health status health behavior and variability in healthcare spending radm penelope slade-sawyer,...
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Health StatusHealth Behavior and Variability in Healthcare Spending
RADM Penelope Slade-Sawyer, P.T., M.S.W. Department of Health and Human Services (DHHS)
Director, Office of Disease Prevention and Health Promotion Acting Director, President’s Council on Physical Fitness
and Sports Office of the Secretary, Office of Public Health and
Science
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• Prices paid for medical services
• Health and illness status of residents of a given region
• Regional preferences about the use of healthcare services
• Residual variation
Factors Contributing to Geographic Variation in Health Care Spending
Congressional Budget Office, Geographical Variation in Health Care Spending, 2008
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Two thirds of Medicare spending is for people with five or more chronic conditions
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Percent of Healthcare Spending for Individuals with chronic conditions by type of insurance
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People with Multiple Chronic Conditions are much more likely to be hospitalized
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Spending for inpatient hospital care increases with the number of chronic conditions
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Healthcare Spending Increases with the Number of Chronic Conditions
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Source: Olin GL, Rhoades JA. The five most costly medical conditions, 1997 and 2002: estimates for the U.S. civilian noninstitutionalized population. Statistical Brief #80. Agency for Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/mepsweb/data_files/publications/st80/stat80.pdf. Accessed April 7, 2006.
The Five Most Costly Conditions as a Percentage of
Total Health Expenditures: United States, 2002
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Smoking Prevalence of Adults* by state
0
5
10
15
20
25
30
Kent
ucky
Wes
t Virg
inia
Oklah
oma
Miss
ouri
Tenn
esse
e
Indian
a
Miss
issippi
Ohio
North
Car
olina
Louisia
na
Alab
ama
Arka
nsas
Alas
ka
Wyo
ming
Sout
h Car
olin
a
Nevad
a
Mich
igan
North
Dak
ota
Penn
sylvan
ia
New M
exico
Illino
is
Maine
Nebra
ska
Arizo
naIowa
Sout
h Dak
ota
Wisc
onsin
Mon
tana
New H
amps
hire
Texa
s
Flor
ida
Georg
ia
Idah
o
Delaw
are
New Yor
k
Color
ado
Virg
inia
Kans
as
Verm
ont
DC
New Je
rsey
Mar
ylan
d
Hawaii
Rhode
Island
Orego
n
Was
hing
ton
Minne
sota
Mas
sach
uset
ts
Conne
cticu
t
Califo
rnia
Utah
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2006
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Developing chronic diseases is not an inevitable consequence of aging
Behaviors Poor diet (low fruit and vegetable intake) High cholesterol High blood pressure Lack of physical activity Tobacco useChronic Diseases• Type 2 diabetes• congestive heart failure• Stroke• hypertension
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Overweight and obesity raise the risk for:type 2 diabeteshigh blood pressurehigh cholesterol levelscoronary heart diseasecongestive heart failure
angina pectorisstrokeasthmaosteoarthritismusculoskeletal disordersgallbladder diseasesleep apnea and respiratory problemsgoutbladder control problemspoor female reproductive health – complications of pregnancy – menstrual irregularities – infertility – irregular ovulationcancers of the – uterus – breast – prostate – kidney – liver – pancreas – esophagus – colon and rectum
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Geographic variation in Public Health Spending is even greater than variation in Medicare Spending
Public Health Activities Monitor community health status Investigate and control disease outbreaks Educate the public about health risks and prevention strategies Enforce public health laws and regulations Inspect and assure the safety and quality of water, air, and other
resources necessary for good health Public Health Spending
State government’s per capita spending on public health activities varied by a factor of 30 in 2003 (more than 400$ per person in Hawaii, less than $75 per person in Iowa)
Variation even great on the local level (less than 1$ per capita to more than 200$ per capita in 2005)
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Glen P Mays, Sharla A. Smith. Geographic Variation in Public Health spending: correlates and consequences. Public Health Services and Systems Research. 2009.
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*Body mass index > 30, or ~ 30 pounds overweight for a 5'4" person. Source: CDC, Behavioral Risk Factor Surveillance System.
Percentage of Adults Who Are Obese,* by State
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White – Non HispanicHispanicBlack Non-Hispanic
Source: CDC, MMWR. Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006--2008 . For this study analysis, CDC analyzed the 2006−2008 BRFSS data.
Differences in Prevalence of Obesity 2006--2008
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Prevalence of Physical Activity*, 2007
*Recommended physical activity is defined as at least 5 days a week for 30 minutes a day of moderate intensity activity or at least 3 days a week for 20 minutes a day of vigorous intensity activity
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Percentage of U.S. adults aged ≥ 18 years who consumed fruit two or more times/day and vegetables three or more times/day, by state (2007)
Source: Behavioral Risk Factor Surveillance System 2007
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Percent of Adults Ages 18+ with Diagnosed Diabetes, by State, 2007
7% – 7.9%
6% – 6.9%
≥ 8%
< 5.9%
National Average = 7.8%
Source: Centers for Disease Control and Prevention. (2009). Percentage of Adults with Diagnosed Diabetes By State, 2007. Link: http://apps.nccd.cdc.gov/DDTSTRS/StateSurvData.aspx.
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County Level Estimates of Diagnosed Diabetes — Percentage of Adults in Texas, 2005
County Level Estimates of Diagnosed Diabetes — Percentage of Adults in Colorado, 2005
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Focus Areas include Physical Activity and Fitness Nutrition and Weight Status Diabetes Heart Disease and Stroke Tobacco Use Cancer Examples of New Objectives (for Healthy People 2020)
Early and Middle Childhood Health, Adolescent Health Healthcare Associated Infections
Healthy People 2010
Overarching goals: 1) increase quality and years of healthy life 2) eliminate health disparities
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By changing the way they live, Americans could change their personal health status and the health landscape of the Nation dramatically.