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

An Unhealthy AmericaMilken Institutepercent was spent on hospital care. These kinds of expenditures must be broken out from the regional totals andallocated by state.To allocate treatment costs to the states, we apply MEPS expenditure shares (by site of service) to the state personalhealth-care costs from CMS. This produces a “weighted” per capita expenditure by state (weighted by site of service).We next index each state’s weighted per capita expenditure against MEPS’s regional per capita expenditures. Thus, weobtain state expenditures per PRC.In order to calculate state PRC numbers, we use state-level statistics from several sources: (1) the National Cancer Instituteof the CDC, which tracks disease incidence; (2) the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), whichtracks disease prevalence; and (3) the National Center for Health Statistics (NCHS), which tracks death rates. (Incidencerates apply to breast, lung, colon and prostate cancer. Prevalence rates apply to diabetes, pulmonary conditions, andhypertension. For the remaining diseases—stroke, heart disease, and mental disorders—we use death rates due to alack of incidence/prevalence data. These figures are benchmarked back to the regional totals to ensure accuracy.Using disease-specific state shares of incidence/prevalence/death relative to the region, we break out PRC by state.Then we multiply the state PRC by the state expenditures per PRC to calculate each state’s total expenditures by disease.The following flow chart illustrates this process.Estimating Disease-Specific State Expenditure (PRC = Population Reporting Condition)Expenditures PRC* Expenditures/PRCCMS statistics: expenditures byDisease state, but by site of (Billions) service only (Millions) (Thousands)Cancer 48.1 10.6 4.5Breast Cancer 5.5 1.1 4.8Colon Cancer MEPS statistics: PRC and 3.9 regional 0.3 11.5Lung Cancerexpenditures by site of6.3service0.4 17.1Prostate Cancer 4.3 1.0 State 4.1Other Cancers 28.0 7.7 Population 3.6Pulmonary ConditionsDisease-specific45.2 49.2 0.9state health-care expenditures per capitaDiabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4Disease-specificStroke 13.6Disease-specific2.4state expenditure5.6indexregional Mental expenditures Disorders per PRC= 45.8 ratios of the state-to-regional 30.3 expenditure 1.5 per capitaestimated Total using MEPS277.0 162.2 1.7PRC: Population Reporting ConditionDisease-specific state expenditures per PRCPRC by stateIncidence/prevalence/death rateby stateDisease-specific state total expenditures= Disease-specific (PRC x expenditures per PRC)[ 51 ]