1992 at the height of the flu epidemic. Total employment in the health service sector continued to grow at nearly the same rate as in 1992. In the first quarter of 1993, there were 360,900 more health services jobs than in the first quarter of 1992, an increase of 4.3 percent. For non-supervisory workers, the average number of hours worked per week declined 0.4 percent during this period. The health service sector, maintaining steady employment growth during 1991, appeared immune to the recent recession marked by sagging total private sector employment growth. In the past three quarters, growth in health services employment also appears to be unaffected by the recent upsurge in employment growth for all private, non-agricultural establishments, as health sector employment growth remains steady (Figure 2). Implied work hours (the product of the number of non-supervisory employees and average weekly hours) in private health service establishments grew at a rate lower than in any quarter since 1987, 3.7 percent. Slow growth was caused by the decline in average hours worked per week, rather than a slowing in employment growth. This may signal an impending slowdown in employment for the health service sector, as employers initially cut work hours rather than lay off workers when faced with falling demand for services. Growth for implied payroll (work hours times average hourly earnings) in private 151

health service establishments was also at its lowest since 1987. This, in turn, is caused by slow growth in work hours. Growth in implied payroll for private hospitals has followed this trend as well, and may be one reason for the deceleration in operating-expense growth seen in the AHA Panel Survey (as previously noted). Medical prices, as measured by the CPI for medical care, continued to increase more rapidly than prices for all other items. In the first quarter of 1993, prices for medical care increased 6.3 percent from the first quarter of 1992, more than two times the 2.9-percent growth for all other items. However, the gap between price increases for medical care and all other items has gotten smaller than what it was throughout 1992 (Figure 4). Although growth for nearly all components of the medical care CPI has decelerated, the most dramatic slowdown in growth occurred with the prices of prescription drugs. In calendar year 1991, the CPI for prescription drugs increased 9.9 percent. In 1992 this growth decelerated to 7.6 percent. By the first quarter of 1993, it slowed further to only 5.0 percent. There are two possible reasons for this rapid change to have taken place. First, there has been a price war among retail establishments selling prescription drugs. As the number of non-traditional types of retail outlets has grown, competition against the traditional retail pharmaceutical outlets increased. Mass-merchandisers, such as Walmart, are competing for the business of prescription drug customers. Secondly, recent proposals on health care reform have pharmaceutical manufacturers concerned about the freemarket privileges from which they have

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historically benefitted. Manufacturers have traditionally been permitted to charge whatever price the market would bear. Conceivably, manufacturers and wholesalers have been voluntarily holding pricing down in an effort to avoid being faced with less desirable, mandatory price controls. Evidence of the behavior of drug manufacturers can be found in the producer price index (PPI) for pharmaceuticals, which measures average changes in prices received by domestic producers of commodities in all stages of processing. Growth in the PPI for pharmaceuticals decelerated at nearly the same rate as the CPI for prescription drugs. In calendar year 1991, the PPI for pharmaceuticals increased 8.4 percent. By the first quarter of 1993, growth in this PPI slowed to 4.6 percent. In the first quarter of 1993, overall economic conditions continued to improve modestly, as shown by the eighth straight quarter of positive growth in real GDP. The unemployment rate (7.0 percent) was lower than it had been since the fourth quarter of 1991. Total employment in private non-agricultural establishments increased 1.3 percent, which is the largest increase experienced in nearly 3 years. REFERENCES American Hospital Association: National Hospital Panel Survey. Unpublished. Chicago. 1963-93. Federal Register: Medicare Program; Changes to the Inpatient Hospital Prospective Payment System and Fiscal Year 1991 Rates; Final Rule. Vol. 55, No. 170, 36043-36050 and 36169-36173. Office of the Federal Register. National Archives and Records Administration. Washington. U.S. Government Printing Office, September 4 1990.

HEALTH CARE FINANCING REVIEW/Fall 1993/Volume15,Number 1

Federal Register: Medicare Program; Changes to the Inpatient Hospital Prospective Payment System and Fiscal Year 1993 Rates; Final Rule. Vol. 57, No. 170, 39832-39987. Office of the Federal Register, National Archives and Records Administration. Washington. U.S. Government Printing Office, September 1, 1992a.

Letsch, S.W.: National Health Care Spending in 1991. Health Affairs 12(1):94-110, Spring 1993. U.S. Department of Commerce: National Income and Product Accounts. Survey of Current Business. Vol. 73, No. 7. Bureau of Economic Analysis. Washington. U.S. Government Printing Office, July 1993.

Federal Register: Medicare Program; Schedules of Limits of Home Health Agency Cost per Visit for Cost Reporting Periods Beginning on or After July 1, 1992. Vol. 57, No. 127, 29412-29413. Office of the Federal Register, National Archives and Records Administration. Washington. U.S. Government Printing Office, July 1, 1992b.

U.S. Department of Labor: Employment and Earnings. Vol. 40, No. 6, Bureau of Labor Statistics. Washington. U.S. Government Printing Office, June 1993a. U.S. Department of Labor: Notes on Current Labor Statistics: Price Data. Monthly Labor Review. Vol. 116, No. 7. Bureau of Labor Statistics. Washington. U.S. Government Printing Office, July 1993b.

Federal Register. Medicare Program; Schedules of Limits of Skilled Nursing Facility Inpatient Routine Service Costs; Final Rule. Vol. 57, No. 195, 46177-48187. Office of the Federal Register, National Archives and Records Administration. Washington. U.S. Government Printing Office, October 7, 1992c. Letsch, S.W., Lazenby, H.C., Levit, K.R., and Cowan, C.A.: National Health Expenditures, 1991. Health Care Financing Review 14(2):1-30, Winter 1992.

For inquiries concerning input price index data, contact Brenda T. Maple at (410) 966-7954. For all other inquiries, contact Carolyn S. Donham at (410) 966-7947. Reprint requests: Carolyn S. Donham, Room L-1, 1705 Equitable Building, 6325 Security Boulevard, Baltimore, Maryland 21207.

Table 1 Selected Community Hospital Statistics: 1990-93 Calendar Year Item Operating Expenses Total in Millions Labor in Millions Non-Labor in Millions

1990

1991

1990 Q1

1992

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

$217,113 $238,633 $260,994 $52,471 :$57,189 $63,739 $64,532 $65,829 $66,894 $68,527 117,828 128,704 140,112 28,319 30,971 34,143 34,501 35,396 36,073 36,782 99,286 109,929 120,882 24,152 26,218 29,597 30,031 30,434 30,821 31,746

Inpatient Expense in Millions Amount per Patient Day Amount per Admission

165,792 765 5,021

178,401 844 5,461

191,401 927 5,905

40,705 712 4,780

43,406 47,495 47,284 47,873 48,733 795 922 950 965 876 5,260 5,683 5,836 5,980 6,133

50,447 948 6,041

Utilization Admissions in Thousands Inpatient Days in Thousands Adult Length of Stay in Days

33,017 216,836 6.6

32,670 211,475 6.5

32,411 206,440 6.4

8,516 57,132 6.7

8,253 54,578 6.6

8,357 54,238 6.5

8,102 51,306 6.3

8,005 50,387 6.3

7,947 50,509 6.4

8,351 53,228 6.4

21,904

21,983

22,463

5,449

5,379

5,608

5,641

5,630

5,584

5,646

326,498

344,116

366,243

79,336

82,471

89,168

91,572

93,271

92,232

94,677

921 64.5

912 63.5

908 62.1

926 68.5

915 66.3

909 65.6

910 62.0

908 60.3

904 60.7

905 65.3

3,229 3.5

3,249 3.6

3,300 3.6

3,212 3.5

3,242 3.5

3,277 3.6

3,290 3.6

3,310 3.6

3,324 3.7

3,322 3.7

88

87

85

23

22

22

21

21

21

22

Surgical Operations in Thousands Outpatient Visits in Thousands Beds in Thousands Adult Occupancy Rate1 Full-Time Equivalent (FTE) Personnel Total in Thousands Number per Bed Adjusted Patient Days2 per FTE

Adjusted Patient Days in Thousands 283,959 282,874 281,502 73,647 71,908 72,789 70,021 69,286 69,332 72,306 1 Adult occupancy rate is the ratio of average daily census to the average number of beds maintained during the reporting period. 2 Adjusted patient days is an aggregate figure reflecting the number of days of inpatient care, plus an estimate of the volume of outpatient services, expressed in units equivalent to an inpatient day in terms of level of effort. It is derived by multiplying the number of outpatient visits by the ratio of outpatient revenue per outpatient visit to inpatient revenue per inpatient day, and adding the product to the number of inpatient days. 0 NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted. 0 SOURCE: American Hospital Association: National Hospital Panel Survey Reports. Chicago. Monthly reports for January 1990-March 1993.

