<DOC>
Ways and Means Committee Print WMCP:106-14]
[2000 Green Book]
[From the U.S. Government Printing Office Online via GPO Access]

                      LEGISLATIVE HISTORY, 1980-99

    This section summarizes major Medicare legislation enacted 
into law since 1996. Previous editions of the Green Book review 
legislation enacted before 1996.
    The summary highlights major provisions; it is not a 
comprehensive list of all Medicare amendments. Included are 
provisions which had a significant budget impact, changed 
program benefits, modified beneficiary cost sharing, or 
involved major program reforms. Provisions involving policy 
changes are mentioned the first time they are incorporated in 
legislation, but not necessarily every time a modification is 
made. The descriptions include either the initial effective 
date of the provision or, in the case of budget savings 
provisions, the fiscal years for which cuts were specified.

Health Insurance Portability and Accountability Act of 1996, Public Law 
                                 104-1

     Added new criminal health care fraud provisions, 
strengthened existing civil and criminal fraud and abuse 
provisions and provided funding for new antifraud programs 
(generally effective on enactment or January 1, 1997).

          Balanced Budget Act (BBA) of 1997, Public Law 105-33

Hospitals
     Froze PPS hospital and PPS-exempt hospitals and units and 
limited updates for fiscal years 1999-2002. Established a PPS 
for inpatient rehabilitation hospitals, effective beginning in 
fiscal year 2001. Rebased capital payment rates and provided 
for additional reductions over the fiscal year 1997-2002 
period. Reduced the indirect medical education payment from the 
current 7.7 percent to 5.5 percent by fiscal year 2001 and 
reformed direct graduate medical education payments (generally 
effective on enactment or October 1, 1997).
 Skilled nursing facilities
     Provided for a phase in of a PPS that will pay a Federal 
per-diem rate for covered SNF services (generally effective 
July 1, 1998).
Home health
     Provided for the establishment of a PPS for home health 
services. Provided for a reduction in per-visit cost limits 
prior to the implementation of the PPS, clarified the 
definitions of part-time and intermittent care, and provided 
for a study of the definition of homebound. Provided for the 
transfer of some home health costs from part A to part B 
(prospective payment effective October 1, 1999, reduction in 
cost limits effective on enactment, definition clarification 
effective October 1, 1997, and transfer of costs effective 
January 1, 1998).
 Hospice
     Reduced the hospice payment update for each of fiscal 
years 1998-2002, and clarified the definition of hospice care 
(generally effective on enactment).
Physicians
     Provided for use of a single conversion factor; replaced 
the volume performance standard with the sustainable growth 
rate; provided for phased-in implementation of resource-based 
practice expenses; and permitted use of private contracts under 
specified conditions (generally effective January 1, 1998).
 Hospital outpatient departments
     Extended reductions in payments for outpatient hospital 
services paid on the basis of costs through December 1999 and 
established a PPS for hospital outpatient departments (OPDs) 
for covered services beginning in 1999 (generally effective on 
enactment).
Other providers
     Froze payments for laboratory services for fiscal years 
1998-2002; provided for establishment of a fee schedule in 2000 
for payment for ambulance services (generally effective on 
enactment).
 Beneficiary payments
     Permanently set the part B premium at 25 percent of 
program costs and expanded the premium assistance beginning in 
1998 available under the Specified Low-Income Medicare 
Beneficiary (SLMB) Program (effective on enactment).
 Prevention initiatives
     Authorized coverage for annual mammograms for all women 
over 40. Added coverage for screening pelvic exams, prostate 
cancer screening tests, colorectal cancer screening tests, 
diabetes self-management training services, and bone mass 
measurements for certain high-risk persons (generally effective 
in 1998, except prostate cancer screening effective 2000).
 Supplementary coverage
     Provided for guaranteed issuance of specified Medigap 
policies without a preexisting condition exclusion for certain 
continuously enrolled aged individuals (effective July 1, 
1998).
 Competitive bidding
     Provided for competitive bidding demonstrations for 
furnishing part B services (not including physicians services) 
(effective on enactment).
Commissions
     Established a 17-member National Advisory Commission on 
the Future of Medicare (with appointments to be made by 
December 1, 1997). Established the Medicare Payment Advisory 
Commission replacing the Prospective Payment Assessment 
Commission and the Physician Payment Review Commission (with 
appointments to be made by September 30, 1997).
 Medicare+Choice
     Established a new part C of Medicare called 
Medicare+Choice (M+C). This program is built on the existing 
Medicare Risk Contract Program which enabled beneficiaries to 
enroll, where available, in health maintenance organizations 
(HMOs) that contracted with the Medicare Program. The M+C 
Program expands, beginning in 1999, the private plan options 
that could contract with Medicare to other types of managed 
care organizations (for example, preferred provider 
organizations and provider-sponsored organizations), private 
fee-for-service plans, and, on a limited demonstration basis, 
high deductible plans (called medical savings account plans) 
offered in conjunction with medical savings accounts (effective 
on enactment).

    Balanced Budget Refinement Act (BBRA) of 1999 (Incorporated in 
      Consolidated Appropriations Act of 1999, Public Law 106-113)

