We know the region’s population is elderly. We are surpassed only by Dade County, Fla. Regionally, there are approximately 56,000 people over the age of 85. It is projected that within 20 years, that number will increase to about 77,000. And while this population has been aging, it has also been declining. In Allegheny County, for instance, the number of working age people between 20 and 64 is projected to decline by 7 percent in the next 20 years, while the number of people over 65 will go up 14 percent over that same period.

Adding to our challenges, statewide data suggest that this region is simply not healthy. Among Pennsylvania cities, we are at the top quartile in bronchitis and asthma, congestive heart failure, diabetes and gastroenteritis. This perhaps is one of the reasons we rank seventh among the top 20 comparable cities in the country in hospital occupancy.

While Highmark’s cost per unit is decreasing, the number of units of care being consumed is increasing. This above-average utilization not withstanding, our health insurance premiums for the non-Medicare population from 1998 ranked seventh-lowest among the same 20 cities. We were also below the national average by almost 9 percent.

However, the picture is different when we look at the Medicare population. For this segment, we ranked third in hospital utilization. Costs are also higher. While we can’t ignore that we are a high utilizer for health care services, we must also focus on the very important matter of improving the quality of care. This is where we are strong and can look ahead. We have seen dramatic increases in people’s access to various preventive programs that we have developed. The Dean Ornish program would be one example. Pennsylvania has one of the lowest rates of uninsured among all states -- 10.5 percent -- which compares favorably with Maryland, New York and New Jersey, where the percentage is about 16.