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Table 2 Percent Change in Selected Community Hospital Statistics: 1990-93 Calendar Year Item

1990

1991

1992

Annual Percent Change

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

Percent Change from the Same Period of Previous Year

Operating Expenses Total Labor Non-Labor

11.1 11.1 11.1

9.9 9.2 10.7

9.4 8.9 10.0

10.9 10.8 11.0

9.0 9.4 8.6

11.5 10.2 12.9

9.5 8.9 10.3

9.3 8.9 9.9

7.4 7.6 7.1

7.5 7.7 7.3

Inpatient Expenses Amount per Patient Day Amount per Admission

9.0 10.7 9.5

7.6 10.3 8.8

7.3 9.9 8.1

9.2 9.3 9.0

6.6 11.6 10.0

9.4 10.1 8.0

7.5 10.4 8.6

7.4 9.7 8.3

5.0 9.7 7.8

6.2 8.2 6.3

Utilization Admissions Inpatient Days Adult Length of Stay

0.5 1.6 1.1

1.1 2.5 1.4

0.8 2.4 1.6

0.1 0.1 0.2

3.1 4.5 1.4

1.3 0.6 1.9

1.0 2.6 1.6

0.9 2.1 1.2

2.6 4.3 1.7

0.1 1.9 1.8

Surgical Operations

2.4

0.4

2.2

1.3

1.3

4.2

1.2

1.7

1.6

0.7

Outpatient Visits Beds Adult Occupancy Rate1

6.0 0.9 0.4

5.4 1.0 0.9

6.4 0.5 1.4

6.0 1.0 0.6

4.0 1.2 2.3

8.1 0.6 0.7

6.1 0.3 1.5

6.4 0.3 1.1

5.2 0.5 2.4

6.2 0.4 0.2

Full-Time Equivalent (FTE) Personnel Total Number per Bed Adjusted Patient Days per FTE

2.1 3.1

0.6 1.7

1.6 2.0

2.4 3.4

0.9 2.2

1.1 1.7

1.4 1.7

1.8 2.1

2.0 2.6

1.4 1.8

1.7

1.0

2.0

0.9

3.3

0.1

2.2

2.1

4.0

2.0

0.5 1.5 2.4 1.2 0.3 2.1 0.7 Adjusted Patient Days 0.3 0.4 0.8 1 Change in rate, rather than percent change. 0 NOTE: Q designates quarter of year. 0 SOURCE: American Hospital Association: National Hospital Panel Survey Reports. Chicago. Monthly reports for January 1989-March 1993.

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Figure 1 Percent Change in Inpatient Days and Outpatient Visits from the Same Period of Previous Year: 1984-93

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Table 3 Employment, Hours, and Earnings in Private1 Health Service Establishments, by Selected Type of Establishment: 1990-93 Type of Establishment and Measure Health Services (SIC 80) Total Employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings Offices and Clinics of Medical Doctors (SIC 801) Total Employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings Offices and Clinics of Dentists (SIC 802) Total Employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings Nursing and Personal Care Facilities (SIC 805) Total Employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings Private Hospitals (SIC 806) Total employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings All Private Non-Agricultural Establishments Total Employment in Thousands Non-Supervisory Workers: Employment in Thousands Average Weekly Hours Average Hourly Earnings

Calendar Year 1990

1991

1992

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

7,814.3 8,182.9 8,523.3 7,651.4 8,033.1 8,374.8 8,470.6 8,580.5 8,667.4 8,735.7 6,947.6 7,275.8 7,575.3 6,801.2 7,142.1 7,444.4 7,531.4 7,627.1 7,698.2 7,755.0 32.5 32.5 32.8 32.4 32.4 32.8 32.6 32.9 32.8 32.7 $10.40 $10.96 $11.39 $10.24 $10.73 $11.23 $11.30 $11.44 $11.57 $11.68

1,338.2 1,404.5 1,472.7 1,310.2 1,371.9 1,440.3 1,460.2 1,485.7 1,504.7 1,517.6 1,104.5 1,155.4 1,209.4 1,080.9 1,129.4 1,184.0 1,200.7 1,219.9 1,232.9 1,242.0 31.8 31.9 32.1 31.8 31.8 32.3 32.2 32.2 32.1 32.0 $10.58 $11.13 $11.41 $10.32 $11.00 $11.22 $11.32 $11.46 $11.65 $11.72

512.9

527.6

541.9

508.4

519.1

533.8

539.1

545.2

549.3

552.3

449.7 28.4 $10.14

463.5 28.3 $10.62

474.3 28.3 $11.01

445.8 28.3 $9.89

455.9 28.3 $10.47

467.4 28.5 $10.91

471.6 28.2 $10.97

477.3 28.3 $10.99

481.1 28.3 $11.19

483.5 28.1 $11.25

1,415.4 1,492.6 1,542.7 1,384.1 1,466.3 1,518.3 1,531.1 1,552.5 1,569.1 1,581.9 1,278.9 1,347.4 1,393.7 1,250.1 1,323.5 1,370.6 1,383.2 1,403.4 1,417.8 1,428.6 32.1 31.7 32.0 32.7 32.3 32.0 32.1 32.3 32.2 32.0 $7.24 $7.56 $7.46 $7.90 $7.95 $8.05 $7.85 $7.09 $7.75 $7.81 3,548.7 3,655.1 3,759.8 3,497.4 3,615.9 3,720.4 3,746.4 3,780.0 3,792.4 3,805.5 3,248.4 3,352.5 3,451.4 3,199.7 3,314.0 3,415.0 3,439.0 3,470.2 3,481.3 3,491.8 34.2 34.2 34.4 34.2 34.0 34.4 34.4 34.5 34.4 34.5 $11.79 $12.50 $13.03 $11.63 $12.16 $12.85 $12.90 $13.12 $13.26 $13.38

91,115

89,854

89,866

89,691

88,788

88,112

89,924

90,715

90,714

89,217

73,800 34.5 $10.01

72,650 34.3 $10.32

72,866 34.4 $10.57

72,502 34.2 $9.89

71,559 33.8 $10.22

71,132 34.1 $10.50

72,898 34.3 $10.53

73,678 34.6 $10.57

73,755 34.5 $10.70

72,357 34.0 $10.78

Employment in Thousands All Hospitals 4,852.5 4,958.2 5,086.2 4,801.3 4,913.5 5,035.5 5,068.1 5,112.5 5,128.8 5,146.6 Private Hospitals (SIC 806) 3,548.7 3,655.1 3,759.8 3,497.4 3,615.9 3,720.4 3,746.4 3,780.0 3,792.4 3,805.5 Federal Hospitals 231.6 233.5 237.0 232.2 230.8 235.9 236.7 237.5 237.7 238.1 State Hospitals 416.7 417.7 420.2 419.1 418.2 426.2 419.8 429.9 419.8 420.1 Local Hospitals 652.9 669.7 641.8 674.8 679.6 684.7 646.1 649.2 659.3 664.9 1 Excludes hospitals, clinics, and other health-related establishments run by all governments. 0 NOTES: Data presented here incorporate conversion to the 1987 Standard Industrial Classification (SIC) and an historical reconstruction of components back to the inception of the series, whenever possible. Q designates quarter of year. Quarterly data are not seasonally adjusted. 0 SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1990-June 1993.

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Table 4 Percent Change in Employment, Hours, and Earnings in Private1 Health Service Establishments, by Selected Type of Establishment: 1990-93 Type of Establishment and Measure

Calendar Year 1990

1991

1992

Annual Percent Change Health Services (SIC 80) Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings Offices and Clinics of Medical Doctors (SIC 801) Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings Offices and Clinics of Dentists (SIC 802) Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings Nursing and Personal Care Facilities (SIC 805) Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings Private Hospitals (SIC 806) Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings All Private Non-Agricultural Establishments Total Employment Non-Supervisory Workers: Employment Average Weekly Hours Average Hourly Earnings

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

Percent Change From the Same Period of Previous Year

4.7

4.6

4.2

4.3

5.0

4.3

4.2

4.0

4.2

4.3

4.7 0.3 5.9

4.7 0.0 5.3

4.1 0.7 3.9

4.2 0.2 6.4

5.0 0.2 4.9

4.2 1.3 4.7

4.2 0.3 3.7

4.0 0.6 3.6

4.1 0.5 3.7

4.2 0.4 4.0

5.5

5.0

4.9

5.4

4.7

5.0

4.8

4.6

5.1

5.4

5.5 0.4 8.1

4.6 0.4 5.3

4.7 0.7 2.5

5.3 0.2 8.2

4.5 0.2 6.7

4.8 1.6 2.0

4.6 0.1 2.2

4.4 0.6 2.8

4.9 0.6 3.0

4.9 0.4 4.4

2.6

2.9

2.7

3.5

2.1

2.8

2.7

2.6

2.7

3.5

2.8 0.2 7.8

3.1 0.4 4.7

2.3 0.2 3.7

3.6 0.4 7.0

2.3 0.0 5.8

2.5 0.7 4.2

2.3 0.4 3.7

2.1 0.4 3.3

2.5 0.0 3.8

3.4 1.3 3.1

4.4

5.5

3.4

3.7

5.9

3.5

3.1

3.2

3.6

4.2

4.3 0.9 6.5

5.4 0.1 4.4

3.4 0.5 3.9

3.6 0.4 6.7

5.9 0.8 5.3

3.6 0.8 3.9

3.2 0.1 3.9

3.3 0.8 4.0

3.7 0.2 3.8

4.2 0.7 3.8

3.2

3.0

2.9

3.0

3.4

2.9

3.0

2.9

2.6

2.3.

