Rising Health Care Costs, Rising Health Care Costs, Prevention - PowerPoint PPT Presentation

Rising Health Care Costs, Rising Health Care Costs, Prevention & Primary Care, and Prevention & Primary Care, and Personal Responsibility Personal Responsibility Marcia Nielsen, Ph.D., MPH Marcia Nielsen, Ph.D., MPH Executive Director Executive Director July Advisory Council Meetings July Advisory Council Meetings

Objectives Objectives � To explore evidence regarding rising costs of To explore evidence regarding rising costs of � health care, chronic disease, and health behavior health care, chronic disease, and health behavior � To explore the evidence regarding coordination To explore the evidence regarding coordination � of care, primary care, a medical home of care, primary care, a medical home � To discuss personal responsibility related to To discuss personal responsibility related to � health behaviors, cost effective use of health health behaviors, cost effective use of health care services and health literacy, and care services and health literacy, and contribution to the cost of health insurance. contribution to the cost of health insurance.

Rising health care costs Rising health care costs and the burden of chronic and the burden of chronic disease disease

Institute of Medicine’ ’s Top 10 s Top 10 Institute of Medicine Concerns re: the US Health System Concerns re: the US Health System � The number of uninsured The number of uninsured � � The rising costs of care and increases in health The rising costs of care and increases in health � care expenses care expenses � Deficient quality and safety Deficient quality and safety � � Inadequate evidence about value performance Inadequate evidence about value performance, , � cost of intervention and insufficient reliance on cost of intervention and insufficient reliance on available evidence available evidence � Dysfunctional competition, Dysfunctional competition, perverse incentives perverse incentives, , � inefficiency and waste inefficiency and waste Dr Fineberg, President of IOM, National Governor’s Association Meeting, July 2007

Institute of Medicine’ ’s Top 10 s Top 10 Institute of Medicine Concerns re: the US Health System Concerns re: the US Health System � Insufficient use of Health Information Insufficient use of Health Information � Technology Technology � Underinvestment in prevention Underinvestment in prevention � � Workforce shortages, low morale, and Workforce shortages, low morale, and � mismatches to current and future needs mismatches to current and future needs � Disparities in access and outcomes Disparities in access and outcomes � � Low health literacy and poor accommodations Low health literacy and poor accommodations � to patients to patients

Building a better Building a better health system health system “30 to 40% of every dollar spent in the 30 to 40% of every dollar spent in the “ US on health care is spent on overuse, US on health care is spent on overuse, underuse, misuse, duplication, etc , misuse, duplication, etc” ” underuse Dr Fineberg, President of IOM, National Governor’s Association Meeting, July 2007

What accounts for growth in health care spending ? Secretary Bremby, KHPA Board Retreat, 2007

Health Care Costs Concentrated in Sick Few — Sickest 10 Percent Account for 64 Percent of Expenses Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2003 Expenditure threshold 1% 0% (2003 dollars) 5% 10% 10% 20% $36,280 24% 30% 40% 49% $12,046 50% 50% 60% 64% $6,992 70% 80% 90% 97% $715 100% U.S. Population Health Expenditures Source: The Commonwealth Fund. Data from S. H. Zuvekas and J. W. Cohen, “Prescription Drugs and the Changing Concentration of Health Care Expenditures,” Health Affairs , Jan./Feb. 2007 26(1):249–57.

Health Expenditure Grow th 2000–2005 for Selected Categories of Expenditures Average annual percent grow th in health expenditures, 2000–2005 20 15 12.0 10.7 10 8.6 8.0 7.9 6.1 5 0 Total Hospital care Physician & Nursing home & Prescription Prog. admin. & clinical services home health drugs net cost of private health insurance Source: A. Catlin et al., “National Health Spending in 2005: The Slowdown Continues,” Health Affairs , Jan./Feb . 2007 26(1):142–53.