Prospective payment system hospitals
    Froze the indirect medical education adjustment at 6.5 
percent through fiscal year 2000, reduced the adjustment to 
6.25 percent in fiscal year 2001 and to 5.5 percent in fiscal 
year 2002 and subsequent years. Froze the reduction in the DSH 
adjustment to 3 percent in fiscal year 2001; changed the 
reduction to 4 percent in fiscal year 2002. Changed the 
methodology for Medicare's direct graduate medical education 
payments to teaching hospitals to incorporate a national 
average amount calculated using fiscal year 1997 hospital-
specific per-resident amounts. Increased the number of years 
that would count as an initial period for child neurology 
residency training programs. Provided for the reclassification 
of certain counties and areas for the purposes of Medicare 
reimbursement.
PPS-exempt hospitals
    Adjusted the labor-related portion of the 75-percent cap to 
reflect the wage differences in the hospitals' area relative to 
the national average. Increased the amount of continuous bonus 
payments to eligible long-term care and psychiatric providers 
from 1 percent to 1.5 percent for cost reporting periods 
beginning on or after October 1, 2000 and before September 30, 
2001 and to 2 percent for cost reporting periods beginning on 
or after October 1, 2001 and before September 30, 2002. 
Required the Secretary to report on a discharge-based PPS for 
long-term care hospitals which would be implemented in a budget 
neutral fashion for cost reporting periods beginning on or 
after October 1, 2002. Required the Secretary to report on a 
per-diem-based PPS for psychiatric hospitals which would be 
implemented in a budget neutral fashion for cost reporting 
periods beginning on or after October 1, 2002. Required the 
Secretary base the PPS for inpatient rehabilitation hospitals 
on discharges and incorporate functional related groups as the 
basis for payment adjustments.
Rural providers
    Permitted reclassification of certain urban hospitals as 
rural hospitals. Updated existing criteria used to designate 
outlying rural counties as part of metropolitan statistical 
areas for the purposes of Medicare's hospital PPS. Changed 
certain requirements pertaining to Medicare's Critical Access 
Hospital Program. Extended the Medicare dependent hospital 
classification through fiscal year 2006. Permitted certain sole 
community hospitals to receive Medicare payments based on their 
hospital specific fiscal year 1996 costs. Increased the target 
amount for SCHs by the full market basket amount for discharges 
occurring in fiscal year 2001.
Skilled nursing facilities
    Increased, from April 1, 2000, until October 1, 2000, per-
diem payments by 20 percent for 15 resource utilization groups 
(RUGs) under the PPS. Permitted payment under the Federal PPS 
rate for agencies for which it is more advantageous than under 
the transition rates. Provided for payment beyond the 
designated PPS rate for ambulance services for dialysis 
patients and for specific chemotherapy items and services, 
radioisotope services, and prosthetic devices. Until October 1, 
2001, fixed PPS per-diem rates at 50 percent of the facility-
specific rate and 50 percent of the Federal rate for facilities 
in which 60 percent of the patients are immunocompromised.
Home health agencies
    Delayed the 15-percent reduction in home health payments 
until 12 months after implementation of the PPS but, within 6 
months of implementation, required the Secretary to assess the 
need for any reductions. Increased per-beneficiary limits by 2 
percent for older agencies; excluded DME from consolidated 
billing, and provided $10 per beneficiary to offset HHA costs 
for collecting outcome and assessment information set (OASIS) 
data.
Hospice
    Increased payment rates otherwise in effect under the 
hospice PPS for fiscal year 2001 by 0.5 percent and for fiscal 
year 2002 by 0.75 percent, provided that these increases are 
not to be included in the base on which subsequent increases 
will be computed.
Physicians
    Made technical changes to limit oscillations in the annual 
update to the conversion factor beginning in 2001 and provided 
that the sustainable growth rate is calculated on a calendar 
year basis. Required the Secretary, in determining practice 
expense relative values, to establish by regulation a process 
under which the Secretary would accept for use and would use, 
to the maximum extent practicable and consistent with sound 
data practices, data collected by outside organizations and 
entities.
Hospital outpatient departments
    Made seven major changes to Medicare payments under the 
hospital OPD PPS: (1) required the Secretary of the U.S. 
Department of Health and Human Services (DHHS) to provide 
payments (within specified limits, and on a budget neutral 
basis) over and above PPS payments for certain high cost 
(``outlier'') patients; (2) as a transition to the PPS, for 2-3 
years, on a budget neutral basis, required the Secretary of 
DHHS to provide ``passthrough payments'' to hospital OPDs above 
and beyond PPS payments for costs of certain ``current 
innovative'' and ``new, high cost'' devices, drugs, and 
biologicals; (3) limited the cost range of items or services 
that are included in any one PPS category and required the 
Secretary to review the PPS groups and amounts annually and to 
update them as necessary; (4) as a transition to the PPS, 
through 2003, limited the reduction in Medicare payments 
individual hospitals experience due to the PPS; (5) provided 
special payments until 2004 for small, rural hospitals to 
ensure that they receive no less under the outpatient PPS than 
they would have received under the prior system and provided 
the same protection permanently for cancer hospitals; (6) 
limited beneficiary copayments for outpatient care to no more 
than the amount of the beneficiary deductible for inpatient 
care; and (7) required that the pre-PPS payment base used as 
the budget neutrality benchmark for the PPS include beneficiary 
coinsurance amounts as paid under the pre-PPS system (i.e., 20 
percent of hospital charges).
Therapy services
    Suspended for 2 years (2001 and 2002) application of the 
caps on physical therapy and occupational therapy services.
Pap smears
    Set the minimum payment for the test component of a Pap 
smear at $14.60.
Immunosuppressive drugs
    Extended the 36-month limit on coverage of 
immunosuppressive drugs for persons exhausting their coverage 
in 2000-2004. Set the increase for persons exhausting benefits 
in 2000 at 8 months, and limited total expenditures to $150 
million over the 5 years.
Studies
    Required a number of studies including a Medicare Payment 
Advisory Commission comprehensive study of the regulatory 
burdens placed on all classes of providers under fee-for-
service Medicare and the associated costs. Required GAO to 
conduct a study of Medigap policies.
Medicare+Choice
    Contained several provisions designed to facilitate the 
implementation of M+C. Changed the phase in of the new risk 
adjustment payment methodology based on health status to a 
blend of 10 percent new health status method/90 percent old 
demographic method in 2000 and 2001, and not more than 20 
percent health status in 2002. Provided for payment of a new 
entry bonus of 5 percent of the monthly M+C payment rate in the 
first 12 months and 3 percent in the subsequent 12 months to 
organizations that offer a plan in a payment area without an 
M+C plan since 1997, or in an area where all organizations 
announced withdrawal as of January 1, 2000. Reduced the 
exclusion period from 5 years to 2 years for organizations 
seeking to reenter the M+C Program after withdrawing. Allowed 
organizations to vary premiums, benefits, and cost sharing 
across individuals enrolled in the plan so long as these are 
uniform within segments comprising one or more M+C payment 
areas. Provided for submission of adjusted community rates by 
July 1 instead of May 1. Provided that the aggregate amount of 
user fees collected would be based on the number of M+C 
beneficiaries in plans compared to the total number of 
beneficiaries.
    Delayed implementation of the Medicare+Choice Competitive 
Bidding Demonstration Project.

CBO SAVINGS AND REVENUE ESTIMATES FOR BUDGET RECONCILIATION AND RELATED 
                             ACTS, 1981-99

    Table 2-31 shows estimates of savings and revenue increases 
for budget reconciliation legislation enacted from 1981 to 1997 
and spending increases enacted in 1999. These estimates were 
made at the time of enactment by the Congressional Budget 
Office (CBO). It should be noted that the estimates are 
compared with the CBO budget baseline in effect at the time. 
The savings from the various reconciliation bills cannot be 
added together.

