The health sector in the U.S. represents approximately 18% of the world’s largest economy. Given the steady numerical and proportional increase in the number of individuals in this nation who are age 65 and older, many of whom have co-morbidities that are costly to treat, that 18% figure can be expected to continue to inch higher. A complaint issued at regular intervals over the decades is that the health sector consists of too many silos that function independently of one another. An area in which improvements have been made, however, involves interprofessional education and clinical care. The Association of Schools Advancing Health Professions (ASAHP), the proprietor of this newsletter, has played an active role in fostering interprofessional improvements and innovations.
Apart from the silo aspect that characterizes portions of the health sphere, it is worth considering that the health domain is just one of several major silos (e.g., agriculture, housing, and national defense) in the overall economy. These other entities bear directly and indirectly on what transpires in the health area. The cost and availability of healthy foods has a role to play in enhancing individual and community health status. The quality of the housing stock and where it is located in every community around the nation have an impact on health. High rental costs, ability to obtain loans to purchase homes, and the extent of crime in neighborhoods are factors that influence personal health. A defense system capable of detecting and preventing biological warfare launched by other nations is necessary to ward off a threat of future pandemics. From the framework of this larger perspective, listed below are some ingredients of the overall U.S. economy that can influence events that unfold in the health domain.
U.S. Census Bureau Data On Income, Poverty, And Health Insurance
The U.S. Census Bureau announced on September 14, 2021 that median household income was $67,521 in 2020, a decrease of 2.9% from the 2019 median of $69,560. The drop is the first statistically significant decline in median household income since 2011. The total number of individuals with earnings decreased by about 3.0 million, while the number of full-time, year-round workers decreased by approximately 13.7 million. The official poverty rate in 2020 was 11.4%, up 1.0 percentage point from 2019, which is the first increase in poverty after five consecutive annual declines. In 2020, there were 37.2 million individuals in poverty, approximately 3.3 million more than in 2019. Private health insurance coverage continued to be more prevalent than public coverage, at 66.5% and 34.8%, respectively. Some beneficiaries may have more than one type of coverage during the calendar year. Of the subtypes of health insurance, employment-based insurance was the most common variety, covering 54.4% of the population for some or all of the calendar year.
Employment represents the main source of income for a great many inhabitants of the United States. A recurring fear is that the COVID-19 pandemic has resulted in the permanent elimination of many different kinds of jobs. Depending on an individual’s level of education and job skills, it may be possible to obtain new employment in totally different sectors of the economy, but what happens to everyone who is not so fortunate? Even when public assistance is available, will the newly unemployed be able to obtain the same quality of health care from the same providers they relied upon in the past? Declines in household income can affect the ability to meet out-of-pocket health care expenses for necessary purchases, such as for pharmaceuticals. Although not considered a tax, recent increases in inflation that have occurred in 2021 have led to a dramatic rise in the cost of fuel for motor vehicles. Food costs also have been soaring in recent months. Placing food on the table and filling gasoline tanks needed to commute to the workplace are unavoidable expenses that have the potential to crowd out other necessities, such as health care.
U.S. Health Insurance Market Competition
Seventy-three percent of U.S. commercial health insurance markets are highly concentrated based on guidelines used by the Department of Justice and Federal Trade Commission to assess market competition, according to the latest annual report on health insurance competition by the American Medical Association. In 91% of the 384 metropolitan statistical areas studied, at least one insurer had a commercial market share of 30% or more, and in 46% of MSAs a single insurer’s share was at least 50%. Fifty-four percent of markets that were highly concentrated in 2014 became even more concentrated by 2020. A concern is that these markets are ripe for the exercise of health insurer market power, which harms consumers and providers of care.