In 1932, Benjamin Malzberg, a New York epidemiologist, published a study showing that people with mental illness died, on average, 14 to 18 years earlier than otherwise similar people in the general population.1 This mortality gap persists today and may even have widened: a 2006 U.S. study suggested that it ranged from 13 to 30 years.2 Indeed, the gap persists worldwide,3 mostly owing to medical conditions, such as cancer and cardiovascular disease, rather than “unnatural” causes, such as accidents and suicide.
Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government’s share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation.
Changes in Medicare Spending per Beneficiary by Age: Working Paper 2015-08 | Congressional Budget OfficeNovember 23, 2015
The aging of the population exerts upward pressure on federal spending for health care, especially Medicare, as both the number and average age of elderly beneficiaries increase. Total Medicare expenditures may also be affected by changes in relative per-beneficiary spending for beneficiaries of different ages as the population ages. In this paper, we use the Master Beneficiary Summary File to estimate spending per beneficiary for the elderly population (people between ages 65 and 105) enrolled in the traditional fee-for-service (FFS) Medicare program between 1999 and 2012. Over that period, the age for which Medicare spending per beneficiary was highest increased from 89 to 97. In addition, spending per beneficiary grew faster for older beneficiaries than for younger ones in the second half of the period.
Over the entire period, the average annual growth rate of Medicare spending per beneficiary for people ages 65 to 74 was about half of that for those ages 85 to 94. Faster decline in the use of acute inpatient hospital care among younger beneficiaries than among older beneficiaries contributed to the slower growth of spending per beneficiary for the 65- to 74-year-old age group. More rapid growth in spending on care provided in skilled nursing facilities and hospice care—services that are more widely used by older beneficiaries—than in spending on other Medicare services contributed to the faster growth in spending per beneficiary among the older groups; that growth also accounted for the increase in the age for which Medicare spending per beneficiary was highest. Neither increases in life expectancy nor changes in the composition of beneficiaries who were enrolled in the Medicare FFS program can account for those changes in Medicare spending per beneficiary by age.
These roots [of health inequalities] lie primarily in what Dr. Marmot identifies as the social determinants of health (SDH). These are not simply economic, although of course poverty is associated with bad health—a link established in the 19th century by Edwin Chadwick in Britain and Lemuel Shattuck in the U.S. But “poverty is not destiny,” Dr. Marmot insists. Rather, he seeks to develop a model of SDH that is intrinsically linked with human autonomy and control. Prosperity brings all sorts of empowerments, just as poverty denies them. It is the empowerment rather than the absolute poverty that he believes is most crucial.
Before the donors can choose who to fund, the sites themselves make a choice about who will be allowed to ask for funding at all. In September 2014, GoFundMe made headlines after it shut down the fundraising page of a woman named Bailey, who was collecting money for an abortion. She had no insurance, Bailey wrote on her page, and complications from a “rough, unplanned, and unexpected” pregnancy had left her unable to keep a job.
“We do not permit campaigns that could be considered divisive. Abortion would be a good example.”
After removing Bailey’s fundraiser (she was allowed to keep the money that had been donated up until that point), the site issued a list of causes that would be prohibited going forward, including “directly funding an abortion (human or animal).”
“As we scale, it’s important that GoFundMe is used in ways that our community and company can be proud of,” the company said in a statement. (Lee, of YouCaring, said his site has a similar policy: “We do not permit crowdfunding campaigns that could be considered divisive to our community,” he said. “Abortion would be a good example.”)
Over the last decade there has been increasing concern about an impending shortage of primary-care physicians. The most cited study projecting a shortage of these doctors (whose specialties include internal medicine, family medicine, and pediatrics) was published by the Association of American Medical Colleges Center for Workforce Studies in 2008, and its projections were updated in 2010 to take account of the Affordable Care Act. Lost in the dire warnings is an equally alarming shortage of non-primary-care physicians: The same organization puts the numbers at 33,100 this year; 46,109 by 2020; and 64,600 by 2025.
The annual County Health Rankings, conducted by the University of Wisconsin and sponsored by the Robert Wood Johnson Foundation, grade localities on a variety of health outcomes and factors.
Select your county from the menus below to see how it stacked up against others in your state. Rankings data is shown separately for 2012, 2013 and 2014.
For a full description of the methodology, visit the county health rankings website. The online hub also includes a searchable map and idea centers for policymakers to confront the challenges presented by the findings.