                        MEDICARE HISTORICAL DATA

    Tables 2-32 through 2-41 present detailed historical data 
on the Medicare Program. Tables 2-32, 2-33, and 2-34 present 
detailed enrollment data. Table 2-35 describes the percentage 
of enrollees participating in a State buy-in agreement. Tables 
2-36 and 2-37 show the distribution of Medicare payments by 
type of coverage and by type of service. Tables 2-38 and 2-39 
show the number of persons served and the average reimbursement 
per person served and per enrollee. Table 2-40 shows the 
utilization of short stay hospital services. Table 2-41 shows 
the number of participating institutions and organizations.

            TABLE 2-31.--MEDICARE SAVINGS ESTIMATES, 1981-99
                        [In billions of dollars]
------------------------------------------------------------------------
                       Legislative act                          Savings
------------------------------------------------------------------------
Omnibus Budget Reconciliation Act of 1981:
    Spending reductions for fiscal years 1982-84.............       $4.3
Tax Equity and Fiscal Responsibility Act of 1982:
    Spending reductions for fiscal years 1983-87.............       23.1
Social Security Amendments of 1983:
    Spending reductions for fiscal years 1983-88.............        0.2
    Revenue increases for fiscal years 1983-88...............       11.5
Deficit Reduction Act of 1984:
    Spending reductions for fiscal years 1984-87.............        6.1
Consolidated Omnibus Budget Reconciliation Act of 1985:
    Spending reductions for fiscal years 1986-81.............       12.6
Omnibus Budget Reconciliation Act of 1986:
    Spending reductions for fiscal years 1987-89.............        1.0
Omnibus Budget Reconciliation Act of 1987:
    Spending reductions for fiscal years 1988-90.............        9.8
Omnibus Budget Reconciliation Act of 1989:
    Spending reductions for fiscal years 1990-94.............       10.9
Omnibus Budget Reconciliation Act of 1990:
    Spending reductions for fiscal years 1991-95.............       43.1
    Revenue increases for fiscal years 1991-95...............       26.9
Omnibus Budget Reconciliation Act of 1993:
    Spending reductions for fiscal years 1994-98.............       55.8
    Revenue increases for fiscal years 1994-98...............       53.8
Health Insurance Portability and Accountability Act of 1996:
    Spending reductions for fiscal years 1996-2002...........        3.0
Balanced Budget Act of 1997:
    Spending reductions for fiscal years 1998-2002...........      116.4
    Spending reductions for fiscal years 1998-2007...........      393.8
Balanced Budget Refinement Act of 1999:
    Spending increases for fiscal years 2000-2004............      -15.0
    Spending increases for fiscal years 2004-9...............     -25.1
------------------------------------------------------------------------
Note.--Savings relative to baseline at time of enactment. Figures cannot
  be summed.

 Source: Committee on Ways and Means, (1998); Congressional Budget
  Office.


                                          TABLE 2-32.--NUMBER OF MEDICARE ENROLLEES BY TYPE OF COVERAGE AND TYPE OF ENTITLEMENT, SELECTED YEARS 1968-98
                                                                                         [In thousands]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                        Year                                                             Average annual rate of
                                              ------------------------------------------------------------------------------------------------------------------------      growth (percent)
       Type of entitlement and coverage                                                                                                                               --------------------------
                                                 1968      1975      1980      1982      1984      1986      1988      1990      1995      1996      1997      1998    1968-75  1975-85  1985-98
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Total:
  HI \1\ and/or SMI \2\......................    19,821    24,959    28,478    29,494    30,456    31,750    32,980    34,203    37,535    38,064    38,445    38,825      3.3      2.2      1.9
Total HI:                                        19,770    24,640    28,067    29,069    29,996    31,216    32,413    33,719    37,135    37,662    38,052    38,432      3.2      2.2      1.9
  HI only....................................     1,016     1,054     1,079     1,082     1,040     1,160     1,363     1,574     1,850     1,925     1,985     2,044      0.5      0.4      5.3
  Total SMI..................................    18,805    23,905    27,400    28,412    29,416    30,590    31,617    32,629    35,685    36,140    36,460    36,781      3.5      2.3      1.7
  SMI only...................................        51       318       411       425       460       534       567       484       400       402       393       393     29.9      4.5     -1.9
Aged:
  HI and/or SMI..............................    19,821    22,790    25,515    26,540    27,571    28,791    29,879    30,948    33,142    33,424    33,630    33,802      2.0      2.1      1.5
  Total HI...................................    19,770    22,472    25,104    26,115    27,112    28,257    29,312    30,464    32,742    33,022    33,237    33,410      1.8      2.1      1.6
  HI only....................................     1,016       845       835       833       807       928     1,098     1,263     1,000     1,440     1,466     1,494     -2.6      0.2      4.7
  Total SMI..................................    18,805    21,945    24,680    25,707    26,765    27,863    28,780    29,686    31,742    31,984    32,164    32,308      2.2      2.2      1.4
  SMI only...................................        51       318       411       425       459       534       567       484       400       402       393       392     29.9      4.5     -1.9
All disabled:
  HI and/or SMI..............................     (\4\)     2,168     2,963     2,954     2,884     2,959     3,102     3,255     4,393     4,640     4,815     5,023       NA      3.0      4.7
  Total HI...................................     (\4\)     2,168     2,963     2,954     2,884     2,959     3,101     3,255     4,393     4,640     4,815     5,023       NA      3.0      4.7
  HI only....................................     (\4\)       209       244       249       233       232       265       311       451       485       519       551       NA      0.9      7.6
  Total SMI..................................     (\4\)     1,959     2,719     2,759     2,682     2,727     2,837     2,943     3,942     4,155     4,296     4,472       NA      3.2      4.4
  SMI only \3\...............................     (\4\)        NA        NA        NA        NA        NA        NA        NA        NA        NA        NA        NA       NA       NA       NA
End-stage renal disease only:
  HI and/or SMI..............................     (\4\)        13        28        27        30        39        53        65        71        73        75        77       NA      9.1      7.9
  Total HI...................................     (\4\)        13        28        27        30        39        53        65        71        73        75        77       NA      9.1      7.9
  HI only....................................     (\4\)         1         1         2         2         3         4         6         8         8         9        10       NA      7.2     14.4
  Total SMI..................................     (\4\)        12        27        26        28        36        49        59        63        65        66        67       NA      9.2      7.2
  SMI only \3\...............................     (\4\)        NA        NA        NA        NA        NA        NA        NA        NA        NA        NA        NA       NA       NA      NA
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Hospital insurance.
\2\ Supplementary medical insurance.
\3\ Disabled and end-stage renal disease only must have HI to be eligible for SMI coverage.
\4\ Medicare disability entitlement began in 1973.

 NA--Not available.

 Source: Health Care Financing Administration.


