An Unhealthy America: The Economic Burden of ... - Milken Institute

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An Unhealthy AmericaMilken InstituteFinally, we project state PRC from the regional MEPS conversions, using state variations from the models. Then the sumsof disease-specific state PRC are adjusted with U.S. MEPS control totals for each year.PRC Projections with Early Screening and TreatmentPRC Projections with Early Screening and TreatmentExpendituresPRC (Thousands) PRC* PRC Expenditures/PRCper 100,000 Population**Chronic Disease Year* Baseline Optimistic Baseline OptimisticDisease(Billions) (Millions) (Thousands)Colon Cancer 2003 339 339 116.6 116.6Cancer 2013 368 48.1 333 10.6 116.2 4.5 105.2Breast Cancer 2023 4475.5 3681.1 129.9 4.8 106.9Prostate Colon Cancer Cancer 2003 1,0433.9 1,0430.3 729.0 11.5 729.02013 1,466 1,400 941.1 898.6Lung Cancer 6.3 0.4 17.12023 1,828 1,436 1081.6 849.3Prostate Cancer PRC 4.3 (Thousands) 1.0 PRC per 4.1 CapitaChronic Other Disease Cancers Year* Baseline 28.0 Optimistic 7.7 Baseline 3.6OptimisticHypertension Pulmonary Conditions 2003 36,761 45.2 36,761 49.2 12,642 0.9 12,6422013 45,011 41,676 14,200 13,148Diabetes 27.1 13.7 2.02023 51,138 41,578 14,869 12,089Heart Hypertension Disease 2003 19,145 32.5 19,145 36.8 6,584 0.9 6,584Heart Disease 2013 23,153 64.7 20,092 19.2 7,304 3.4 6,339Stroke 2023 27,016 13.6 17,6612.4 7,855 5.6 5,135Stroke 2003 2,425 2,425 834 834Mental Disorders 45.8 30.3 1.52013 2,700 2,500 852 789Total 2023 3,127 277.0 2,538 162.2 909 1.7 738Mental PRC: Disorders Population Reporting 2003 Condition 30,338 30,338 10,433 10,4332013 36,774 35,349 11,602 11,1522023 46,673 40,910 13,571 11,895*Selected years for twenty-year projection** Male population was used for prostate cancer.Source: Milken InstitutePRCPRC ProjectionsProjectionswithoutwithoutEarlyEarlyScreeningScreeningandandTreatmentTreatmentExpendituresPRC (Thousands) PRC* PRC Expenditures/PRCper 100,000 Population**Chronic Disease Year* Baseline Optimistic Baseline OptimisticDisease(Billions) (Millions) (Thousands)Breast Cancer 2003 1,140 1,140 772 772Cancer 48.1 10.6 4.52013 1,461 1,429 989 886Breast Cancer 2023 1,7195.5 1,5081.1 1,163 4.8 862Lung Cancer Colon Cancer 2003 3703.9 3700.3 127 11.5 127Lung Cancer 2013 4056.3 3720.4 128 17.1 118Prostate Cancer 2023 4964.3 4041.0 144 4.1 118Other Cancers 2003 7,689 7,689 2,644 2,644Other Cancers 28.0 7.7 3.62013 10,333 9,720 3,260 3,067Pulmonary Conditions 2023 12,692 45.2 10,407 49.2 3,690 0.9 3,026Diabetes PRC 27.1 ( Thousands ) 13.7 PRC per 2.0CapitaChronic Hypertension Disease Year* Baseline 32.5 Optimistic 36.8 Baseline 0.9 OptimisticPulmonary Heart Conditions Disease 2003 49,206 64.7 49,206 19.2 16,922 3.4 16,922Stroke 2013 55,667 13.6 52,6182.4 17,562 5.6 16,6002023 64,595 55,517 18,782 16,142Mental Disorders 45.8 30.3 1.5Diabetes 2003 13,729 13,729 4,721 4,721Total 2013 17,752 277.0 17,296 162.2 5,600 1.7 5,457PRC: Population Reporting 2023 Condition 20,992 18,201 6,104 5,292*Selected years for twenty-year projection** Female population was used for breast cancer.Source: Milken Institute[ 89 ]
An Unhealthy AmericaMilken InstituteProjections for Health-Care Cost GrowthAssumptions for Health-Care Cost Growth in the Baseline ScenarioFor the baseline scenario, we assume that health-care cost growth will follow projections of the Centers for Medicareand Medicaid Services (CMS). 45 Implicit in the CMS projections are a broad range of complex assumptions about futurehealth-care cost growth, including trends in specific sectors and changes in public and private insurance coverage. 46To make disease-specific expenditure projections, we adjust the CMS-projected inflation rates to account for futurecosts associated with four specific sites of service (again, we use 2003 MEPS data). The four sites of service include (1)outpatient and office-based visits; (2) home health care; (3) prescription drugs; and (4) hospital inpatient visits, includingemergency room services.Assumptions for Health-Care Cost Growth in the Optimistic ScenarioHealth-care cost growth for the “optimistic” scenario is 0.5 percentage point lower than that in the baseline projections.This is a plausible reduction in cost growth as there are a number of trends that could have a moderating effect onhealth-care cost growth.For example, more widespread breast self-examination or improved diagnostics would catch breast cancer at an earlierstage, when less-aggressive treatments are available, and reduce the growth in expenditures to treat patients. In thecase of asthma (included in pulmonary conditions), improper management can lead to frequent hospitalizations andresult in higher treatment expenditures. Improved disease management of diabetes can lessen the risk factors fordeveloping cardiovascular disease and other conditions.Notably, while the baseline scenario assumes some growth of disease management, more widespread adoption of carecoordination and disease management could reduce the rate of future growth of health-care costs. If greater advancesin these areas are achieved, slower growth in health-care costs and treatment expenditures would be possible. Similarly,efforts to improve adoption of health-care information technology could reduce clinical and administrative componentsof health-care costs.45. The CMS projects a “personal health care” price deflator, which is its overall rate of inflation for the private healthsector. The CMS does not report medical cost growth by site-of-service”. To estimate medical cost growth for our fourcategories—outpatient and office based visits; home health care; prescription drugs; and hospital inpatient visits,including emergency room services—consistent with the CMS projection of overall medical inflation, we extracthistorical data and projections for specific health-care price indexes from Global Insight.46. Christine Borger, Sheila Smith, Christopher Truffer, Sean Keehan, Andrea Sisko, John Poisal, and M. Kent Clemens,“Health Spending Projections Through 2015: Changes on the Horizon,” Health Affairs, Vol. 25. February 22, 2006, pp.w61–w73.[ 90 ]
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