3.3 0.7 5.2

3.2 0.0 6.0

2.9 0.6 4.2

3.0 0.9 6.0

3.6 0.6 4.6

3.0 1.2 5.6

3.1 0.4 3.8

3.0 0.3 3.6

2.6 0.4 3.9

2.2 0.4 4.2

1.1

1.4

0.0

1.7

1.0

0.8

0.0

0.2

0.6

1.3

1.0 0.3 3.7

1.6 0.6 3.1

0.3 0.2 2.5

1.7 0.4 3.7

1.3 1.1 3.3

0.6 0.7 2.8

0.3 0.2 2.3

0.5 0.0 2.3

1.0 0.1 2.5

1.7 0.1 2.6

Employment All Hospitals 2.4 2.2 2.6 2.2 2.3 2.5 2.7 2.7 2.5 2.2 2.9 2.6 2.3 3.4 2.9 3.0 Private Hospitals (SIC 806) 3.2 3.0 2.9 3.0 Federal Hospitals 1.9 0.8 1.5 2.9 0.6 2.2 1.5 1.1 1.1 0.9 3.7 0.7 4.1 2.8 0.5 0.7 1.2 0.6 0.4 State Hospitals 2.2 Local Hospitals 2.2 1.1 2.6 2.5 1.1 1.6 2.2 2.9 3.6 3.9 1 Excludes hospitals, clinics, and other health-related establishments run by all governments. 0 NOTES: Data presented here incorporate conversion to the 1987 Standard Industrial Classification (SIC) and an historical reconstruction of components back to the inception of the series whenever possible. Q designates quarter of year. 0 SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1989-June 1993.

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Figure 2 Percent Change in Employment from the Same Period of Previous Year; 1984-93

HEALTH CARE FINANCING REVIEW/Fall 1993/Volume15,Number 1

159

Table 5 Percent Change in implied Non-Supervisory Payrolls and Work Hours in Private1 Health Service Establishments, by Selected Type of Establishment: 1990-93 Calendar Year Type of Establishment

1990

1991

1992

Annual Percent Change

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

Percent Change From the Same Period of Previous Year

Private Health Service Establishments (SIC 80) Payrolls Work Hours

11.2 5.0

10.3 4.7

8.9 4.8

11.1 4.4

9.9 4.8

10.6 5.6

8.3 4.5

8.4 4.6

8.5 4.6

7.9 3.7

Offices and Clinics of Medical Doctors (SIC 801) Payrolls Work Hours

13.6 5.1

10.6 5.1

8.1 5.4

14.1 5.5

11.2 4.3

8.6 6.5

6.9 4.7

8.0 5.1

8.7 5.5

9.1 4.5

Offices and Clinics of Dentists (SIC 802) Payrolls Work Hours

10.6 2.6

7.5 2.6

6.4 2.5

10.4 3.3

8.2 2.3

7.6 3.3

5.7 1.9

5.8 2.5

6.4 2.5

5.3 2.1

Nursing and Personal Care Facilities (SIC 805) Payrolls Work Hours

12.1 5.2

10.1 5.5

8.0 4.0

10.9 4.0

12.4 6.8

8.5 4.4

7.3 3.4

8.3 4.1

7.8 3.9

7.4 3.5

Private Hospitals (SIC 806) Payrolls Work Hours

9.4 4.0

9.4 3.2

7.9 3.5

10.1 3.9

7.7 3.0

10.1 4.3

7.5 3.5

7.0 3.3

7.1 3.0

6.9 2.6

All Private Non-Agricultural Establishments Payrolls Work Hours

4.5 0.8

0.9 2.1

3.0 0.5

5.0 1.3

0.9 2.4

2.9 0.1

2.9 0.5

2.7 0.5

3.6 1.1

4.3 1.6

1

Excludes hospitals, clinics, and other health-related establishments run by all governments.

0

NOTES: Data presented here incorporate conversion to the 1987 Standard Industrial Classification (SIC) and an historical reconstruction of components back to the inception of the series, whenever possible. Q designates quarter of year. Quarterly data not seasonally adjusted. 0

SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1989-June 1993.

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Figure 3 Percent Change for Non-Supervisory Payroll from the Same Period of Previous Year: 1984-93

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161

Table 6 Selected Items of the Consumer Price Index for All Urban Consumers: 1990-93 Calendar Year Item

1990

1991

1992

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

All Items All Items Less Medical Care Apparel and Upkeep Energy Food and Beverages Housing: Shelter

130.7 128.8 124.1 102.1 132.1 140.0

136.2 133.8 128.7 102.4 136.8 146.3

140.3 137.5 131.9 103.0 138.7 151.2

128.0 126.3 120.8 96.5 130.7 136.9

134.8 132.6 126.3 103.2 136.1 144.6

138.7 136.0 130.5 99.3 138.3 149.8

139.8 137.0 132.5 102.6 138.5 150.5

140.9 138.0 130.9 105.8 138.7 152.0

141.9 138.9 133.6 104.3 139.3 152.5

143.1 140.0 133.1 102.7 140.7 154.3

Medical Care Medical Care Services 1 Professional Services Physicians' Services Dental Services Hospital and Related Services Hospital Room Other Inpatient Services 2 Outpatient Services 2

162.8 162.7 156.1 160.8 155.8 178.0 175.4 142.7 138.7

177.0 177.1 165.7 170.5 167.4 196.1 191.9 158.0 153.4

190.1 190.5 175.8 181.2 178.7 214.0 208.7 172.3 168.7

157.4 157.1 152.2 156.5 152.3 171.5 169.7 136.7 134.0

172.4 172.6 162.3 167.4 162.7 190.9 187.3 153.7 148.9

185.9 186.1 172.3 177.2 174.7 208.1 202.8 168.0 163.5

188.7 188.9 174.7 180.3 177.0 211.3 206.1 170.2 166.4

191.5 192.1 177.0 182.6 180.4 216.0 210.6 173.9 170.1

194.1 195.0 179.0 184.6 182.6 220.6 215.2 177.0 174.7

197.7 198.8 181.6 187.7 184.8 226.2 220.6 181.1 179.9

Medical Care Commodities 163.4 171.7 184.9 187.8 176.8 188.0 158.5 189.0 190.4 193.0 Prescription Drugs 181.7 192.9 210.9 214.5 215.6 218.0 221.4 199.7 214.7 175.5 Non-Prescription Drugs and Medical Supplies 2 120.6 126.2 131.2 118.0 124.1 129.3 131.1 132.1 132.1 133.2 Internal and Respiratory Over-the-Counter Drugs 158.2 150.4 155.3 158.4 159.9 159.3 160.4 145.9 152.4 142.6 Non-Prescription Medical Equipment and Supplies 138.0 145.0 150.9 135.2 141.4 150.1 150.4 151.2 152.1 153.8 1 Includes net cost of private health insurance not shown in professional or hospital and related services. 2 December 1986 = 100. 0 NOTES: 1982-84 = 100.0 unless noted. Q designates quarter of year. Quarterly data not seasonally adjusted. 0 SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: CPI Detailed Report. Washington. U.S. Government Printing Office. Monthly reports for January 1990-March 1993.

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Table 7 Percent Change in Selected Items of the Consumer Price Index for All Urban Consumers: 1990-93 Calendar Year Item All Items

1990

1991

1992

Annual Percent Change 5.4 4.2 3.0

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

Percent Change from the Same Period of Previous Year 3.1 5.2 5.3 2.9 3.1 3.1 3.2

All Items Less Medical Care Apparel and Upkeep Energy Food and Beverages Housing: Shelter

5.2 4.6 8.2 5.8 5.4

3.9 3.7 0.4 3.6 4.5

2.7 2.5 0.5 1.4 3.4

5.0 3.6 8.0 6.5 5.0

5.0 4.5 6.9 4.1 5.6

2.6 3.4 3.7 1.6 3.6

2.8 2.8 0.9 0.8 3.5

2.8 2.2 2.6 1.4 3.3

2.8 1.4 2.4 1.7 3.1

2.9 2.0 3.4 1.8 3.0

Medical Care Medical Care Services 1 Professional Services Physicians' Services Dental Services Hospital and Related Services Hospital Room Other Inpatient Services Outpatient Services