                                                 TABLE 2-33.--GROWTH IN NUMBER OF AGED MEDICARE ENROLLEES BY SEX AND AGE, SELECTED YEARS 1968-98
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                    Year                                         Average annual growth                 Enrollees
                                                              --------------------------------------------------------------------------------       rate (percent)                   as percent
                                                                                                                                              --------------------------- Total aged   of total
                         Sex and age                                                                                                                                      population     aged
                                                                 1968      1975      1980      1990      1995      1996      1997      1998    1968-75  1975-84  1986-98   1998 \1\   population
                                                                                                                                                                                         1998
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All persons..................................................    19,496    22,548    25,515    30,948    33,142    33,424    33,630    33,802      2.1      2.3      1.3     34,401         98.3
  65-69......................................................     6,551     7,642     8,459     9,695     9,517     9,445     9,317     9,184      2.2      1.6      0.0      9,593         95.7
  70-74......................................................     5,458     5,950     6,756     7,951     8,756     8,745     8,737     8,725      1.2      2.3      1.2      8,802         99.1
  75-79......................................................     3,935     4,313     4,809     6,058     6,563     6,749     6,932     7,055      1.3      2.4     2.08      7,218         97.7
  80-84......................................................     2,249     2,793     3,081     3,957     4,470     4,554     4,619     4,707      3.1      2.2      2.4      4,734         99.4
  85 and older...............................................     1,303     1,850     2,410     3,286     3,837     3,930     4,025     4,130      5.1      4.6      2.9      4,054        101.9
Males........................................................     8,177     9,201    10,268    12,416    13,434    13,583    13,701    13,806      1.7      2.0      1.5     14,199         97.2
  65-69......................................................     2,944     3,420     3,788     4,352     4,348     4,332     4,284     4,234      2.2      1.6      0.3      4,393         96.4
  70-74......................................................     2,322     2,504     2,841     3,406     3,791     3,796     3,808     3,819      1.1      2.4      1.4      3,857         99.0
  75-79......................................................     1,596     1,669     1,854     2,382     2,642     2,730     2,816     2,876      0.6      2.4      2.4      2,997         96.0
  80-84......................................................       864     1,005     1,062     1,369     1,593     1,636     1,670     1,717      2.2      1.6      2.9      1,764         97.3
  85 and older...............................................       450       604       722       906     1,060     1,090     1,122     1,159      4.3      3.1      2.9      1,188         97.6
Females......................................................    11,319    13,347    15,247    18,532    19,708    19,841    19,929    19,996      2.4      2.4      1.2     20,203         99.0
  65-69......................................................     3,606     4,222     4,671     5,343     5,169     5,113     5,032     4,950      2.3      1.5      0.2      5,201         95.2
  70-74......................................................     3,136     3,446     3,914     4,545     4,964     4,949     4,928     4,906      1.4      2.3      1.0      4,945         99.2
  75-79......................................................     2,338     2,644     2,954     3,676     3,921     4,019     4,116     4,179      1.8      2.4      1.7      4,221         99.0
  75-84......................................................     1,386     1,788     2,019     2,588     2,877     2,919     2,949     2,989      3.7      2.4      2.1      2,970        100.6
  85 and older...............................................       853     1,246     1,689     2,380     2,777     2,840     2,903     2,972      5.6      5.3      2.9      2,866       103.7
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ U.S. residents only.

 Source: Health Care Financing Administration, Bureau of Data Management and Strategy; and U.S. Department of Commerce, U.S. Census Bureau.


  TABLE 2-34.--GROWTH IN NUMBER OF DISABLED MEDICARE ENROLLEES WITH HOSPITAL INSURANCE COVERAGE BY TYPE OF ENTITLEMENT AND AGE, SELECTED YEARS 1975-98
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                             Year                                          Average annual percent growth
                                     ------------------------------------------------------------------------------------              rate
     Type of entitlement and age                                                                                         -------------------------------
                                         1975        1980        1990        1995        1996        1997        1998      1975-84   1984-94    1984-98
--------------------------------------------------------------------------------------------------------------------------------------------------------
All disabled persons................   2,058,424   2,425,231   3,254,983   4,393,287   4,640,180   4,814,782   5,022,811       3.8        3.7        4.0
    Under age 35....................     238,070     193,392     483,262     587,709     587,160     570,264     558,417       5.6        4.0        2.6
    35-44...........................     251,142     258,374     654,953     973,328   1,030,456   1,057,583   1,093,962       5.9        8.0        7.0
    45-54...........................     508,345     572,823     741,193   1,187,993   1,291,453   1,373,326   1,453,356       1.6        6.4        6.7
    55-64...........................   1,060,967   1,400,642   1,375,575   1,644,257   1,731,111   1,813,609   1,917,076       3.8        0.5        1.8
All disabled workers................   1,638,662   2,396,897   2,579,097   3,602,559   3,828,220   3,987,130   4,180,635       3.9        3.8        4.3
    Under age 35....................     100,439     184,619     257,760     357,794     357,442     343,052     333,963       7.5        6.0        4.0
    35-44...........................     164,439     253,186     482,071     769,071     819,512     840,790     872,918       6.5        9.4        8.2
    45-54...........................     426,451     565,846     612,692   1,023,616   1,120,184   1,195,960   1,269,628       1.4        6.7        7.1
    55-64...........................     947,333   1,393,246   1,226,574   1,452,078   1,531,082   1,607,328   1,704,126       3.9        0.3        1.7
Adults disabled as children.........     324,864     409,072     542,416     609,081     621,620     632,300     642,579       3.9        2.6        2.4
    Under age 35....................     151,708     173,684     208,901     213,973     213,456     210,936     208,220       2.1        1.4        0.8
    35-44...........................      84,508     105,092     158,725     189,108     195,185     200,758     204,694       4.6        3.8        3.5
    45-54...........................      71,484      80,381     107,092     132,484     137,704     142,839     148,336       2.3        3.9        3.9
    55-64...........................      45,164      49,910      67,698      73,516      75,275      77,766      81,329       3.2        1.9        2.2
Widows and widowers.................      83,771     110,785      68,793     111,121     117,028     120,137     122,203       0.2        1.9        2.6
    Under 55........................       7,446       7,577       5,615      12,420      13,014      13,198      13,162      -5.2        9.5        7.8
    55-64...........................      76,325     103,208      63,178      98,701     104,014     106,939     109,041       0.6        1.3        2.2
End-stage renal disease only........      11,127      28,334      64,677      70,526      73,312      75,215      77,394      11.5        8.7        7.1
    Under age 35....................       3,729       8,773      16,601      15,942      16,262      16,276      16,234      10.5        5.6        4.2
    35-44...........................       2,187       5,188      14,157      15,149      15,759      16,034      16,350      10.9       10.3        8.0
    45-54...........................       2,966       6,977      15,794      19,473      20,551      21,328      22,230       9.7       10.4        8.8
    55-64...........................       2,245       7,396      18,125      19,962      20,740      21,576      22,580      15.4        9.1       7.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: Health Care Financing Administration.


