The problem of escalating healthcare costs that touched off the reform debate of 1993-94 hasn't disappeared, a new study indicates.
The study projects that per-capita health spending will grow nationally at a 36% clip between 1996 and 2000. But an analysis of data for three states shows that rates of spending vary substantially from one state to the next.
Because of local economic conditions, per-capita health spending in New York is expected to grow by 41% over the period. That compares with a projected 33% increase in Texas and 28% in California, the analysis found.
"The problems are still real," said Kathryn M. Langwell, director of health economics at Barents Group, a Washington-based affiliate of KPMG Peat Marwick. Barents Group performed the analysis for the Henry J. Kaiser Family Foundation.
Incremental federal and state initiatives to drive down healthcare spending may shift the burden to different segments of the economy, Langwell said. For instance, federal costs may be turned over to the states, and state costs may become the private sector's burden.
Barents' analysis of cost and access issues in California, New York and Texas provides a baseline for assessing the impact of different healthcare reform policies. The findings "do illustrate differences among states in their capacity to deal with problems," Langwell said.
For example, the proportion covered by Medicaid in the three states differs significantly. Nationally, 9% have Medicaid as their primary healthcare coverage, compared with 12% in California, 11% in New York and 8% in Texas. If California's Medi-Cal program covered just 8% of the population, as Texas' Medicaid program does, then California might have had an uninsured rate of 24% in 1994 instead of 20%, the report notes.