9.1 9.3 6.6 7.2 6.7

8.7 8.9 6.2 6.0 7.5

7.4 7.6 6.1 6.3 6.7

8.5 8.5 6.2 6.6 6.5

9.6 9.8 6.6 7.0 6.8

7.8 7.9 6.2 5.9 7.4

7.7 7.8 6.2 6.5 6.9

7.2 7.5 6.0 6.4 6.5

6.8 7.2 5.8 6.3 6.1

6.3 6.8 5.4 5.9 5.8

10.9 10.9 10.7 11.2

10.2 9.4 10.7 10.6

9.1 8.8 9.1 10.0

10.9 11.1 10.3 11.8

11.3 10.4 12.5 11.1

9.0 8.3 9.3 9.8

9.4 8.8 9.5 10.1

9.1 9.0 9.1 9.7

9.0 9.0 8.4 10.2

8.7 8.8 7.8 10.1

8.4 8.2 8.4 7.7 7.1 5.7 5.2 4.3 Medical Care Commodities 6.4 8.5 Prescription Drugs 10.0 9.9 9.3 8.5 6.5 5.0 7.6 10.1 9.9 6.0 Non-Prescription Drugs and Medical Supplies 5.2 4.7 3.9 5.6 5.2 4.2 4.1 3.9 3.4 3.0 Internal and Respiratory Over-the-Counter Drugs 5.2 4.5 5.5 3.3 4.3 4.0 3.7 3.3 3.8 5.3 Non-Prescription Medical Equipment and Supplies 5.3 5.0 4.1 5.9 4.6 6.2 3.9 3.6 2.7 2.4 1 Includes net cost of private health insurance not shown in professional or hospital and related services. 0 NOTE: Q designates quarter of year. 0 SOURCE: U.S. Department of Labor, Bureau of Labor Statistics: CPI Detailed Report. Washington. U.S. Government Printing Office. Monthly reports for January 1989-March 1993.

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163

Figure 4 Percent Change in Measures of Price Inflation from the Same Period of Previous Year: 1984-93

164

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Table 8 Percent Change in Four-Quarter Moving Averages in the Prospective Payment System Hospital Input Price Index, by Expense Category: 1991-94 Fou r Quarters Endi ng

Base Year

Expense Category 1

Weights 19872

1991 Q1

1991 Q2

Total

100.000

4.8

4.6

4.3

3.7

61.713 52.216 9.497 1.649 2.368 0.624 1.135 0.343 0.230 0.036 1.433 32.838 21.788 3.873 3.299 2.111 1.188 3.126 2.672 2.623 2.323 1.399 1.142 0.497 0.833 11.050 3.845 1.992 1.233 0.987 0.588 0.372 1.233 0.800

5.3 4.9 7.5 4.7 9.7 21.1 4.3 2.5 17.9 6.5 0.4 3.6 3.4 8.4 3.7 3.2 4.5 0.9 2.2 2.3 1.3 1.1 2.4 2.6 4.5 4.2 4.1 6.0 5.8 0.4 0.3 2.7 4.0 5.4

5.2 4.8 7.2 4.6 10.7 21.7 5.6 1.7 18.9 6.6 2.0 3.6 3.3 8.1 2.8 2.0 4.1 2.6 2.0 1.1 1.7 0.5 2.2 2.5 4.6 4.1 3.7 5.1 6.5 0.6 0.2 6.7 3.9 5.5

5.0 4.6 7.0 4.5 7.5 11.4 7.1 0.9 8.4 6.9 2.5 3.2 2.8 8.3 1.8 0.7 3.8 2.3 1.7 0.3 1.9 0.4 2.1 2.3 3.8 3.8 3.2 4.1 5.7 1.3 0.1 10.8 4.1 5.0

4.7 4.3 6.5 4.3 1.9 11.3 7.1 1.6 11.2 7.3 1.3 2.4 1.9 8.4 1.2 0.0 3.4 1.3 1.5 1.4 1.3 1.5 2.1 1.9 2.1 3.3 2.9 3.0 2.8 1.6 1.0 14.8 4.1 4.2

Compensation Wages and Salaries Employee Benefits Other Professional Fees Energy and Utilities Fuel Oil, Coal, and Other Fuel Electricity Natural Gas Motor Gasoline Water and Sewerage Maintenance Professional Liability Insurance All Other Other Products Pharmaceuticals Food Direct Purchase Contract Service Chemicals and Cleaning Products Surgical and Medical Instruments Photographic Supplies Rubber and Plastics Paper Products Apparel Minor Machinery and Equipment Miscellaneous Products Other Services Business Services Computer and Data Processing Transportation and Shipping Telephone Blood Services Postage Other—Labor Intensive Other—Non-Labor Intensive

1991 Q3

1991 Q4

1992 Q1

1992 Q2

1992 Q3

1992 Q4

3.4

3.1

3.0

3.1

4.5 4.2 6.4 4.3 5.5 18.3 5.3 3.0 15.5 7.6 2.4 1.8 1.2 8.3 0.8 0.6 3.1 4.0 1.6 1.4 0.4 2.7 1.9 1.4 1.4 3.0 2.8 2.1 1.4 1.7 2.1 13.1 4.1 3.6

4.3 3.9 6.3 4.2 6.2 17.7 3.4 4.2 15.1 7.6 3.8 1.5 1.0 7.9 0.7 0.5 2.8 5.2 1.8 1.2 0.1 2.7 1.7 0.9 0.8 2.5 2.4 1.4 1.0 1.7 4.5 8.8 3.9 3.2

4.1 3.7 6.1 4.0 5.0 14.4 1.8 1.9 11.2 7.1 4.7 1.5 1.1 7.2 0.9 0.0 2.4 4.4 1.9 0.7 0.3 2.1 1.6 0.5 0.8 2.3 2.4 1.2 1.0 1.2 6.5 4.9 3.4 3.0

3.9 3.4 6.2 3.9 0.9 5.5 1.2 2.0 2.6 6.8 3.3 1.7 1.4 6.5 0.8 0.2 2.0 2.3 2.2 0.2 0.0 1.4 1.7 0.3 1.2 2.1 2.1 1.3 2.2 0.6 5.8 1.2 2.9 3.0

See footnotes at end of table.

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165

Table 8—Continued Percent Change in Four-Quarter Moving Averages in the Prospective Payment System Hospital Input Price Index, by Expense Category: 1991-94 Expense Category 1 Total

Base Year Weights 19872 100.000

Four Quarters Ending 1993 Q1

1993 Q2

1993 Q3

1993 Q4

1994 Q1

1994 Q2

1994 Q3

1994 Q4

3.1

3.1

3.2

3.5

3.7

4.0

4.3

4.4

Compensation 3.7 4.2 61.713 3.7 3.8 4.0 4.3 4.4 4.3 Wages and Salaries 3.7 52.216 3.3 3.2 3.3 3.5 3.9 3.9 4.0 Employee Benefits 9.497 6.1 6.2 6.5 6.4 6.3 6.3 6.5 6.2 Other Professional Fees 1.649 3.7 4.2 4.3 4.4 4.3 3.8 3.8 4.0 Energy and Utilities 1.2 4.1 2.368 2.4 2.3 0.9 1.0 2.2 4.7 Fuel Oil, Coal, and Other Fuel 0.624 3.1 2.2 4.9 6.6 8.3 10.1 1.0 8.5 Electricity 1.1 0.2 1.135 1.3 0.1 0.1 0.1 1.6 2.2 Natural Gas 4.9 7.3 3.2 0.343 3.4 3.5 6.0 6.0 1.6 Motor Gasoline 1.2 0.230 2.0 0.1 0.9 1.1 4.8 7.8 8.7 Water and Sewerage Maintenance 6.3 5.7 5.7 0.036 6.5 6.0 5.7 6.0 6.2 Professional Liability Insurance 4.5 6.7 7.4 8.5 1.433 3.8 5.5 8.0 9.0 All Other 2.0 2.1 2.4 2.9 32.838 1.9 3.4 3.8 4.2 Other Products 2.1 2.4 2.7 3.3 21.788 1.8 2.2 3.0 3.6 Pharmaceuticals 3.873 5.7 5.4 5.0 5.4 5.4 5.5 5.0 5.4 Food 3.299 0.9 1.0 1.2 1.5 1.9 2.6 2.9 2.3 Direct Purchase 2.111 0.5 0.5 0.7 1.1 1.5 2.4 2.0 2.6 Contract Service 1.7 1.7 2.1 2.4 1.188 1.8 2.7 3.0 3.3 Chemicals and Cleaning Products 3.126 0.2 1.9 3.2 3.7 4.2 5.0 2.4 5.3 Surgical and Medical Instruments 2.672 2.4 2.4 2.5 2.3 2.0 2.0 2.1 2.5 Photographic Supplies 2.623 0.0 0.1 0.0 0.2 0.9 1.6 2.2 0.1 Rubber and Plastics 2.323 0.7 1.0 0.6 0.7 0.8 1.1 1.0 1.0 Paper Products 1.399 0.4 1.0 2.5 4.2 5.3 0.6 0.0 5.8 Apparel 1.4 1.7 2.2 1.142 1.8 1.8 1.5 1.5 1.8 Minor Machinery and Equipment 0.497 0.2 0.3 1.0 1.4 2.0 2.2 0.6 1.8 Miscellaneous Products 0.833 1.6 1.7 1.7 1.9 2.2 2.5 2.9 3.1 Other Services 3.2 4.1 4.8 11.050 1.9 2.0 2.1 2.6 5.4 Business Services 4.5 3.845 1.5 1.6 1.7 2.3 3.1 3.8 4.8 Computer and Data Processing 1.992 1.7 2.3 3.3 2.8 3.9 4.6 5.1 5.5 Transportation and Shipping 1.233 3.0 3.3 3.7 3.8 4.4 4.8 5.0 3.5 Telephone 0.987 0.2 0.5 2.5 2.3 1.0 1.8 2.5 2.0 Blood Services 1.0 2.2 3.3 0.588 4.6 2.1 0.6 2.8 3.3 Postage 0.372 0.0 0.0 0.0 2.1 11.2 20.3 0.0 29.3 Other—Labor Intenstive 1.233 2.4 2.2 2.2 2.6 3.1 3.6 4.0 3.9 Other—Non-Labor Intensive 3.1 3.2 3.2 3.2 0.800 3.1 3.2 3.2 3.3 1 For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1990). 2 Category weights may not sum to totals because of rounding. 0 NOTES: Data through 1993, Quarter 1 are historical. Data beginning with 1993, Quarter 2 are forecasted. Q designates quarter of year. Percent change data shown are four-quarter moving averages. The following is an example of how a percent change is calculated. Use the quarterly index levels shown in Tables 9, 11, and 13. Choose the four-quarter period ending for which you would like to calculate the percent change (e.g., year-end 1993, Quarter 3). Count back three quarters so that you have a total of four (e.g., 1993, Quarter 3; 1993, Quarter 2; 1993, Quarter 1; 1992, Quarter 4). Average these four quarters (add the index levels and divide by 4). Now take the four quarters previous to the four quarters that you just used (e.g., 1992, Quarter 3; 1992, Quarter 2; 1992, Quarter 1; 1991, Quarter 4). Average these four quarters. Finally, compute a percent change using the two averages. 0 SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics, Division of Health Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc./McGraw-Hill.