TABLE 2-35.--NUMBER AND PERCENTAGE OF INDIVIDUALS ENROLLED IN SUPPLEMENTARY MEDICAL INSURANCE UNDER STATE BUY-IN
         AGREEMENTS BY TYPE OF BENEFICIARY AND BY YEAR OR 1998 AREA OF RESIDENCE, SELECTED YEARS 1968-98
----------------------------------------------------------------------------------------------------------------
                                                       All persons              Aged               Disabled
                                                  --------------------------------------------------------------
          Year or area of residence \1\                        Percent              Percent              Percent
                                                   Number in   of SMI   Number in   of SMI   Number in   of SMI
                                                   thousands  enrolled  thousands  enrolled  thousands  enrolled
----------------------------------------------------------------------------------------------------------------
Year:
    1968.........................................      1,648       8.8      1,648       8.8         NA        NA
    1975.........................................      2,846      12.0      2,483      11.4        363      18.7
    1980.........................................      2,954      10.9      2,449      10.0        504      18.9
    1985.........................................      2,670       9.0      2,164       8.0        505      19.2
    1990.........................................      3,604      11.0      2,714       9.1        890      30.2
    1995.........................................      4,895      13.7      3,369      10.6      1,526      38.7
    1996.........................................      5,001      13.1      3,404      10.6      1,597      38.4
    1997.........................................      5,089      13.2      3,445      10.7      1,644      38.3
    1998.........................................      5,109      13.2      3,492      10.8      1,775      39.7
Area of residence: \1\
    Alabama......................................        122      18.2         86      16.4         34      41.5
    Alaska.......................................          7      18.4          4      14.8          2      50.0
    Arizona......................................         51       7.8         31       6.0         15      30.0
    Arkansas.....................................         79      18.2         58      16.7         22      41.5
    California...................................        777      20.5        561      17.9        204      63.6
    Colorado.....................................         52      11.5         32       9.0         17      42.5
    Connecticut..................................         51      10.0         31       7.1         19      51.4
    Delaware.....................................          9       8.3          4       4.6          3      33.3
    District of Columbia.........................         15      19.7         11      17.5          4      57.1
    Florida......................................        314      11.4        211       9.0         77      42.3
    Georgia......................................        171      19.3        119      17.5         48      45.3
    Guam and Virgin Islands \2\..................          1       5.3          1       9.1          0       6.3
    Hawaii.......................................         19      11.9         14      10.8          4      44.4
    Idaho........................................         15       9.4          8       6.2          5      41.7
    Illinois.....................................        146       9.0         89       6.4         54      37.8
    Indiana......................................         81       9.6         53       7.5         29      34.9
    Iowa.........................................         50      10.5         33       7.8         18      48.6
    Kansas.......................................         39      10.0         24       7.1         12      41.4
    Kentucky.....................................        107      17.5         67      14.3         35      42.2
    Louisiana....................................        115      19.3         80      17.1         35      44.9
    Maine........................................         33      15.6         18      10.6         12      57.1
    Maryland.....................................         62       9.9         44       8.5         19      38.8
    Massachusetts................................        139      14.6         83      10.6         49      59.0
    Michigan.....................................        136       9.9         75       6.5         53      37.6
    Minnesota....................................         58       9.0         35       6.3         26      53.1
    Mississippi..................................        106      25.8         77      24.4         30      51.7
    Missouri.....................................         82       9.6         48       6.7         28      34.1
    Montana......................................         12       9.0          7       6.3          5      38.5
    Nebraska.....................................         18       7.1          9       4.1          8      44.4
    Nevada.......................................         17       7.6         10       6.1          5      33.3
    New Hampshire................................          6       3.6          3       2.2          3      23.1
    New Jersey...................................        138      11.6         92       9.0         39      42.4
    New Mexico...................................         34      15.1         22      12.6          9      40.9
    New York.....................................        363      13.6        232      10.5        105      42.7
    North Carolina...............................        210      19.2        138      16.1         56      47.9
    North Dakota.................................          6       5.8          4       4.3          2      25.0
    Ohio.........................................        180      10.7        119       8.3         54      32.5
    Oklahoma.....................................         63      12.6         45      10.8         17      38.6
    Oregon.......................................         51      10.6         29       7.1         16      42.1
    Pennsylvania.................................        179       8.6        105       5.8         64      38.8
    Puerto Rico..................................          0       0.0          0       0.0          0       0.0
    Rhode Island.................................         18      10.6         10       7.0          6      40.0
    South Carolina...............................        104      19.0         69      16.6         31      48.4
    South Dakota.................................         13      11.0          9       8.8          4      44.4
    Tennessee....................................        172      21.3        104      16.4         52      55.3
    Texas........................................        340      15.5        252      14.1         75      41.4
    Utah.........................................         15       7.6          8       5.0          6      40.0
    Vermont......................................         13      14.9          8      11.4          5      62.5
    Virginia.....................................        108      12.5         74      10.8         34      40.5
    Washington...................................         89      12.4         46       7.8         29      49.2
    West Virginia................................         43      12.9         26       9.7         16      34.0
    Wisconsin....................................         74       9.5         45       6.8         31      45.6
    Wyoming......................................          6       9.4          3       5.8          2      40.0
                                                  --------------------------------------------------------------
        United States............................      4,892      12.9      3,367      10.7      1,525      41.7
        All areas................................      5,109      13.2      3,369      10.6      1,526     41.0
----------------------------------------------------------------------------------------------------------------
\1\ State of residence is not necessarily State that bought coverage.
\2\ Data for these areas combined to prevent disclosure of confidential information.

 NA--Not available.

 Source: Health Care Financing Administration, Office of Strategic Planning.


