Exhibit 4. Subtractions from and Additions to the National Health Expenditure Accounts (NHEA) to Make it Consistent with the Medical Expenditure Panel Survey.

Amount Subtracted1	Health Care Service or Type of Expenditure
Adjusting the Scope of Included Populations
Long-Term Care Facility Expenditures
$23.0	Hospital (Non-Community)
$144.5	Nursing Home
$5.0	Hospital (Veterans' Administration)
$0.8	Physician (Veterans' Administration)
$3.5	Physicians in Long Term Care Hospitals
Acute Care Expenditures of Institutionalized
$98.1	Acute Care Services for People in Institutions
Expenditures for Active Duty Military and Foreign Visitors
$14.4	Active Duty Military Expenditures
$2.2	Services for Foreign Visitors to U.S.
Adjusting for Patient Care Services Not Included in MEPS
$41.0	Non-Durable Medical products (e.g., Aspirin and Bandages)
$95.5	Other Personal Health Care (e.g., Housekeeping Services)
$6.9	Outpatient Care Centers not in MEPS
$2.3	Personal Care Expenditures in Medicaid Home Health
Adjusting for Expenditures not Tied to Specific Patient Events
Non-Patient Care Revenues Not Included in MEPS
$71.2	Private Non-Patient Services (e.g. Gift Shop Revenue)
$1.3	Replace NHEA Other Public Expenditures with MEPS Other Public Expenditures
$23.2	Disproportionate Share Hospital (DSH), Graduate Medical Education (GME) and Indirect Medical Education (IME)
$8.0	Public Grants to Hospitals
$13.4	Medicaid Non-DSH Supplemental Payments
$5.7	Non-patient Revenues for Physician Services Paid by Other Federal and Other State
Previously Paid Expenditures
$5.4	Lab Services and Tests Paid by Other Providers
$565.4	Total Subtractions from NHEA
$17.3	Prescription Drug Rebates (additions to NHEA)
$548.2	Net Subtraction from NHEA

¹In billions of 2007 U.S. dollars.

SOURCES: Available on request from Didem Bernard, Ph.D., Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Email: Didem.Bernard@ahrq.hhs.gov