Spending for health care services has been steadily increasing over the past several years. In 2000, national health expenditures in the U.S. totaled $1.3 trillion, up 6.9 percent from the previous year and 5.7 percent the year before. In 1960, expenditures totaled $26.7 billion.

Of the $1.3 trillion spent on health care in 2000, 32 percent went for hospital care. Physician services accounted for 22 percent, prescription drugs for 9 percent and nursing home care for 7 percent. Increasing at the fastest rate was spending for prescription drugs at a 15-percent increase each year from 1995-2000.

With overall spending on the rise, there has been a shift over the last several decades in who pays for health care. The major source of funding for health care services in 2000 was federal and state government programs – principally Medicare and Medicaid – which paid 43.3 percent of all medical bills. Private insurance covered 34.6 percent, other private sources paid for 5 percent and consumers paid for 17.2 percent out of their own pockets.

Whereas in 1960, before Medicare and Medicaid were formed, consumers paid out of pocket for the majority, or 55.2 percent, of health care services. That year private insurance paid 21.4 percent, other private sources accounted for 2 percent and government programs footed the bill for 21.4 percent. As more and more people were enrolled in Medicare and Medicaid and private insurance companies expanded the types of health care services covered, the amount consumers paid out of pocket has steadily decreased.

The way consumers receive health care has also changed over the years. As the average length of stay decreased from 7.4 days in 1980 to 4.9 days in 2000, the number of surgeries performed as an outpatient procedure has increased rapidly. In community hospitals in 1980, 16.3 percent of surgeries were outpatient procedures. By 2000, that number had soared to 62.7 percent. One factor contributing to these trends is that as health technology improves, patients need less invasive procedures and recovery time, allowing hospitals to provide more efficient care in the outpatient setting.

In looking at preventable health risks, Americans are making healthier choices in regards to tobacco use. In 2000, 23.1 percent of Americans were smokers compared to 25.3 percent in 1990 and 41.9 percent in 1965. Likewise, the number of pregnant women who smoke has decreased from 20 percent in 1989 to 12.2 percent in 2000.

However, Americans seem to be ignoring an increasingly dangerous health problem – obesity and overweight. The prevalence of overweight and obesity among adults has increased substantially since the late 1970s. In 1999 an estimated 61 percent of adults 20-74 years of age were overweight with 27 percent obese. That same year, an estimated 13 percent of children and 14 percent of adolescents were overweight. Despite America’s problem with weight, its citizens aren’t doing enough to prevent overweight and obesity. In 2000, almost 40 percent of adults reported they did not engage in physical activity during leisure time.

To keep America healthy in the future, providers will continue educating patients about the importance of healthy lifestyle choices and encourage them to get involved in their care. Hospitals will also continue balancing financial pressures with their dedication to improving how they deliver care to ensure appropriate access and quality health care to all patients.