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

An Unhealthy AmericaMilken InstituteIII: Historical Indirect Impacts (Forgone Economic Growth)Good health is a vital component of individual well-being. But it also plays a major role in employee productivity. Whenindividuals suffer from chronic disease, the result is often diminished productivity, in addition to lost workdays. An illemployee who shows up for work (to avoid sick days, for example) may not perform well, a circumstance known as“presenteeism.” Output loss due to presenteeism is immense; some literature suggests that for certain diseases, it canbe up to fifteen times greater than for absenteeism, which is defined as work missed due to sick days, etc. 63Caregivers also contribute to lost productivity through missed workdays and presenteeism. Currently, more than 20million full-time employees provide care to others. 64 For this study, therefore, it is necessary to consider both employeegroups—caregivers as well as patients—for a more complete picture of the indirect impacts of chronic disease due tolost workdays and presenteeism.A. Data and MethodologyMethodology for Individuals with Chronic DiseaseTo calculate the impacts of lost workdays and presenteeism for individuals with chronic disease (not for caregivers), weuse data from the National Health Interview Survey (NHIS). This is a nationally representative sample of the populationand comprises several components: the family core, a household level, person level, a sample adult file, and a samplechild file. The sample adult file is representative of the adult U.S. population when appropriately weighted.The NHIS dataset does not provide numbers of lost workdays per particular disease, forcing the use of a proxy in thisregard. We take one of the survey questions from the sample adult file—“During the past twelve months, about howmany days did you “miss job or business due to illness or injury (not including maternity leave)?”—and match allindividuals (whom we call the Employed Population Reporting Condition) who have ever had a particular illness withthe number of lost workdays in past twelve months due to illness or injury.EPRC for the U.S.*EPRC for the Millions, U.S.* - 2003 Millions, 2003Chronic Disease Expenditures PRC* EPRC Expenditures/PRCDisease Cancer (Billions) (Millions) 5.9 (Thousands)Cancer Asthma 48.1 10.6 13.84.5Breast Cancer Diabetes 5.5 1.15.94.8Colon Cancer Hypertension 3.9 0.3 27.2 11.5Lung Cancer Heart Disease 6.3 0.49.517.1Prostate Cancer Stroke 4.3 1.01.14.1Other Cancers Emotional Disturbances 28.0 7.7 7.73.6Pulmonary Conditions* Employed Population45.2Reporting a Condition49.2 0.9Diabetes 27.1 13.7 2.0Sources: NHIS, Milken InstituteHypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Stroke 13.6 2.4 5.6Mental Disorders 45.8 30.3 1.563 “The Hidden Competitive Total Edge - Employee Health and 277.0 Productivity,” 162.2 (Newton, MA: Employers 1.7 Health Coalition, 2000).64. National AlliancePRC:forPopulationCaregivingReportingand AARP,Condition“Caregiving in the U.S.” 2004.[ 127 ]