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

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An Unhealthy AmericaMilken InstituteIV: Projections of Avoidable Indirect Impacts(Forgone Economic Growth)A. Baseline and Optimistic ProjectionsBaseline ScenarioIn developing baseline and optimistic scenarios of future indirect impacts, we use employment and populationprojections to calculate employment-to-population ratios (the population as defined by 16 and older). By dividing theratio for every year by the ratio of 2003, we build an E/P index. 82We next create a baseline PRC index forProjection of Employment and PopulationProjections of Employment and Populationeach disease. This is built by dividingbaseline PRC (obtained from “ProjectingEmployment Population* Employment/ E/PExpenditures PRC* Avoidable Expenditures/PRCYear (Millions) (Millions) Population IndexDirect Costs,” Part II) for everyDisease(Billions) (Millions)year by(Thousands)2003 130.0 225.2 0.58 1.000baseline PRC for 2003. The table2004 131.4 Cancer 227.7 0.58 48.1 1.000 10.6 4.5on the next page provides a PRC index for2005 133.5 Breast Cancer 230.3 0.58 5.5 1.004 1.1 4.8cancer. The index reading for 2004 (1.03) is2006 135.4 Colon Cancer 233.0 0.58 3.9 1.006 0.3 11.52007 136.8 Lung Cancer 235.7 0.58 6.3 1.005 0.4 derived by 17.1 dividing 2004 PRC (10.932008 138.3 Prostate Cancer 238.2 0.58 4.3 1.006 1.0 million) by 2003 4.1 PRC (10.58 million).2009 140.1 Other Cancers 240.6 0.58 28.0 1.008 7.7 3.62010 142.0Pulmonary Conditions242.9 0.5845.21.01349.2 We multiply 0.9 the E/P index by the PRC2011 144.0 245.1 0.59 1.017Diabetes 27.1 13.72012 145.9 247.3 0.59 1.022index to create2.0an E/P-PRC index, alsoHypertension 32.5 36.8 0.92013 147.8 249.3 0.59 1.027shown in the next table. This index is2014 149.8 Heart Disease251.3 0.60 64.71.03219.2 3.4scaled to the 2003 EPRC to obtain2015 151.7 Stroke 253.4 0.60 13.61.0372.4 5.62016 153.7 Mental Disorders 255.4 0.60 45.81.04230.3 projections 1.5 of EPRC by disease. For2017 155.7 Total 257.6 0.60 277.0 1.047 162.2 example, in 2003, 1.7 the cancer EPRC totaled2018 157.6 PRC: Population 259.8 Reporting Condition 0.61 1.0512019 159.6 261.9 0.61 1.0562020 161.6 264.1 0.61 1.0602021 163.5 266.3 0.61 1.0642022 165.4 268.5 0.62 1.0672023 167.3 270.7 0.62 1.070* Adult Population is defined as 16 years and overSources: BLS, U.S Census, Economy.com, Milken Institute5.92 million (obtained in Part III, SectionA). Hence, each year’s EPRC is multipliedby 5.92 million to obtain cancer projectionsof EPRC through 2023. 83Baseline EPRC totals are converted into lost workdays and presenteeism for both Individuals and caregivers, consistentwith the methodology used to estimate the indirect impacts (Part III, Section A).We then use projections of wages and nominal GDP, respectively, to obtain wage- and GDP-based projections of indirectimpact for the baseline scenario.82. For example, the E/P index for 2004 was derived by dividing the 2004 employment-to-population (0.58) by the 2003ratio (0.58).83. We followed the same methodology to calculate projections of ECC by disease.[ 139 ]
An Unhealthy AmericaMilken InstituteCancer - Projection of Lost WorkdaysDisease YearPRC(Millions)PRC Expenditures E/P-PRCIndex(Billions)Index*PRC* EPRC(Millions)Expenditures/PRCLost Workdays(Thousands)(Millions)Cancer 2003 10.58 1.00 48.1 1.00 10.6 5.92 60.14 4.5Breast 2004Cancer 10.93 1.03 5.5 1.03 6.11 1.1 62.09 4.8Colon 2005Cancer 11.25 1.06 3.9 1.07 6.36 0.3 64.59 11.5Lung 2006 Cancer 11.61 1.10 6.3 1.10 6.58 0.4 66.81 17.1Prostate 2007 Cancer 12.00 1.13 4.3 1.14 6.79 1.0 68.99 4.1Other 2008Cancers 12.35 1.17 28.0 1.17 6.99 7.7 71.04 3.6Pulmonary 2009 Conditions 12.70 1.20 45.2 1.21 49.2 7.21 73.22 0.9Diabetes 2010 13.03 1.23 27.1 1.25 13.7 7.43 75.44 2.0Hypertension 2011 13.36 1.26 32.5 1.28 36.8 7.65 77.73 0.9Heart 2012 Disease 13.72 1.30 64.7 1.33 19.2 7.90 80.22 3.4Stroke 2013 14.06 1.33 13.6 1.36 8.13 2.4 82.58 5.6Mental 2014Disorders 14.39 1.36 45.8 1.40 30.3 8.36 84.91 1.5Total 2015 14.71 1.39 277.0 1.44 162.2 8.59 87.22 1.7PRC: 2016 Population 15.01 Reporting Condition 1.42 1.48 8.81 89.482017 15.33 1.45 1.52 9.03 91.732018 15.64 1.48 1.55 9.26 94.052019 15.97 1.51 1.59 9.49 96.392020 16.30 1.54 1.63 9.73 98.812021 16.62 1.57 1.67 9.95 101.112022 16.95 1.60 1.71 10.18 103.442023 17.28 1.63 1.75 10.41 105.74* E/P-PRC Index was created by multiplying the E/P Index with the PRC IndexSources: BLS, U. S . Census, Economy.com, Milken InstituteOptimistic ScenarioIn this scenario, the indirect economic impacts of lost workdays are calculated as they were for the baseline scenario,using optimistic PRC figures from Part II, Section B, “Projecting Avoidable Direct Costs: Findings of the Baseline andOptimistic Scenarios.” However, we don’t just want to incorporate optimistic PRC. We also want to include changes intreatment that will reduce presenteeism through less-invasive treatments and lower side effects. This reduction willultimately affect the indirect impact ratio of presenteeism to lost workdays.To quantify reductions in presenteeism, we rely chiefly on the National Cancer Institute. For example, to determinefigures for cancer, we follow a statistical report of the National Cancer Institute on cancer treatment from 1992 to 2002. 84(This report is one of the best available and can be used as a proxy to measure the relative invasiveness of treatmentoptions for other diseases.) For breast cancer, the report looked at four options: (1) no surgery; (2) breast-conservingsurgery (BCS) without radiation; (3) BCS with radiation; and (4) mastectomy. Ranking the four options, we project eachout through 2023.84. “Cancer Trends Progress Report: 2005.” See: www.cancer.gov.[ 140 ]
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