ALTARUM INSTITUTE PRESENTATION 2 00 9
National Health Expenditures on
Chronic Illness Prevention and
Treatment
Charles Roehrig
AcademyHealth Annual Research Meeting
Chronic Care Communication & Evaluation Strategies
June 30, 2009
www.altarum.org
ALTARUM INSTITUTE PRESENTATION 2 00 9
Introduction
• Does the nation improperly emphasize spending on
treatment over prevention?
• In order to answer this question, it is helpful to know
what we have been spending on each
• Annual estimates of such spending are surprisingly
absent
• Our research program was designed to fill this gap
and support related studies
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Introduction
• We developed estimates of national health expenditures
by medical condition and by category of prevention
• Estimates are annual from 1996 to 2006 with updates as
required national data sets become available
• Methods and findings have been published in Health
Affairs and Advances in Health Economics and HSR
• Funding has been provided by Altarum’s internal R&D
program, PhRMA, and Kaiser Family Foundation
“Quantifying National Expenditures on Wellness and Prevention”, (with George Miller, Craig Lake, and
Paul Hughes-Cromwick), Beyond Health Insurance: Public Policy to Improve Health. Advances in
Health Economics and Health Services Research, vol. 19, pp. 1–24, 2008.
“National Health Spending By Medical Condition”, (with George Miller, Craig Lake, and Jenny Bryant),
Health Affairs, 28, no. 2 (2009): w358-w367 (published on line February 2009).
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Methods: Spending on Prevention
• Primary prevention – interventions to prevent occurrence
of disease or disability
• Secondary prevention – interventions to detect and arrest
disease or disability in early asymptomatic stages
• Tertiary prevention -- interventions to prevent
progression of disease or disability in persons with
symptomatic illness or injury
Tertiary prevention is not included in our estimates
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Methods: Spending on Prevention
National
Health
Expenditures
(NHE)
Components of NHEA:
Structures
and
Equipment
Personal
Health
Care
Admin. & Net Cost
of Priv. Health
Insurance
Public
Health
Activity
Research
Public
Health
Prevention
Research
Prevention Elements:
Medical
Preventive
Services
Dental
Preventive
Services
Counseling
Cleaning/
Counseling
Immunizations
Examinations
Screening
Diagnose/Treat
(Asymptomatic)
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Results – Prevention Spending
12%
11%
Secondary Prevention (Treatment)
10%
Secondary Prevention (Screening/Examination)
9%
Percent of NHEA
Primary and Secondary Prevention (Research)
Primary Prevention
8%
7%
6%
5%
4%
3%
2%
1%
0%
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Methods: Spending by Medical Condition
• Adjust National Health Expenditure Account (NHEA)
estimates by type of service
• Allocate service spending to population groups
• Identify data sets to allocate spending to medical
conditions for each service/population cell
• Eliminate double counting for those with multiple
conditions
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Methods: Spending by Medical Condition
Service types, population groups, and data sources for
NHEA spending by medical condition
Population Group
Civilian Non-Institutional
Nursing Home
Long Term Psychiatric
Active Duty Military
Prisoners
Hosp
Phys
Dental
Oth Prof
Home H
Rx
NH
Main Data Sources
MEPS
NNHS
HCUP
Other
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Results: Spending by Medical Condition
Category / condition
Circulatory System
Heart conditions
Coronary Heart Disease
Congestive Heart Failure
Dysrhythmias
Cerebrovascular disease
Hypertension
Hyperlipidemia*
Mental disorders
Anxiety and Depression
Dementia**
Musculoskeletal
Osteoarthritis
Back Problems
Injury and poisoning
Trauma
Digestive
Upper GI
Neoplasms
Cancers
Colon
Lung
Prostate
Breast
1996
150.9
81.0
53.5
12.3
12.6
22.9
22.6
4.6
81.5
30.5
19.5
57.9
23.5
17.9
65.5
60.3
47.6
10.5
59.4
55.6
2.9
6.3
2.7
5.0
2006
256.3
117.1
69.6
23.9
19.0
26.7
54.6
25.2
149.2
65.6
29.9
134.8
51.6
45.1
122.1
110.5
112.6
32.1
108.0
99.6
6.9
5.9
5.8
18.6
Annual
Grwth
5%
4%
3%
7%
4%
2%
9%
18%
6%
8%
4%
9%
8%
10%
6%
6%
9%
12%
6%
6%
9%
-1%
8%
14%
Category / condition
Respiratory
Pulmonary
COPD
Asthma
Pneumonia
Nervous System
Eye problems
Genitourinary
Kidney
Endocrine
Diabetes
Other Categories
Maternal
Skin
Infectious diseases
Blood
Congenital
Prevention / Exams
General Exam
Dental
All Allocated Expendi
Not Allocated
Total NHEA PHE
1996
64.1
38.0
11.8
6.3
16.6
52.9
16.2
33.6
12.2
30.2
18.2
87.0
33.5
12.0
11.9
6.9
3.8
47.2
30.5
46.8
824.7
85.6
910.3
2006
104.4
68.2
17.3
13.8
20.5
98.1
26.2
81.6
39.8
74.9
42.8
174.6
61.4
27.3
23.3
17.2
8.5
102.7
73.4
91.5
1610.8
151.1
1761.9
Annual
Grwth
5%
6%
4%
8%
2%
6%
5%
9%
13%
10%
9%
7%
6%
9%
7%
10%
8%
8%
8%
8%
7%
8%
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Results: Spending by Medical Condition
Spending by diabetics versus spending on diabetes, 2004
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Summary
• We have developed annual estimates of national
spending by prevention category and medical condition
• We plan annual updates and are pursuing related studies:
–
–
–
–
–
Disaggregation of spending growth into prevalence and cost per case
Spending on interventions for which we have cost-effectiveness findings
Spending by population groups defined by condition combinations
Spending on prevention that is not included in NHEA
Modeling the impact on quality adjusted life years (QALYs) of spending
on prevention and treatment
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ALTARUM INSTITUTE PRESENTATION 2 00 9
Policy Relevance
Cohen J, Neumann P, Weinstein M. Does preventive care save money? Health Economics
and the presidential candidates. N Engl J Med 358(7) 661-3. February 14, 2008.
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