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Table 9 Quarterly Index Levels of the Prospective Payment System Hospital Input Price Index, by Expense Category: 1991-94 Expense Category Total

1

Base Year Weights 19872

1991 Q1

1991 Q2

1991 Q3

1991 Q4

1992 Q1

1992 Q2

1992 Q3

1992 Q4

100.000

120.3

121.0

122.2

123.1

123.9

124.8

126.1

126.7

127.0 125.0 138.3 124.9 114.6 120.5 114.9 92.3 126.8 137.0 133.8 121.0 121.0 150.6 116.5 114.0 121.1 115.8 113.2 113.9 112.5 115.7 112.0 112.1 117.6 120.9 120.0 130.1 121.5 103.1 115.4 131.9 119.6 124.4

128.5 126.2 140.8 126.4 120.0 125.0 120.4 101.5 129.5 140.3 135.3 121.6 121.7 152.1 116.5 113.7 121.6 118.1 113.3 114.2 113.0 115.4 112.4 112.0 118.0 121.3 120.4 131.2 122.3 102.8 112.9 131.9 120.5 125.4

129.4 127.0 142.5 127.1 117.0 123.9 113.5 109.6 122.6 141.9 137.5 122.0 122.1 153.5 116.5 113.5 122.0 118.1 113.7 114.2 113.4 115.1 113.1 112.2 118.5 121.7 120.2 132.3 124.0 102.7 112.3 131.9 121.0 126.3

Compensation 61.713 121.0 122.1 52.216 120.6  Wages and Salaries 119.6 9.497 130.4  Employee Benefits 128.8 Other Professional Fees 1.649 119.0 120.0 Energy and Utilities 2.368 113.2 119.5 114.5  Fuel Oil, Coal, and Other Fuel0.624 141.3  Electricity 1.135 110.4 114.1  Natural Gas 0.343 103.0 97.8 126.2  Motor Gasoline 0.230 128.7 128.2  Water and Sewerage Maintenance 0.036 125.4 Professional Liability Insurance 1.433 129.1 129.3 All Other 32.838 119.1 118.8  Other Products 21.788 119.5 119.5   Pharmaceuticals 3.873 137.4 141.3 115.1   Food 3.299 115.5    Direct 2.111 Purchase 113.7 113.8    Contract 1.188 117.4Service 118.6   Chemicals and 3.126 Cleaning 123.7 Products 119.8   Surgical and 2.672 Medical 110.1 Instruments 110.7   Photographic 2.623 Supplies 114.8 114.1   Rubber and Plastics 2.323 113.6 112.9   Paper products1.399 119.4 117.1 1.142   Apparel 109.7 110.3   Minor Machinery 0.497and 111.7 Equipment 111.9   Miscellaneous Products 0.833 116.0 116.1  Other Services 118.5 11.050 117.5 3.845   Business Services 117.0 118.1   Computer and 1.992 Data Processing 128.0 129.3   Transportation 1.233 and Shipping 119.3 118.6   Telephone 0.987 102.1 102.2   Blood Services 0.588 106.1 105.6   Postage 0.372 125.7 131.9   Other—Labor 1.233 Intensive114.5 116.0   Other—Non-Labor 0.800 Intensive 119.9 120.7 See footnotes at end of table.

HEALTH CARE FINANCING REVIEW/Fall 1993/Volume15,Number1

123.8 122.2 132.6 121.8 116.5 119.9 119.0 94.4 125.6 132.0 131.1 119.1 119.3 143.4 115.3 112.9 119.6 117.0 111.0 114.1 112.4 115.8 110.6 111.8 116.1 118.7 117.8 129.2 119.1 102.5 105.3 131.9 117.6 121.6

124.9 123.3 134.1 122.8 115.6 129.7 111.4 97.3 122.3 133.1 133.2 119.7 119.8 145.3 115.7 113.1 120.2 117.3 111.0 114.3 112.4 115.7 110.7 111.9 116.6 119.6 118.4 129.6 120.2 103.0 110.2 131.9 118.5 122.5

126.2 124.2 136.8 123.9 108.9 108.3 111.6 96.8 110.9 134.7 133.2 120.2 120.1 148.1 115.8 113.1 120.7 115.0 112.5 114.2 112.2 115.1 111.2 112.3 116.5 120.5 120.8 129.3 119.8 103.4 111.3 131.9 119.1 123.4

167

Table 9—Continued Quarterly Index Levels of the Prospective Payment System Hospital Input Price Index, by Expense Category: 1991-94 Expense Category

1

Total Compensation Wages and Salaries Employee Benefits Other Professional Fees Energy and Utilities Fuel Oil, Coal, and Other Fuel Electricity Natural Gas Motor Gasoline Water and Sewerage Maintenance Professional Liability Insurance All Other Other Products Pharmaceuticals Food Direct Purchase Contract Service Chemicals and Cleaning Products Surgical and Medical Instruments Photographic Supplies Rubber and Plastics Paper Products Apparel Minor Machinery and Equipment Miscellaneous Products Other Services Business Services Computer and Data Processing Transportation and Shipping Telephone Blood Services Postage Other—Labor Intensive Other—Non-Labor Intensive

Base Year Weights 19872

1993 Q1

1993 Q2

1993 Q3

1993 Q4

1994 Q1

1994 Q2

1994 Q3

1994 Q4

100.000

127.8

128.9

130.5

131.7

133.2

134.5

136.2

137.5

61.713 52.216 9.497 1.649 2.368 0.624 1.135 0.343 0.230 0.036 1.433 32.838 21.788 3.873 3.299 2.111 1.188 3.126 2.672 2.623 2.323 1.399 1.142 0.497 0.833 11.050 3.845 1.992 1.233 0.987 0.588 0.372 1.233 0.800

130.7 128.1 145.1 128.3 113.5 117.6 113.4 102.0 115.8 143.2 140.1 122.7 122.7 154.9 117.0 113.8 122.6 118.2 115.4 114.2 113.9 114.7 113.1 112.6 118.7 122.6 121.9 132.9 124.4 103.4 111.6 131.9 121.6 127.3

131.8 129.1 147.1 129.6 115.4 122.5 114.9 95.6 123.8 145.3 142.4 123.6 123.6 158.2 117.8 114.7 123.5 119.7 116.1 113.4 113.5 115.2 113.7 112.8 119.5 123.6 122.4 134.0 125.6 105.0 114.6 131.9 122.2 128.4

133.7 130.8 149.9 131.6 117.1 124.3 117.2 93.9 127.1 147.7 145.1 124.6 124.6 159.5 118.6 115.3 124.3 121.5 116.0 114.2 114.1 117.0 114.3 113.5 120.0 124.6 123.3 135.9 126.7 105.5 113.9 131.9 123.8 129.5

135.0 132.0 151.7 132.7 119.2 136.9 114.4 94.5 127.5 149.3 148.4 125.7 125.5 161.7 118.9 115.3 125.1 122.7 116.5 114.6 114.1 119.0 114.4 114.0 121.2 126.1 124.7 137.7 128.9 105.6 116.2 131.9 125.3 130.3

