Transcript Slide 1

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What Accounts for the Recent Rise in Health
Care Spending?
Kenneth E. Thorpe, Ph.D.
Robert W. Woodruff Professor and Chair of the Department of Health Policy
& Management, Rollins School of Public Health, Emory University
[email protected]
AS
The Data
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 Healthcare Spending growth in spending can be
decomposed into:
– Change in treated prevalence
– Change in spending per treated case
– Interactions
 About 60 growth linked to treated prevalence
increases between 1987 and 2008. Includes both
rising clinical incidence (diabetes) and increased
treatment intensity (lipids, anti-hypertensives)
Factors accounting for recent growth in
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spending—differs
from
theMaster
1940-90title
period
 Between 1940 and 1990:
– Uninsured declined from 90 to 15 percent
roughly constant since then.
– Medicare and Medicaid
– Important treatment innovations including
NICU (low birthweight babies), treatment for
AMI, stroke, other cardiovascular conditions
Treated Prevalence by Medical Condition, 19872008, Adults 18+
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1987
2008
Hyperlipidemia
1.3%
19.1%
Mental Disorders
4.9%
13.9%
Diabetes
3.9%
9.1%
Hypertension
13.1%
23.9%
Arthritis
7.2%
14.8%
Heart Disease
7.4%
9.7%
Cancer
3.6%
6.6%
Pulmonary Disease
8.1%
12.9%
What accounts for the rise in prevalence of
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treated disease?
 Increased incidence (diabetes) linked
largely to rising obesity
 Changing clinical thresholds for treatment
(hypertension, lipids)
 New medical technologies (SSRI)
 Longevity
 Changing definitions of disease (diabetes)
Key Drivers of Rising Health Care
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Costs
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 Doubling of obesity since 1987 accounts for 7 to
10% of the rise in health care spending (varies by
time period). CBO estimates 8%.
 Five chronic conditions are key drivers of rising
health care spending in Medicare (account for a
third of the growth) :
–
–
–
–
–
Diabetes (8 percent of growth)
Arthritis (7 percent)
Kidney disease (6%)
Hypertension (6%)
Mental disorders (5%)
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Percent of Change in Total Health Care Spending Associated with
Obesity, Increased Treatment Intensity and Both Obesity and
Treatment Intensity, 1987-2007
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The Challenge:
Obese workers spend nearly 40% more on health care
than normal weight adults, adds about 20 percent to health
Care spending
For each additional dollar spent to treat health care costs
associated with chronic disease, there is an additional
$4 lost in productivity
Need a better system to avert disease, change behavior
and keep chronically Ill patients healthier before entering
Medicare and while they are enrolled in the program.