Health Care Expenditure per Capita by Source of Funding in 2004 Adjusted for Differences in Cost of Living $7,000 $6,000 Private Spending Out-of-Pocket Spending $5,000 $2,572 Public Spending $4,000 $803 $3,000 $483 $444 $342 $354 $148 $239 $906 $313 $472 $28 $370 $582 $113 $396 $2,000 $389 $238 $359 $2727 $2,475 $2,350 $2,210 $2,176 $1,000 $1,940 $1,917 $1,894 $1,832 $1,611 $0 a a b a United Canada France Netherlands Germany Australia United OECD Japan New States Kingdom Median Zealand a 2003 b 2002 (Out-of-Pocket) Source: The Commonwealth Fund, calculated from OECD Health Data 2006.

Prevention, Health Prevention, Health Behavior, Personal Behavior, Personal Responsibility Responsibility

Health Factors Medical Genetic Care Make-Up 10% 17% How We Live - Behavior 51% Environment 22% Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.” Atlanta, GA, Bureau of State Services, Health Analysis & Planning for Preventive Services, p 35, 1978

Causes of Death United States, 2 0 0 0 Actual Causes of Death † Leading Causes of Death* Heart Disease Tobacco Cancer Poor diet/ lack of exercise Stroke Alcohol Chronic low er I nfectious agents respiratory disease Unintentional I njuries Pollutants/ toxins Diabetes Firearm s Pneum onia/ influenza Sexual behavior Alzheim er’s disease Motor vehicles Kidney Disease I llicit drug use 0 5 10 15 20 25 30 35 0 5 10 15 20 Percentage ( of all deaths) Percentage ( of all deaths) * National Center for Health Statistics. Mortality Report. Hyattsville, MD: US Department of Health and Human Services; 2002 † Adapted from McGinnis Foege, updated by Mokdad et. al.

Obesity Trends* Am ong U.S. Adults BRFSS, 1 9 9 1 , 1 9 9 6 , 2 0 0 3 ( * BMI ≥ 3 0 , or about 3 0 lbs overw eight for 5 ’4 ” person) 1 9 9 1 1 9 9 6 2 0 0 3 No Data <10% 10%–14% 15%–19% 20%–24% ≥ 25%

Prevalence of Diabetes in Adults Prevalence of Diabetes in Adults United States, BRFSS: 2000 United States, BRFSS: 2000 <4% 4–6% >6%

Percentage of U.S. High School Students Who Did Not Attend Physical Education Classes Daily YRBS National Surveys, 1991–2001 Centers for Disease Control & Prevention

Coordination of care and Coordination of care and a primary care medical a primary care medical home home

Chronic Care Model Environment Medical System Family Information Systems Patient School Decision Support Self-Management Worksite Delivery System Design Community Self Management Support

Adults w ith a Medical Home Are More Likely to Report Checking Their Blood Pressure Regularly and Keeping It in Control Does not check BP Percent of adults 18–64 Checks BP, not controlled w ith high blood pressure Checks BP, controlled 100 48 75 56 58 50 10 15 17 25 42 29 25 0 Total Medical home Regular source of care, not a medical home Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time. Source: The Commonwealth Fund 2006 Quality of Care Survey Source: Commonwealth Fund 2006 Health Care Quality Survey.

The Majority of Adults w ith a Medical Home Alw ays Get the Care They Need Percent of adults 18–64 reporting alw ays getting care they need w hen they need it 100 74 75 55 52* 50 38* 25 0 Total Medical home Regular source of No regular source of care, not a medical care/ER home Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time. * Compared with medical home, differences remain statistically significant after adjusting for income or insurance. Source: The Commonwealth Fund 2006 Quality of Care Survey Source: Commonwealth Fund 2006 Health Care Quality Survey.

Adults w ith a Medical Home Have Higher Rates of Counseling on Diet and Exercise Even When Uninsured Percent of obese or overw eight adults 18–64 w ho w ere counseled on diet and exercise by doctor Medical home Regular source of care, not a medical home No regular source of care/ER 100 80 73 69 65 75 39* 50 34* 25 0 Insured all year Any time uninsured Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time. * Compared with medical home, differences are statistically significant. Source: The Commonwealth Fund 2006 Quality of Care Survey Source: Commonwealth Fund 2006 Health Care Quality Survey.