136.6 133.2 155.0 134.1 118.8 135.4 114.6 96.9 122.0 152.1 151.5 127.2 126.8 164.7 120.1 116.6 126.3 124.0 117.3 115.4 114.2 121.0 114.6 114.8 122.3 128.1 127.1 139.7 129.7 106.2 117.3 143.1 126.6 131.2

137.6 134.2 156.4 135.2 121.0 133.0 116.5 98.7 138.5 154.1 154.7 128.8 128.0 166.5 121.1 117.6 127.4 125.9 118.1 116.2 114.7 122.5 115.9 115.4 123.1 130.5 128.3 141.4 132.6 106.9 116.7 179.7 127.2 132.5

139.5 136.0 158.9 137.2 122.9 132.1 120.8 98.1 139.5 157.1 158.6 130.0 129.2 167.5 122.1 118.5 128.5 128.5 118.7 117.3 115.5 124.0 117.2 116.1 123.9 131.7 129.5 143.4 133.5 107.3 117.1 179.7 128.7 133.8

140.7 137.2 160.3 138.3 124.4 143.5 118.0 98.4 137.2 158.4 163.1 131.2 130.1 169.6 122.5 118.5 129.6 129.0 119.6 117.9 115.7 125.4 117.8 116.7 125.0 133.3 131.2 145.6 135.3 107.5 120.5 179.7 130.2 134.7

1 2

For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1990). Category weights may not sum to totals because of rounding.

NOTES: Data through 1993, Quarter 1 are historical. Data beginning with 1993, Quarter 2 are forecasted. Q designates quarter of year. SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics, Division of Health Care Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc./McGraw-Hill.

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HEALTH CARE F I N A N C I N G REVIEW/Fall 1993/Volume 15, Number 1

Table 10 Percent Change in Four-Quarter Averages in the Skilled Nursing Facility Input Price Index, by Expense Category: 1991-94

Expense Category1 Total

Base Year Weights 19772

1991 Q1

1991 Q2

1991 Q3

1991 Q4

1992 Q1

1992 Q2

1992 Q3

1992 Q4

100.000

6.0

5.5

5.0

4.3

3.9

3.7

3.6

3.6

6.1 6.2 5.8 7.4 16.0 2.5 0.2 6.5 3.8 3.2 4.3 5.9 8.4 5.4 7.3 5.3 5.4

5.6 5.5 6.4 7.3 15.1 2.6 0.6 6.6 3.0 2.0 3.8 5.9 8.1 5.5 6.9 5.3 5.5

5.2 5.0 6.8 5.7 10.0 3.2 1.1 6.9 2.2 0.7 3.4 5.6 8.3 5.1 6.5 5.2 5.1

4.7 4.4 7.0 0.7 3.8 3.8 1.1 7.3 1.6 0.0 3.0 5.1 8.4 4.2 6.0 4.8 4.2

4.3 4.0 6.7 1.3 8.3 3.3 0.4 7.6 1.4 0.6 3.1 4.7 8.3 3.6 5.7 4.6 3.6

4.1 3.9 6.1 1.9 9.7 3.2 0.4 7.6 1.3 0.5 2.8 4.4 7.9 3.2 5.9 4.3 3.2

4.0 3.8 5.5 1.4 8.5 2.8 0.9 7.1 1.3 0.0 2.4 4.1 7.2 3.0 6.1 4.0 3.0

4.0 3.8 5.0 0.5 3.9 2.2 1.7 6.8 1.2 0.1 2.1 4.0 6.5 3.0 6.3 3.8 3.0

Compensation 70.620  Wages and Salaries 63.020  Employee Benefits 7.600 Fuel and Other Energy 4.270  Fuel Oil and Coal 1.660  Electricity 1.210 0.910  Natural Gas 0.490  Water and Sewerage Maintenance Food 9.740  Direct Purchase 4.930  Contract Service 4.810 All Other 15.370  Drugs 1.500  Supplies 3.280  Health Services 1.210  Other Business Services 4.590 4.790  Miscellaneous

Total

Fou r Quarters Ending

Base Year Weights 19772

1993 Q1

1993 Q2

1993 Q3

1993 Q4

1994 Q1

1994 Q2

1994 Q3

1994 Q4

100.000

3.6

3.7

3.8

4.0

4.3

4.6

4.7

4.8

Fou r Quarters Ending

Compensation 70.620 5.2 5.2 3.9 4.0 4.1 4.4 4.8 5.0 Wages and Salaries 63.020 3.9 4.0 4.7 5.2 5.3 3.8 4.4 5.0 Employee Benefits 7.600 4.6 4.9 4.9 4.6 4.5 4.4 4.8 4.9 Fuel and Other Energy 4.7 4.270 2.4 2.7 2.5 2.6 3.0 3.9 2.6 Fuel Oil and Coal 1.660 0.3 1.1 0.9 2.3 2.9 4.3 6.1 7.0 Electricity 0.7 0.8 1.3 1.210 2.2 1.7 1.2 0.4 0.4 Natural Gas 0.910 4.4 2.8 4.1 3.4 4.4 3.5 2.9 2.3 0.490 6.0 Water and Sewerage Maintenance 6.5 6.3 6.0 5.7 5.7 5.7 6.2 Food 9.740 2.8 3.0 1.2 1.3 1.5 1.9 2.3 2.6 Direct Purchase 4.930 1.7 2.2 2.4 2.6 0.4 0.5 0.8 1.2 Contract Service 4.810 2.1 2.7 2.9 3.1 3.2 1.8 2.4 1.8 All Other 15.370 3.9 4.0 4.0 3.9 3.9 3.8 3.8 3.8 Drugs 1.500 5.4 5.4 5.5 5.7 5.0 5.0 5.4 5.4 Supplies 3.280 3.1 3.2 3.1 3.1 3.1 3.1 3.1 3.3 Health Services 1.210 6.4 6.7 6.9 6.3 6.0 5.9 5.8 6.0 Other Business Services 4.590 3.7 3.8 3.7 3.6 3.6 3.6 3.6 3.8 3.2 Miscellaneous 4.790 3.1 3.1 3.1 3.1 3.3 3.1 3.1 1 For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1992c). 2 Category weights may not sum to totals because of rounding. NOTES: Data through 1993, Quarter 1 are historical. Data beginning with 1993, Quarter 2 are forecasted. Q designates quarter of year. Percent change data shown are four-quarter moving averages. The following is an example of how a percent change is calculated. Use the quarterly index levels shown in Tables 9,11, and 13. Choose the four-quarter period ending for which you would like to calculate the percent change (i.e., year-end 1993: Quarter 3). Count back three quarters so that you have a total of four (e.g., 1993: Quarter 3; 1993: Quarter 2; 1993: Quarter 1; 1992; Quarter 4). Average these four quarters (add the index levels and divide by 4). Now, take the four quarters previous to the four quarters that you just used (e.g., 1992: Quarter 3; 1992; Quarter 2; 1992: Quarter 1; 1991: Quarter 4). Average these four quarters. Finally, compute a percent change using the two averages. SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics, Division of Health Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc./McGraw-Hill.

HEALTH CARE FINANCING REVIEW/Fall 1993/Volume15,Number1

169

Table 11 Quarterly Index Levels in the Skilled Nursing Facility Input Price Index, by Expense Category: 1991-94

Expense Category 1

Base Year Weights 19772

1991 Q1

1991 Q2

1991 Q3

1991 Q4

1992 Q1

1992 Q2

1992 Q3

1992 Q4

Total

100.000

227.6

229.1

231.1

233.2

235.7

237.5

239.7

241.5

229.2 228.4 235.5 229.0 230.6 212.7 229.8 261.7 184.5 165.6 203.9 247.3 320.6 222.7 286.2 256.4 222.7

231.2 230.2 239.2 219.7 207.7 212.9 225.0 267.6 185.0 165.0 205.5 249.9 329.7 223.9 289.4 259.2 223.9

233.4 232.3 242.2 221.7 208.6 214.5 226.1 275.6 185.0 163.6 207.0 252.3 334.5 225.4 293.3 261.8 225.4

235.5 234.3 244.9 225.6 214.1 217.0 229.8 277.9 186.4 164.8 208.4 254.6 338.9 227.2 296.7 264.1 227.2

238.6 237.3 249.1 220.4 201.9 216.8 226.1 281.3 186.8 164.6 209.7 257.5 345.4 229.1 303.0 266.9 229.1

240.3 239.0 251.1 222.8 204.5 218.5 228.0 285.9 187.4 165.4 210.0 260.1 351.2 230.8 308.1 269.2 230.8

242.7 241.5 253.3 227.8 211.8 219.5 233.1 292.8 187.4 164.7 210.6 262.2 354.9 232.4 312.1 271.3 232.4

244.6 243.1 256.7 229.1 209.7 221.2 239.0 296.3 188.2 165.2 211.8 264.6 358.2 234.2 315.5 274.2 234.2