 TABLE 2-36.--DISTRIBUTION OF MEDICARE BENEFIT PAYMENTS BY TYPE OF COVERAGE AND TYPE OF SERVICE, CALENDAR YEARS
                                                     1995-98
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                               Amount and distribution of payments for enrollees
                             -----------------------------------------------------------------------------------
Type of coverage and type of          1995                 1996                 1997                 1998
           service           -----------------------------------------------------------------------------------
                                Amount    Percent    Amount    Percent    Amount    Percent    Amount    Percent
----------------------------------------------------------------------------------------------------------------
Hospital insurance..........    $116,176    100.0    $128,457    100.0    $137,592    100.0    $133,244    100.0
  Inpatient.................      81,984     70.6      85,756     66.8      88,498     64.3      87,029     65.3
  Skilled nursing facility..       9,236      8.0      11,101      8.6      12,995      9.4      13,487     10.1
  Home health agency........      16,373     14.1      17,825     13.9      17,680     12.8      11,789      8.8
  Hospice...................       1,883      1.6       1,997      1.6       2,082      1.5       2,180      1.6
  Managed care..............       6,701      5.8      11,777      9.2      16,338     11.9      18,759     14.1
Supplementary medical             64,972     35.9      68,598     37.9      72,757     40.2      76,673     42.3
 insurance..................
  Physicians fee schedule         31,660     17.5      31,631     17.5      31,901     17.6      32,456     17.9
   \1\......................
  Durable medical equipment.       3,689      2.0       3,826      2.1       4,237      2.3       4,033      2.2
  Carrier laboratory........       2,807      1.5       2,550      1.4       2,386      1.3       2,088      1.2
  Other carrier.............       4,530      2.5       5,059      2.8       5,582      3.1       5,937      3.3
  Outpatient hospital.......       8,663      4.8       8,691      4.8       9,455      5.2       8,844      4.9
  Home health agency........         236      0.1         262      0.1         261      0.1         166      0.1
  Intermediary laboratory...       1,448      0.8       1,311      0.7       1,447      0.8       1,476      0.8
  Other intermediary........       5,329      2.9       5,711      3.2       6,527      3.6       6,334      3.5
  Managed care..............       6,610      3.6       9,558      5.3      10,962      6.1      15,338      8.5
                             -----------------------------------------------------------------------------------
    Total payments..........     181,148    100.0     197,055    100.0     210,349    100.0     209,917   100.0
----------------------------------------------------------------------------------------------------------------
\1\ Includes other services.

 Note.--See table 2-3 for historical fiscal year data.

 Source: Health Care Financing Administration, Office of the Actuary.


    TABLE 2-37.--DISTRIBUTION OF MEDICARE BENEFIT PAYMENTS BY TYPE OF COVERAGE, TYPE OF SERVICE, AND TYPE OF
                                          ENROLLEE, CALENDAR YEAR 1998
----------------------------------------------------------------------------------------------------------------
                                                                    Type of enrollee
                                      --------------------------------------------------------------------------
                                            All enrollees                 Aged                   Disabled
     Type of coverage and service     --------------------------------------------------------------------------
                                         Amount                   Amount                   Amount
                                          (in      Percentage      (in      Percentage      (in      Percentage
                                       millions)  distribution  millions)  distribution  millions)  distribution
----------------------------------------------------------------------------------------------------------------
Hospital insurance...................   $133,244       100.0     $117,066       100.0      $16,178       100.0
  Inpatient..........................     87,029        65.3       73,945        63.2       13,084        80.9
  Skilled nursing facility...........     13,487        10.1       12,825        11.0          662         4.1
  Home health agency.................     11,789         8.8       10,659         9.1        1,130         7.0
  Hospice............................      2,180         1.6        2,071         1.8          109         0.7
  Managed care.......................     18,759        14.1       17,566        15.0        1,193         7.4
Supplementary medical insurance......     76,673       100.0       65,882       100.0       10,791       100.0
  Physicians fee schedule............     32,456        42.3       28,491        43.2        3,966        36.8
  Durable medical equipment..........      4,033         5.3        3,299         5.0          734         6.8
  Carrier laboratory.................      2,088         2.7        1,794         2.7          294         2.7
  Other carrier......................      5,937         7.7        5,136         7.8          801         7.4
  Outpatient hospital................      8,844        11.5        7,501        11.4        1,343        12.4
  Home health agency.................        166         0.2          166         0.3            0         0.0
  Intermediary laboratory............      1,476         1.9        1,181         1.8          296         2.7
  Other intermediary.................      6,334         8.3        3,989         6.1        2,346        21.7
  Managed care.......................     15,338        20.0       14,326        21.7        1,012         9.4
                                      --------------------------------------------------------------------------
    Total payments...................    209,917       100.0      182,948       100.0       26,969      100.0
----------------------------------------------------------------------------------------------------------------
Source: Health Care Financing Administration, Office of the Actuary.


 TABLE 2-38.--PERSONS ENROLLED AND PERSONS SERVED UNDER MEDICARE, AND PROGRAM PAYMENTS, BY TYPE OF COVERAGE AND SERVICE, SELECTED CALENDAR YEARS 1967-97
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                             Year                                Average annual rate of
                                                               ---------------------------------------------------------------           change
                 Type of coverage and service                                                                                 --------------------------
                                                                  1967      1980      1990      1994       1996       1997     1967-83  1983-97  1967-97
--------------------------------------------------------------------------------------------------------------------------------------------------------

