What If Ben Franklin Was Our Health Czar?The Leonard David Institute of Health Economics

University of Pennsylvania

Friday, February 19, 2010

Prevention in Health Reform

• Does prevention save money?

• Bias against prevention

• Clinical vs Community

• Future of health care, aging and economics

Prevention of Diabetes Complications

• Huang and O’Grady, Health Affairs

• 10 and 25 year model

• Serious, common, costly

• 10 year 59% of costs offset

• 25 year 89% if costs offset

Does tobacco use save money?

Where You Live Matters

www.countyhealthrankings.org

County Health Rankings

Trends of Elvis Presley Impersonators

Source: Caen H, San Francisco Chronicle; October 27, 1993.

1977 37

1993 48,000

2010 2,500,000,000

An Aging PopulationPercentage of U.S. Population over Age 65

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population. Washington, DC: Watson Wyatt Worldwide, 1996

0

5

10

15

20

25

1930 1950 1970 1990 2010 2030 2050

Year

Pe

rce

nt

Worker-to-Retiree Ratio Drops

Source: Eugene Streuerle and Adam Carasso, Urban Institute. Based on data from the 2001 Social Security Trustees Report. USA Today, December 4, 2001.

Projected Number of Workers Paying into Social Security Fund Compared with Number of Retirees Withdrawing from the Fund

0

1

2

3

4

5

6

7

8

9

1955 1980 2005 2030 2050

8.6

3.4

2.0

projected

Smoker

Overweight

Inactive Ratio

11% 58% 5.5

Source: Jones et al. Arch Intern Med 2002;162:2565–71

Non Smoker

Normal Weight

Active

Predicted Likelihood of Developing Coronary Heart Disease, Stroke, or Diabetes by Age 65

Men, Aged 50

Disability Index,* by Age and Health Risk†

University of Pennsylvania Alumni

63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 780.0

0

0.05

0.10

0.15

0.20

0.25

0.30

Dis

abili

ty I

ndex

Age

* Progression of disability was postponed by approximately 7 years in low risk vs. high risk.† Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2

points, moderate = 3–4 points, high = 5–9 points.Note: A disability index of 0.1 = minimal disability.Source: Vita et al. N Engl J Med 1998;338(15):1035–41

High risk

Moderate risk

Low risk

Health, Life Expectancy & Health Care Spending Among the Elderly

Health Status Life Lifetime Medical Average Annual

At Age 70 Expectancy* Expenditures Expenditures

No Limitations 14.3 $136,000 $9,500

One or More 11.6 $145,000 $12,500

Limitations

Net +32%

Adapted from Lubitz et al., NEJM 2003; 349: 1048-55.

*At age of 70, additional number of years estimated to live