Base Year Weights 19772

1993 Q1

1993 Q2

1993 Q3

1993 Q4

1994 Q1

1994 Q2

1994 Q3

1994 Q4

100.000

244.2

246.5

249.6

252.5

255.9

258.3

261.7

265.0

70.620 63.020 7.600 4.270 1.660 1.210 0.910 0.490 9.740 4.930 4.810 15.370 1.500 3.280 1.210 4.590 4.790

247.7 246.3 259.2 228.5 208.6 220.5 237.7 298.9 189.1 165.5 213.3 267.3 361.4 236.4 320.9 276.9 236.4

250.2 248.7 262.7 229.3 208.3 220.2 239.8 303.2 190.3 166.5 214.7 269.9 368.9 237.9 325.0 279.2 237.9

253.8 252.4 265.3 231.8 212.8 220.5 240.3 308.3 191.5 167.4 216.2 272.3 372.1 239.7 330.3 281.6 239.7

257.0 255.7 267.8 234.1 216.9 221.0 240.9 311.6 192.8 168.4 217.8 274.8 377.3 241.6 334.8 284.0 241.6

260.7 259.1 273.6 237.0 220.9 221.4 243.8 317.5 194.4 169.7 219.8 278.0 384.2 243.7 342.1 286.6 243.7

263.3 261.8 275.8 239.3 223.8 221.9 246.4 321.7 195.9 170.8 221.6 280.6 388.3 245.6 347.8 289.2 245.6

266.9 265.6 277.6 244.3 229.1 225.1 252.7 327.9 197.4 172.0 223.3 283.3 390.7 247.8 353.3 292.0 247.8

270.7 269.6 279.5 246.5 231.9 225.6 255.4 330.7 198.8 173.1 225.1 285.9 395.7 249.8 358.0 294.6 249.8

Compensation 70.620  Wages and Salaries 63.020  Employee Benefits 7.600 Fuel and Other Energy 4.270  Fuel Oil and Coal 1.660  Electricity 1.210  Natural Gas 0.910  Water and Sewerage Maintenance 0.490 Food 9.740 4.930  Direct Purchase  Contract Service 4.810 All Other 15.370  Drugs 1.500  Supplies 3.280  Health Services 1.210  Other Business Services 4.590  Miscellaneous 4.790

Total Compensation Wages and Salaries Employee Benefits Fuel and Other Energy Fuel Oil and Coal Electricity Natural Gas Water and Sewerage Maintenance Food Direct Purchase Contract Service All Other Drugs Supplies Health Services Other Business Services Miscellaneous 1 2

For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1992c). Category weights may not sum to totals because of rounding.

NOTES: Data through 1993, Quarter 1 are historical. Data beginning with 1993, Quarter 2 are forecasted. Q designates quarter of year. SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics. Division of Health Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc./McGraw-Hill.

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Table 12 Percent Change in Four-Quarter Averages in the Home Health Agency input Price Index, by Expense Category: 1991-94

Expense Category 1

Base Year Weights 19762

1991 Q1

1991 Q2

1991 Q3

1991 Q4

Total

100.000

5.0

5.3

5.6

73.040 65.140 7.900 4.870 2.790 1.350 1.170 2.810 6.870 7.100

4.9 4.8 5.8 5.8 5.3 4.2 7.5 4.9 5.0 5.4

5.2 5.1 6.4 6.5 5.3 4.1 7.4 4.7 5.3 5.5

5.7 5.6 6.8 5.7 5.2 3.9 5.8 4.7 5.6 5.1

Compensation Wages and Salaries Employee Benefits Transportation Office Costs Rent Energy and Utilities Medical and Nursing Supplies Contract Services Miscellaneous

Total Compensation Wage and Salaries Employee Benefits Transportation Office Costs Rent Energy and Utilities Medical and Nursing Supplies Contract Services Miscellaneous

Four Quarters Endiing 1992 Q1

1992 Q2

1992 Q3

1992 Q4

5.7

5.7

5.1

4.4

4.1

6.1 6.0 7.0 2.8 4.8 3.5 0.7 5.0 5.7 4.2

6.3 6.3 6.7 1.4 4.6 3.3 1.3 5.5 5.7 3.6

5.6 5.6 6.1 1.0 4.3 2.9 1.9 5.2 5.1 3.2

4.8 4.8 5.5 1.0 4.0 2.6 1.4 4.9 4.4 3.0

4.3 4.2 5.0 2.2 3.8 2.5 0.5 4.1 4.1 3.0

1994 Q1

1994 Q2

1994 Q3

Base Year Weights 19762

1993 Q1

1993 Q2

1993 Q3

1993 Q4

100.000

3.8

3.9

4.0

4.1

4.3

4.4

4.6

4.8

73.040 65.140 7.900 4.870 2.790 1.350 1.170 2.810 6.870 7.100

3.9 3.9 4.6 3.0 3.8 2.3 2.4 3.2 3.8 3.1

4.0 4.0 4.5 3.3 3.7 2.3 2.8 3.0 3.9 3.1

4.2 4.2 4.6 3.5 3.8 2.3 2.6 2.9 4.0 3.1

4.3 4.3 4.4 3.7 3.7 2.1 2.7 3.0 4.1 3.1

4.5 4.5 4.8 3.8 3.6 1.9 2.7 3.3 4.3 3.1

4.6 4.6 4.9 4.4 3.6 1.6 3.1 3.4 4.4 3.1

4.8 4.8 4.9 4.8 3.6 1.4 4.0 3.8 4.6 3.2

5.0 5.1 4.9 5.0 3.6 1.9 4.8 4.1 4.8 3.3

Four Quarters Endi ng 1994 Q4

1 2

For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1992b). Category weights may not sum to totals because of rounding.

NOTES: Data through 1993, Quarter 1 are historical. Data beginning with 1993, Quarter 2 are forecasted. Q designates quarter of year. Percent change data shown are four-quarter moving averages. The following is an example of how a percent change is calculated. Use the quarterly index levels shown in Tables 9, 11, and 13. Choose the four-quarter period ending for which you would like to calculate the percent change (e.g., year-end 1993: Quarter 3). Count back three quarters so that you have a total of four (e.g., 1993: Quarter 3; 1993: Quarter 2; 1993: Quarter 1; 1992: Quarter 4). Average these four quarters (add the index levels and divide by 4). Now, take the four quarters previous to the four quarters that you just used (e.g., 1992: Quarter 3; 1992: Quarter 2; 1992: Quarter 1; 1991: Quarter 4). Average these four quarters. Finally, compute a percent change using the two averages. SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics, Division of Health Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc./McGraw-Hill.

H E A L T H C A R E F I N A N C I N G REVIEW/Fall 1993/Volume 15, Number 1

171

Table 13 Quarterly Index Levels of the Home Health Agency Input Price Index, by Expense Category: 1991-94

Expense Category 1

Base Year Weights 19762

1991 Q1

1991 Q2

1991 Q3

1991 Q4

1992 Q1

1992 Q2

1992 Q3

1992 Q4

Total

100.000

269.6

274.4

278.8

281.0

283.2

284.8

288.8

291.9

73.040 65.140 7.900 4.870 2.790 1.350 1.170 2.810 6.870 7.100

277.8 279.7 261.7 224.8 276.1 231.5 257.9 233.6 269.6 237.1

283.7 285.9 265.9 223.4 279.1 233.5 247.4 239.2 274.4 238.4

288.8 291.1 269.2 224.5 281.9 235.5 249.7 241.0 278.8 240.0

291.0 293.3 272.2 226.5 284.4 237.0 254.1 244.6 281.0 241.9

293.4 295.4 276.9 225.7 287.3 238.5 248.2 248.1 283.2 243.9

294.8 296.7 279.1 229.0 289.9 239.4 251.0 248.5 284.8 245.8

299.5 301.6 281.5 230.5 292.1 240.5 256.8 249.8 288.8 247.4

302.8 304.9 285.3 233.7 295.2 242.7 258.3 251.3 291.9 249.4

Base Year Weights 19762

1993 Q1

1993 Q2

1993 Q3

1993 Q4

1994 Q1

1994 Q2

1994 Q3

1994 Q4

100.000

294.4

296.5

300.8

304.2

307.8

310.4

315.4

319.9

Compensation Wages and Salaries Employee Benefits Transportation Office Costs Rent Energy and Utilities Medical and Nursing Supplies Contract Services Miscellaneous

Total

Compensation 73.040 305.5 307.6 312.5 316.2 320.2 322.7 328.3 333.3 330.7 Wages and Salaries 65.140 307.6 309.5 314.7 318.5 322.2 324.6 336.0 Employee Benefits 297.6 310.7 7.900 288.1 291.9 294.8 304.1 306.5 308.6 Transportation 4.870 234.4 236.7 238.7 243.0 251.5 254.9 244.4 249.9 Office Costs 2.790 298.2 300.6 303.2 305.8 311.4 314.4 317.2 308.6 Rent 245.2 246.2 246.4 248.2 1.350 243.8 246.6 250.8 254.8 Energy and Utilities 1.170 257.6 258.6 261.5 264.0 267.5 270.1 275.9 278.3 Medical and Nursing Supplies 254.1 256.4 257.7 269.4 272.3 2.810 259.9 262.3 266.5 Contract Services 6.870 294.4 296.5 310.4 315.4 319.9 300.8 304.2 307.8 Miscellaneous 7.100 251.7 253.3 255.2 257.2 259.4 261.5 263.9 266.0 1 For data sources used to estimate the input price index relative weights and choice of price proxies, see the Federal Register (1992b). 2 Category weights may not sum to totals because of rounding. NOTES: All data before 1993 are historical. Data for 1993 and 1994 are forecasted. Q designates quarter of year. SOURCES: Health Care Financing Administration, Office of the Actuary: Data from the Office of National Health Statistics, Division of Health Cost Analysis. Second quarter 1993 forecasts were produced by Data Resources, Inc/McGraw-Hill.