                                                               ----------------------------Number of enrollees (in thousands)---------------------------
                                                               -----------------------------------------------------------------------------------------
Hospital insurance and/or supplementary medical insurance.....    19,521    28,478    34,213    36,950     38,093      38,465      2.7      1.9      2.4
    Hospital insurance........................................    19,494    28,067    33,731    36,542     37,677      38,059      2.6      2.0      2.3
    Supplementary medical insurance...........................    17,893    27,400    32,636    35,179     36,165      36,479      3.1      1.8      2.5
                                                               -----------------------------------------------------------------------------------------
                                                                                       Number of persons served (in thousands) \1\
                                                               -----------------------------------------------------------------------------------------
Hospital insurance............................................     3,960     6,752     7,036     7,886      8,175       8,118      4.0      0.7      2.5
    Inpatient hospital services...............................     3,601     6,672     6,543     6,938      6,941       6,887      4.4     -0.3      2.3
    Skilled nursing facility services.........................       354       257       638     1,063      1,373       1,503     -1.8     14.3      5.1
    Home health agency services...............................       126       726     1,936     3,152      3,493       3,458     15.8      7.7     12.1
Supplementary medical insurance...............................     6,523    17,822    26,951    29,912     29,981      29,620      7.1      3.3      5.4
    Physician and other medical services......................     6,415    17,258    26,350    29,222     29,332      28,961      7.0      3.3      5.3
    Outpatient services \2\...................................     1,511     7,538    15,511    18,945     20,305      20,543     11.9      6.5      9.4
    Home health agency services...............................       118       327        38        37         44          48    -10.5      7.0     -3.1
                                                               -----------------------------------------------------------------------------------------
        Total.................................................     7,154    18,031    27,099    30,087     30,195      29,847      6.5      3.2      5.0
                                                               =========================================================================================
                                                                                             Rate per thousand enrollees \3\
                                                               -----------------------------------------------------------------------------------------
Hospital insurance............................................       203       241       209       234        243         241      1.3     -0.3      0.6
    Inpatient hospital services...............................       185       238       194       206        206         205      1.7     -1.3      0.4
    Skilled nursing facility services.........................        18         9        19        32         41          45     -4.3     13.2      3.2
    Home health agency services...............................         6        26        57        94        104         103     12.8      6.6     10.0
Supplementary medical insurance...............................       365       650       826       926        931         920      3.9      2.4      3.2
    Physician and other medical services......................       359       630       807       905        911         899      3.8      2.5      3.2
    Outpatient services \2\...................................        84       275       475       586        630         638      8.5      5.6      7.2
    Home health agency services...............................         7        12         1         1          1           1    -13.2      6.1     -5.0
                                                               -----------------------------------------------------------------------------------------
        Total.................................................       366       633       792       883        886         876      3.7      2.2      3.1
                                                               =========================================================================================
                                                                                        Program payments (in millions of dollars)
                                                               -----------------------------------------------------------------------------------------
Hospital insurance............................................    $2,967   $23,119   $62,347   $94,205   $107,949  \4\ $114,3     16.9      9.2     13.4
                                                                                                                           27
    Inpatient hospital services...............................     2,667    22,297    56,716    75,715     79,911      84,563     17.4      7.1     12.7
    Skilled nursing facility services.........................       274       344     1,971     5,954      9,486      11,237      2.8     28.6     13.7
    Home health agency services...............................        26       478     3,660    12,537     16,546      16,487     28.1     21.1     25.9
Supplementary medical insurance...............................     1,272    10,494    39,072    52,343     59,114      61,096     17.6     10.3     14.3
    Physician and other medical services......................     1,217     8,358    30,222    38,490     42,510      43,621     16.3      9.3     13.1
    Outpatient services \2\...................................        38     1,962     8,773    13,696     16,387      17,256     32.5     13.2     24.2
    Home health agency services...............................        17       175        78       157        216         219      3.4     16.8      9.2
                                                               -----------------------------------------------------------------------------------------
        Total.................................................     4,239    33,613   101,419   146,549    167,062     175,423     17.2      9.6     13.7
                                                               =========================================================================================
                                                                                           Program payments per person served
                                                               -----------------------------------------------------------------------------------------
Hospital insurance............................................       749     3,424     8,861    11,945     13,205      14,082     12.4      8.5     10.6
    Inpatient hospital services...............................       741     3,342     8,688    10,913     11,513      12,279     12.4      7.5     10.2
    Skilled nursing facility services.........................       774     1,339     3,089     5,603      6,909       7,476      4.7     12.5      8.1
    Home health agency services...............................       206       658     1,690     3,977      4,737       4,768     10.6     12.5     11.4
Supplementary medical insurance...............................       195       589     1,450     1,750      1,972       2,063      9.9      6.8      8.5
    Physician and other medical services......................       190       484     1,147     1,317      1,449       1,506      8.7      5.8      7.4
    Outpatient services \2\...................................        25       260       566       723        807         840     18.5      6.3     12.9
    Home health agency services...............................       144       535     2,053     4,267      4,909       4,588     15.5      9.3     12.7
                                                               -----------------------------------------------------------------------------------------
        Total.................................................       593     1,864     3,743     4,871      5,533       5,877     10.0      6.1      8.2
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Does not reflect beneficiaries who received covered services but for whom no program payments were reported during the year. Detail does not add to
  totals by type of service because one person may have used several types of services.
\2\ Prior to April 1, 1968, outpatient hospital services were covered by health insurance and supplementary medical insurance. All outpatient hospital
  services for 1967 are shown as supplementary medical insurance services for purposes of comparison.
\3\ Beginning with 1994, the utilization rates per 1,000 enrollees do not reflect managed care enrollment; that is, Medicare enrollees in managed care
  plans are not included in the denominator used to calculate the utilization rates.
\4\ Includes $2.0 billion for hospice services, not shown separately.

Note.--Medicare Program represents fee-for-service payments only. Numbers may not add to totals because of rounding.

Source: Health Care Financing Administration.



  TABLE 2-39.--PERSONS SERVED AND PROGRAM PAYMENTS FOR MEDICARE BENEFICIARIES, BY DEMOGRAPHIC CHARACTERISTICS,
                                               CALENDAR YEAR 1997
----------------------------------------------------------------------------------------------------------------
                                                   Persons served \1\               Program payments
                                                  --------------------------------------------------------------
                                                                                           Average
            Demographic characteristic                                                      amount
                                                   Number in  Percent  Amount in  Percent    per    Per enrollee
                                                   thousands            millions            person       \2\
                                                                                            served
----------------------------------------------------------------------------------------------------------------
Sex:
    Male.........................................    12,113      40.6    $75,357     43.0   $6,221      $5,326
    Female.......................................    17,734      59.4    100,066     57.0    5,643       5,306
Age:
    Under 65 years...............................     4,129      13.8     25,798     14.7    6,247       5,735
    65-74 years..................................    12,771      42.8     59,687     34.0    4,674       3,953
    75-84 years..................................     9,428      31.6     61,708     35.2    6,545       6,267
    85 years or older............................     3,519      11.8     28,231     16.1    8,023       7,919
Race: \3\
    White........................................    25,801      86.4    145,050     82.7    5,622       5,165
    Nonwhite.....................................     2,550       8.5     21,447     12.2    8,409       4,509
Type of entitlement:
    Aged.........................................    26,130      87.5    151,655     86.5    5,804       5,319
    Disabled.....................................     3,717      12.5     23,768     13.5    6,395       5,284
MSA type \4\
    Urban........................................    21,549      72.2    134,200     76.5    6,228       5,694
    Rural........................................     7,956      26.7     40,142     22.9    5,048       4,648
                                                  --------------------------------------------------------------
        Total....................................    29,847     100.0    175,423    100.0    5,877       5,314
----------------------------------------------------------------------------------------------------------------
\1\ Does not reflect beneficiaries who received covered services but for whom no program payments were reported
  during the year.
\2\ Beginning with 1994, the utilization rates per 1,000 enrollees do not reflect managed care enrollment; that
  is, Medicare enrollees in managed care plans are not included in the denominator used to calculate the
  utilization rates.
\3\ Excludes unknown race.
\4\ Excludes outlying areas.

Note.--MSA is metropolitan statistical area. Numbers may not add to totals because of rounding.

Source: Health Care Financing Administration.



