Health Status
Health Behavior and
Variability in Healthcare Spending
RADM Penelope Slade-Sawyer, P.T., M.S.W.
Department of Health and Human Services (DHHS)
Director, Office of Disease Prevention and Health Promotion
Acting Director, President’s Council on Physical Fitness and Sports
Office of the Secretary, Office of Public Health and Science
Factors Contributing to Geographic Variation in
Health Care Spending
• Prices paid for medical services
• Health and illness status of residents of a given region
• Regional preferences about the use of healthcare services
• Residual variation
Congressional Budget Office, Geographical Variation in Health Care Spending, 2008
Two thirds of Medicare spending is for people with
five or more chronic conditions
Percent of Healthcare Spending for Individuals with chronic
conditions by type of insurance
People with Multiple Chronic Conditions are much more likely to be
hospitalized
Spending for inpatient hospital care increases with the number of
chronic conditions
Healthcare Spending Increases with the Number of Chronic Conditions
The Five Most Costly Conditions as a Percentage of Total Health
Expenditures: United States, 2002
Source: Olin GL, Rhoades JA. The five most costly medical conditions, 1997 and 2002: estimates for the U.S. civilian noninstitutionalized population.
Statistical Brief #80. Agency for Healthcare Research and Quality, Rockville, MD. Web site:
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st80/stat80.pdf. Accessed April 7, 2006.
Ke
n
es tuc
ky
t
Vi
rg
in
O
kl
i
ah a
om
M
a
is
Te sou
nn ri
es
se
e
In
di
M
an
is
a
si
ss
ip
pi
N
or
O
th
h
Ca io
ro
Lo lina
ui
si
an
Al
ab a
am
Ar
ka a
ns
a
Al s
as
W
k
a
So
y
ut om
h
i
Ca ng
ro
lin
a
N
ev
ad
M
a
i
N
or chi
th ga
n
Pe Da
nn ko
sy ta
lv
N
e w an
i
M a
ex
ic
o
Ill
in
oi
s
M
ai
ne
N
eb
ra
sk
Ar a
iz
on
a
So
ut Iow
h
a
D
a
W kot
is
a
co
ns
N
i
M
ew
on n
t
H
a m a na
ps
hi
re
Te
xa
s
Fl
or
id
a
G
eo
rg
ia
Id
D aho
el
aw
a
N
ew re
Yo
rk
Co
lo
ra
do
Vi
rg
in
i
Ka a
ns
a
Ve
s
rm
on
t
N
ew D
C
Je
r
M sey
ar
yl
an
d
Rh H a
od wa
e
i
Is i
la
nd
O
W reg
as
on
hi
n
M gto
i
n
n
M
as n e
sa so
ch ta
Co use
nn tts
ec
t
Ca icu
t
lif
or
ni
a
U
ta
h
W
Smoking Prevalence of Adults* by state
30
25
20
15
10
5
0
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2006
Developing chronic diseases is not an inevitable
consequence of aging
Behaviors
 Poor diet (low fruit and vegetable intake)
 High cholesterol
 High blood pressure
 Lack of physical activity
 Tobacco use
Chronic Diseases
•
Type 2 diabetes
•
congestive heart failure
•
Stroke
•
hypertension
Overweight and obesity raise the risk for:
type 2 diabetes
high blood pressure
high cholesterol levels
coronary heart disease
congestive heart failure
angina pectoris
stroke
asthma
osteoarthritis
musculoskeletal disorders
gallbladder disease
sleep apnea and respiratory problems
gout
bladder control problems
poor female reproductive health
– complications of pregnancy
– menstrual irregularities
– infertility
– irregular ovulation
cancers of the
– uterus
– breast
– prostate
– kidney
– liver
– pancreas
– esophagus
– colon and rectum
Geographic variation in Public Health Spending is even
greater than variation in Medicare Spending

Public Health Activities






Monitor community health status
Investigate and control disease outbreaks
Educate the public about health risks and prevention strategies
Enforce public health laws and regulations
Inspect and assure the safety and quality of water, air, and other
resources necessary for good health
Public Health Spending


State government’s per capita spending on public health activities
varied by a factor of 30 in 2003 (more than 400$ per person in Hawaii,
less than $75 per person in Iowa)
Variation even great on the local level (less than 1$ per capita to more
than 200$ per capita in 2005)
Glen P Mays, Sharla A. Smith. Geographic Variation in Public Health spending: correlates and consequences. Public Health Services and Systems Research. 2009.
Percentage of Adults Who Are Obese,* by State
*Body mass index > 30, or ~ 30 pounds overweight for a 5'4" person.
Source: CDC, Behavioral Risk Factor Surveillance System.
Differences in Prevalence of Obesity 2006--2008
White
Hispanic
– Non Hispanic
Black
Non-Hispanic
Source: CDC, MMWR. Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006--2008 . For this study
analysis, CDC analyzed the 2006−2008 BRFSS data.
Prevalence of Physical Activity*, 2007
*Recommended physical activity is defined as at least 5 days a week for 30 minutes a day of moderate intensity activity or at least 3 days a week for
20 minutes a day of vigorous intensity activity
Percentage of U.S. adults aged ≥ 18 years who consumed fruit two or more
times/day and vegetables three or more times/day, by state (2007)
Source: Behavioral Risk Factor Surveillance System 2007
Percent of Adults Ages 18+ with Diagnosed Diabetes, by State, 2007
National Average = 7.8%
< 5.9%
6% – 6.9%
7% – 7.9%
≥ 8%
Source: Centers for Disease Control and Prevention. (2009). Percentage of Adults with Diagnosed
Diabetes By State, 2007. Link: http://apps.nccd.cdc.gov/DDTSTRS/StateSurvData.aspx.
County Level Estimates of Diagnosed Diabetes —
Percentage
of Adults
Colorado,
2005
Percentage
of in
Adults
in Texas,
2005
Healthy People 2010
Overarching goals: 1) increase quality and years of healthy life
2) eliminate health disparities
Focus Areas include

Physical Activity and Fitness

Nutrition and Weight Status

Diabetes

Heart Disease and Stroke

Tobacco Use

Cancer

Examples of New Objectives (for Healthy People 2020)

Early and Middle Childhood Health, Adolescent Health

Healthcare Associated Infections
By changing the way they live, Americans could change their
personal health status and the health landscape of the Nation
dramatically.