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HEALTH CARE FINANCING REVIEW/Fall 1993/Volume 15, Number 1

Figure 5 Percent Changes in Four Quarter Moving Averages for the Total Prospective Payment System (PPS) Versus the Consumer Price Index (CPI)-AII Items: 1985-94

HEALTH CARE FINANCING REVIEW/Fall 1993/Volume 15, Number 1

173

Table 14 Selected National Economic Indicators: 1990-93 Calendar Year Indicator Gross Domestic Product Billions of Dollars Billions of 1987 Dollars Implicit PriceDeflator(1987=100.0) Employment, Hours, and Earnings Unemployment Rate, All Workers

1990

1991

1992

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

$5,522 $5,677 $5,951 $5,445 $5,586 $5,840 $5,902 $5,979 $6,082 $6,146 $4,878 $4,821 $4,923 $4,891 $4,797 $4,874 $4,892 $4,934 $4,991 $5,000 113.2 117.8 120.9 111.3 116.5 119.8 120.6 121.2 121.9 122.9

5.5

6.7

7.4

5.3

6.5

7.2

7.5

7.6

7.3

7.0

Private Non-Agricultural Workers: Total Employment in Thousands Average Weekly Hours Average Hourly Earnings

91,115 89,854 89,866 89,691 88,788 88,112 89,924 90,715 90,714 89,217 34.5 34.3 34.4 34.2 33.8 34.1 34.3 34.6 34.5 34.0 $10.01 $10.32 $10.57 $9.89 $10.22 $10.50 $10.53 $10.57 $10.70 $10.78

Health Services Workers: Total Employment in Thousands Average Weekly Hours Average Hourly Earnings

7,814 8,183 8,523 7,651 8,033 8,375 8,471 8,580 8,667 8,736 32.5 32.5 32.8 32.4 32.4 32.8 32.6 32.9 32.8 32.7 $10.40 $10.96 $11.39 $10.24 $10.73 $11.23 $11.30 $11.44 $11.57 $11.68

Personal Income and Savings Income in Billions Disposable Income in Billions Savings in Billions Personal Savings Rate

$4,664 $4,828 $5,058 $4,572 $4,753 $4,980 $5,029 $5,062 $5,161 $5,238 $4,043 $4,210 $4,431 $3,962 $4,136 $4,361 $4,412 $4,433 $4,517 $4,582 $176 $200 $213 $173 $193 $215 $232 $203 $200 $223 4.4 4.7 4.8 4.4 4.7 4.9 5.3 4.6 4.4 4.9

Prices1 Gross Domestic Product Fixed-Weight Price Index (1987 = 100.0)

113.5

118.1

121.6

111.6

116.7

120.3

121.2

121.9

122.9

124.2

Consumer Price Index, All Items All Items Less Medical Care Apparel and Upkeep Energy Food and Beverages Housing: Shelter Medical Care

130.7 128.8 124.1 102.1 132.1 140.0 162.8

136.2 133.8 128.7 102.4 136.8 146.3 177.0

140.3 137.5 131.9 103.0 138.7 151.2 190.1

128.0 126.3 120.8 96.5 130.7 136.9 157.4

134.8 132.6 126.3 103.2 136.1 144.6 172.4

138.7 136.0 130.5 99.3 138.3 149.8 185.9

139.8 137.0 132.5 102.6 138.5 150.5 188.7

140.9 138.0 130.9 105.8 138.7 152.0 191.5

141.9 138.9 133.6 104.3 139.3 152.5 194.1

143.1 140.0 133.1 102.7 140.7 154.3 197.7

Producer Price Index,2 Finished Consumer Goods

118.2

120.4

121.7

116.3

120.4

120.2

121.7

122.3

122.5

122.8

1

Base period = 1982-84, unless noted. 2 Formerly called the "Wholesale Price Index." NOTES: Q designates quarter of year. Quarterly data are not seasonally adjusted. SOURCES: U.S. Department of Commerce, Bureau of Economic Analysis: Survey of Current Business. Washington. U.S. Government Printing Office. Monthly reports for January 1990-May 1993; U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1990-June 1993.

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Table 15 Percent Change in Selected National Economic Indicators: 1990-93 Calendar Year Indicator

1990

1991

1992

1990 Q1

1991 Q1

1992 Q1

1992 Q2

1992 Q3

1992 Q4

1993 Q1

Annual Percent Change Percent Change from the Same Period of Previous Year Gross Domestic Product Billions of Dollars Billions of 1987 Dollars Implicit Price Deflator(1987=100.0)

5.2 0.8 4.3

2.8 1.2 4.0

4.8 2.1 2.6

5.7 1.5 4.1

2.6 1.9 4.6

4.6 1.6 2.9

4.3 1.6 2.7

4.6 2.1 2.5

5.7 3.1 2.5

5.2 2.6 2.6

Employment, Hours, and Earnings Unemployment Rate, All Workers 1

0.3

1.2

0.7

0.1

1.3

0.7

0.7

0.8

0.4

0.2

Private Non-Agricultural Workers: Total Employment Average Weekly Hours Average Hourly Earnings

1.1 0.3 3.7

1.4 0.6 3.1

0.0 0.2 2.5

1.7 0.4 3.7

1.0 1.1 3.3

0.8 0.7 2.8

0.0 0.2 2.3

0.2 0.0 2.3

0.6 0.1 2.5

1.3 0.1 2.6

Health Services Workers: Total Employment Average Weekly Hours Average Hourly Earnings

4.7 0.3 5.9

4.6 0.0 5.3

4.2 0.7 3.9

4.3 0.2 6.4

5.0 0.2 4.9

4.3 1.3 4.7

4.2 0.3 3.7

4.0 0.6 3.6

4.2 0.5 3.7

4.3 0.4 4.0

6.5 6.8 15.5 0.3

3.5 4.1 13.7 0.4

4.8 5.3 6.5 0.0

6.2 6.2 4.9 0.5

4.0 4.4 11.4 0.3

4.8 5.4 11.3 0.2

4.6 5.3 18.9 0.6

4.5 4.9 6.4 0.1

5.2 5.4 8.7 0.7

5.2 5.1 3.9 0.0

Prices2 Gross Domestic Product Fixed-Weight Price Index(1987=100.0) 4.5

4.0

3.0

4.4

4.6

3.1

3.0

2.8

3.0

3.2

5.4 5.2 4.6 8.2 5.8 5.4 9.1

4.2 3.9 3.7 0.4 3.6 4.5 8.7

3.0 2.7 2.5 0.5 1.4 3.4 7.4

5.2 5.0 3.6 8.0 6.5 5.0 8.5

5.3 5.0 4.5 6.9 4.1 5.6 9.6

2.9 2.6 3.4 3.7 1.6 3.6 7.8

3.1 2.8 2.8 0.9 0.8 3.5 7.7

3.1 2.8 2.2 2.6 1.4 3.3 7.2

3.1 2.8 1.4 2.4 1.7 3.1 6.8

3.2 2.9 2.0 3.4 1.8 3.0 6.3

5.5

1.9

1.0

5.7

3.5

0.2

1.1

1.6

1.5

2.1

Personal Income and Savings Income Disposable Income Savings Personal Savings Rate1

Consumer Price Index, All Items All Items Less Medical Care Apparel and Upkeep Energy Food and Beverages Housing: Shelter Medical Care Producer Price Index,3 Finished Consumer Goods 1

Change in rate, rather than percent change. 2 Base period = 1982-84, unless noted. 3 Formerly called the "Wholesale Price Index." NOTE: Q designates quarter of year. SOURCES: U.S. Department of Commerce, Bureau of Economic Analysis: Survey of Current Business. Washington. U.S. Government Printing Office. Monthly reports for January 1989-May 1993; U.S. Department of Labor, Bureau of Labor Statistics: Employment and Earnings. Washington. U.S. Government Printing Office. Monthly reports for January 1989-June 1993.

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Figure 6 Percent Change in Indicators of National Economic Activity from the Same Period of Previous Year: 1984-93

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HEALTH CARE F I N A N C I N G REVIEW/Fall 1993/Volume 15, Number 1