       TABLE 2-40.--USE OF SHORT-STAY HOSPITAL SERVICES BY MEDICARE EMPLOYEES BY YEAR AND 1997 DEMOGRAPHIC CHARACTERISTICS, SELECTED YEARS 1975-97
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                          Discharges              Total days of care                       Program payments
                                         Hospital  -----------------------------------------------------------------------------------------------------
    Calendar year, period, and 1994      insurance                                                                                      Per
            characteristic               enrollees   Number in  Per 1,000   Number in     Per     Per 1,000   Amount in     Per       covered      Per
                                            in       thousands  enrollees   thousands  discharge  enrollees   millions   discharge    day of    enrollee
                                         thousands                                                                                     care
--------------------------------------------------------------------------------------------------------------------------------------------------------
Year:
    1975..............................      24,640       8,001        325      89,275       11.2      3,623      $9,748     $1,218        $109      $396
    1980..............................      28,067      10,279        366     109,175       10.6      3,890      22,099      2,150         202       787
    1982..............................      29,069      11,109        382     113,047       10.0      3,889      30,601      2,755         271     1,053
    1984..............................      29,996      10,896        363      96,485        8.9      3,217      38,500      3,533         399     1,284
    1985..............................      30,589      10,027        328      86,339        8.6      2,823      40,200      4,009         466     1,314
    1986..............................      31,216      10,044        322      86,910        8.7      2,784      41,781      4,160         481     1,338
    1987..............................      31,853      10,110        317      89,651        8.9      2,815      44,068      4,359         492     1,383
    1988..............................      32,483      10,256        316      90,873        8.9      2,798      46,879      4,571         516     1,443
    1989..............................      33,040      10,148        307      89,902        8.9      2,721      49,091      4,838         546     1,486
    1990..............................      33,719      10,522        312      92,735        8.8      2,750      53,708      5,104         579     1,593
    1991..............................      34,428      10,896        316      93,936        8.6      2,728      58,901      5,406         627     1,711
    1992..............................      35,154      11,111        316      92,900        8.4      2,643      64,976      5,848         699     1,848
    1993..............................      35,904      11,158        311      88,871        8.0      2,475      67,439      6,044         759     1,878
    1994..............................      36,543      11,471        314      85,734        7.5      2,346      70,623      6,157         824     1,933
    1995..............................      37,135      11,681        315      81,282        7.0      2,189      74,836      6,407         921     2,015
    1996 \1\..........................      33,301      11,796        354      77,193        6.5      2,318      78,546      6,953       1,018     2,359
    1997 \1\..........................      32,614      11,919        365      74,901        6.3      2,297      80,751      7,118       1,078     2,476
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual percentage change in period:
    1975-85...........................         2.2         4.8        2.4         1.0       -2.8       -1.5        18.7       14.2        17.6      15.8
    1985-95...........................         2.0        -1.3       -3.1        -1.2       -1.7       -3.1         6.3        5.7         7.5       4.2
    1975-97 \1\.......................         1.3         1.8        0.5        -0.8       -2.6       -2.1        10.1        8.4        11.0       8.7
========================================================================================================================================================
Age:
    Less than 65 years................       4,829       1,637        364      10,686        6.5      2,213      10,856      7,064       1,016     2,248
    65-69 years.......................       9,217       1,765        230      10,442        5.9      1,133      12,886      7,816       1,234     1,398
    70-74 years.......................       8,641       2,193        303      13,197        6.0      1,527      15,807      7,613       1,198     1,829
    75-79 years.......................       6,830       2,269        393      14,294        6.3      2,093      16,005      7,389       1,120     2,343
    80-84 years.......................       4,581       1,914        487      12,352        6.5      2,696      12,503      6,790       1,012     2,729
    85 years or older.................       3,960       2,141        610      13,930        6.5      3,518      12,694      6,118         911     3,206
Sex:
    Male..............................      16,383       5,208        371      32,652        6.3      1,993      37,436      7,619       1,147     2,285
    Female............................      21,676       6,712        361      42,249        6.3      1,949      43,315      6,736       1,025     1,998
Race: \2\
    White.............................      32,526      10,078        361      62,058        6.2      1,908      67,239      7,010       1,083     2,067
    All other.........................       5,349       1,766        388      12,347        7.0      2,308      12,993      7,739       1,052     2,429
Area of residence:
    Northeast.........................       6,807       2,496        367      21,858        8.8      3,211      19,812      7,938         906     2,911
    Midwest...........................       8,456       3,018        357      19,414        6.4      2,296      19,937      6,606       1,027     2,358
    South.............................      12,080       4,533        375      29,657        6.5      2,455      28,884      6,372         974     2,391
    West..............................       4,862       1,730        356       9,477        5.5      1,949      11,718      6,773       1,236     2,410
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Prior to 1996, data were obtained from the Annual Person Summary Record. Beginning in 1996, utilization rates are based on persons receiving fee-for-
  service care and total persons not enrolled in prepaid health plans.
\2\ Excludes unknown race.

Source: Health Care Financing Administration, Office of Strategic Planning.


   TABLE 2-41.--MEDICARE PARTICIPATING INSTITUTIONS AND ORGANIZATIONS,
                          1984, 1996, AND 1998
------------------------------------------------------------------------
                                                          Year
          Institution or organization          -------------------------
                                                    1984         1998
------------------------------------------------------------------------
Hospitals.....................................        6,675        6,116
  Short stay..................................        6,038        5,038
  Long stay...................................          637        1,078
Skilled nursing facilities....................        5,952       15,032
Home health agencies..........................        4,684        9,330
Laboratories registered under the Clinical               NA      166,817
 Laboratory Improvement Act...................
Outpatient physical therapy providers.........          791        2,890
Portable x-ray suppliers......................          269          659
Rural health clinics..........................          420        3,551
Comprehensive outpatient rehabilitation                  48          590
 facilities...................................
Ambulatory surgical centers...................          155        2,649
Hospices......................................          108        2,317
Facilities providing services to renal disease        1,335        3,581
 benefit......................................
  Hospital certified as both renal transplant           147          148
   and renal dialysis center..................
  Hospital certified as renal transplant                 16           87
   centers....................................
  Hospital dialysis facilities................          117           27
  Nonhospital renal dialysis facilities.......          645           NA
  Dialysis centers only.......................          359          319
  Inpatient care..............................           51           44
Hospital and skilled nursing facility beds:
  Hospitals...................................    1,144,000    1,012,000
    Short stay................................    1,023,000      891,000
    Long stay.................................      120,700      122,000
  Skilled nursing facilities..................      530,400     723,000
------------------------------------------------------------------------
NA--Not available.

Source: Health Care Financing Administration, Bureau of Data Management
  and Strategy.

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