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Growth in Medical Spending by the Department of Defense September 2003 |
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The Congressional Budget Office (CBO) used the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality, to identify a civilian population of beneficiaries that was comparable to the Department of Defense's (DoD's) and examined the relative medical expenditures of that civilian population.(1) CBO broke the population down by sex and by age group (up to 17 years of age, 18 to 44, 45 to 64, and 65 or older). Average total medical expenditures varied among those groups from around $1,000 for females up to age 17 to over $5,800 for males age 65 or older (see Table B-1). Using males who were 18 to 44 years old as the base group, CBO converted average expenditures into relative weights ranging from 0.87 to 4.95.(2) For example, the figure for males age 65 or older indicates that that group spent, on average, 4.95 times as much as males between 18 and 44 years old did (see Figure B-1). CBO then divided the population of DoD beneficiaries up into those same groups and multiplied the total number in each group by the appropriate weight. Because older beneficiaries impose a heavier burden on any health care system, converting each beneficiary into an imaginary number of "weighted beneficiary units" makes tracking the total demand placed on the system easier. For example, if 450 beneficiaries convert into 875 weighted beneficiary units, the demand on the system would equal that by a beneficiary population consisting of 875 males between 18 and 44 years of age and no one else. CBO then adjusted those weighted beneficiary units for the beneficiaries' different rates of reliance on DoD's health care system (including both military medical treatment facilities and civilian providers) by multiplying the number of weighted beneficiary units in each category by the following full-time-equivalent weights:
Those figures represent the approximate average rates of reliance for each group, as revealed by surveys by DoD taken from 1994 to 1998. In reality, utilization by some groups, particularly retirees over age 65, fell during the time when the surveys were taken. Older retirees sought 32 percent of their care from military medical treatment facilities in 1994 but less than 25 percent by 1998, probably because the closure and downsizing of military medical treatment facilities made it more difficult to obtain care on a space-available basis (see Figure B-2).
While it might be possible to vary the adjustment factors to reflect changes in the rates of reliance over time, doing so would mask the impact of those changes in reliance on DoD's system and attribute them to the changing mix of beneficiaries rather than to the reduced use of the system by some groups. Such reduced use could reflect growing access to or preference for alternative sources of care (such as employer-provided health insurance or Medicare), or it could reflect the "squeezing out" of some beneficiaries as space-available care became more difficult to obtain. After weighting the beneficiary population by sex/age group and by rates of reliance, the end result is a number of "full-time-equivalent beneficiary units"--essentially, the number of full-time active-duty males ages 18 to 44 that it would take to impose the same approximate demand on the system as the actual mix does. While the number of beneficiaries decreased from 9.5 million to 8.5 million from 1988 to 2003 (an 11 percent decrease), the number of full-time-equivalent beneficiary units dropped from 11.4 million to 10.4 million (a 9 percent decrease). (See Figure B-3.)
Dividing DoD's total medical expenditures by the number of full-time-equivalent beneficiary units, CBO finds that real spending per unit rose from $1,300 in 1988 to $2,600 in 2003, or by about 5 percent annually.
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