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

An Unhealthy AmericaMilken InstituteOne significant avoidable risk factor for major depressive episodes is routine alcohol or drug abuse. According to theDepartment of Health and Human Services, approximately one in every five adults (19.9 percent) who suffered such anepisode was considered to be dependent upon drugs and/or alcohol, compared to only 8.4 percent of individuals whodid not suffer depressive episodes. Virtually the same rate (19.8 percent) of 12- to 17-year-olds who suffered majordepressive episodes were drug- or alcohol-dependent. 30Total expenditure figures for all mental disorders (various anxiety disorders, such as panic, obsessive-compulsivedisorder, and phobias), including depression, rose by more than 50 percent, from $30.0 billion in 1998 to $45.8 billion in2003. Expenditures per PRC remained largely flat through the period. PRC totals rose by nearly 50 percent, from20,470,000 in 1998 to 30,338,000 in 2003, perhaps because the stigma of mental illness began to diminish.Mental Disorders Population Reporting Condition (PRC) and ExpenditureMental Disorders Population Reporting Condition (PRC) and ExpenditurePRC Expenditures Expenditures PRC* per PRC Expenditures/PRCTotal Year Disease(Thousands)(Billions)(US$)(Millions) (Thousands)(US$ Billions)1998 20,470 1,465 30.0Cancer 48.1 10.6 4.51999 21,616 1,573 34.02000Breast Cancer 22,860 5.5 1,557 1.1 4.8 35.62001Colon Cancer 24,619 3.9 1,585 0.3 11.5 39.02002Lung Cancer 27,518 6.3 1,505 0.4 17.1 41.42003Prostate Cancer30,338 4.3 1,509 1.0 4.1 45.8Sources: MEPS, Milken InstituteOther Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Heart Disease B. Disease Trends and 64.7Direct Costs: 19.2 State Level 3.4Stroke 13.6 2.4 5.6This preceding sectionMentaladdressedDisordersthe methodology for45.8obtaining representative30.3historical1.5treatment costs and PRCTotal 277.0 162.2 1.7totals from MEPS national and census-based statistics, and for calculating historical treatment costs and PRC equivalentsPRC: Population Reporting Conditionfor the five cancers not included in the MEPS summary tables. In this section, we calculate representative treatmentcosts and PRC at the state level.METHODOLOGYAs previously noted, MEPS provides regional disease-specific treatment costs by site of service—but not at the statelevel. Meanwhile, the Center for Medicare & Medicaid Services (CMS) 31 does publish personal treatment expenditures at thestate level, but only by site of service—not by disease. This data is available from 1980 to 2004.Due to the lack of disease-specific health-care costs at the state level, we use the CMS personal health-care expendituresby site of service and the MEPS regional expenditures.MEPS data show great variations in expenditures. For example, in 2003, 53.5 percent of MEPS hypertension expenditures(again, derived from “site of service” expenditure tables) went to prescription medications, and just 15.5 percent tohospital care. In contrast, just 10.8 percent of heart disease expenditures went to prescription medications, while 64.230. U.S. Department of Health and Human Services. See: http://www.drugabusestatistics.samhsa.gov/ mh.cfm.31. The Center for Medicare & Medicaid Services is part of the Office of the Actuary, National Health Statistics Group.[ 50 ]