Where the Money Goes
Higher Premiums Reflect Higher Levels of Healthcare Spending – Buried within the overall increase in health spending are significant changes in the where those dollars are being spent.
Arizona spends a significantly higher percentage on physician and other professional services (33.9%) than does the nation as a whole (29.0%).9
At just 4.3% of the total, nursing home care accounts for a lesser percentage of total spending than the national average of 7.4%.10
Is there a Doctor – or Specialist – In the House?
While an adequate supply of primary care physicians is a concern for Arizona hospitals, the availability – or lack of specialists is often a bigger worry. Many Arizona counties do not have any physicians practicing in certain medical and surgical specialties, and are not able to attract or support them due to the lack of necessary medical facilities.11
The ratio of physicians per 100,000 people increased from 207 in 2004 to 219 in 2005 – but remains well below the estimated national average of 293.12
Overall, the number of physicians increased from 12,024 in 2004, to 13,215 in 2005. However the geographic distribution of physicians throughout the states ranges from just 7 in Greenlee County to 8,501 in Maricopa County.13
Similar variation is found in the number of physicians per 100,000 population, which varies from a low of 50 in Apache County to a high of 292 in Pima County.14
In rural Arizona, primary care needs are often met by advanced practice nurses and physician’s assistants, where they account for 30% to 50% of the medical workforce.15
Throughout the nation, hospitals and healthcare organizations are struggling to attract and retain workers. A national survey of health care providers found that 69% reported having moderate or great difficulty retaining critical-skill workers, with 84% listing the retention of registered nurses as their most difficult staffing challenge.16
With a ratio of 681 nurses to 100,000 residents, Arizona ranks 45th in the nation in terms of its registered nurse workforce. While this represents an improvement for the state’s previous 48th place ranking, it remains far below the national average of 782 nurses per 100,000.17 If left unaddressed, the shortage is projected to increase to 25% in 2010 and to 32% by 2015.18
Next: Public Attitudes
9 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group (2006) Accessed 10/10/06 from:http://www.cms.hhs.gov/NationalHealthExpendData/downloads/nhestatespecific2004.pdf.
11 Rimsza, Mary, William Johnson, Mark Speicher & Michael Grossman. (2006) The Arizona Physician Workforce Study: Part II. Center for Health Information and Research, Arizona State University; Tempe, AZ.
16 Health Care Organizations Still Struggling to Attract, Retain Workers. (2006) Watson Wyatt Worldwide and the American Society for Healthcare Human Resources Administration. October 11, 2006. Accessed 10/23/06 from:http://watsonwyatt.com/news/press.asp?ID=16594.
17 The Registered Nurse Population: National Sample Survey of Registered Nurses. (2004) U.S. Department of Health and Human Services, Health Resources and Services Administration.http://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm.
18 Projected Supply, Demand and Shortage of Registered Nurses: 2000-2020. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Workforce Analysis. . http://www.ahca.org/research/rnsupply_demand.pdf.