The Big Picture: A Look at Hospitals in a Volatile Healthcare Environment

1. The Big Picture: A Look at Hospitals in a Volatile Healthcare Environment Stuart H. Altman, Ph.D. Chaikin Professor of National Health Policy The Florence Heller Graduate School for Social Policy Brandeis University

2. Hospital Margins Not Keeping Up With Spending Growth Stuart Altman

3. Spending Growth Now Dominated by Hospital Services Percentage of Yearly Medical Spending Increase Source: Milliman USA Health Cost Index, in Strunk, Gabel and Ginsburg, 2001,Center for Studying Health System Change 2002 Stuart Altman

4. Total Hospital Margins Beginning To Trend Down * Estimate Sources:1997-2000 Moody’s all rating medians, 2001 AHA national hospital indicators survey Stuart Altman

5. And It’s Not Just The Stock Market! Stuart Altman

6. Financial Conditions of Hospitals In Some States Not Doing Well Hospital Operating Margins 2000

7. Increasing Demand For Services Increased inpatient utilization Continued growth in outpatient use Increased ED use Accelerating Cost of Services But, Inadequate Payment Rates from Medicaid Uninsured, and Medicare Hospitals Face The Following Dilemma Stuart Altman

8. Look At Increasing Labor Costs! Estimate

9. Maybe--- Less Pressure From Managed Care But--- What About Growth of Specialty Hospitals, and New Non-Hospital Delivery Systems that Focus on Well Paying Patients Increased Patient Cost Sharing Could Reduce Use Can We Count on Higher Payments From Private Payers In Future To Bail Out Lower Payments From Government and Increased Number of Uninsured? Stuart Altman

10. Growing Demand for Emergency Room Visits AndThe Addition of New Hospitals Stuart Altman

11. Emergency Department Visits1990-2001 Stuart Altman Year

12. Advisory Board – “We Need More Hospitals” Additional Hospitals In 2011 Under Different Assumption Stuart Altman