The growth in cost per case explains far more of US health spending increases than rising disease prevalence

Health Affairs

Volumn 30, Issue 9, 2011, Pages 1657-1663

  Roehrig, Charles S ^a   Rousseau, David M ^b  

^a ALTARUM INSTITUTE   (United States)

^b HENRY J KAISER FAMILY FOUNDATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITAL; CLINICAL ASSESSMENT; HEALTH CARE COST; HUMAN; PREVALENCE; UNITED STATES;

COSTS AND COST ANALYSIS; EPIDEMIOLOGY; EPISODE OF CARE; HEALTH EXPENDITURES; HUMANS; PREVALENCE; UNITED STATES;

EID: 81855225720     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.0644     Document Type: Article

References (24)

1. For an excellent summary, see Ginsburg PB. High and rising health care costs: demystifying US health care spending. Princeton (NJ): Robert Wood Johnson Foundation; 2008 Oct. (Research Synthesis Report No. 16).
2. Congressional Budget Office. Technological change and the growth of health care spending. Washington (DC): CBO; 2008 Jan. (Publication No. 2764).
3. Smith S, Newhouse JP, Freeland MS. Income, insurance, and technology: why does health spending outpace economic growth? Health Aff (Millwood). 2009;28(5):1276-84.
4. Finkelstein EA, Trogdon JC, Cohen JW, Deitz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff (Millwood). 2009;28(5): w822-31. DOI: 10.1377/ hlthaff.28.5.w822.
5. Thorpe KE, Florence CS, Howard DH, Joski P. The impact of obesity on rising medical spending. Health Aff (Millwood). 2004;23:w4-480-6. DOI: 10.1377/hlthaff.w4.480.
6. Thorpe KE, Howard DH. The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity. Health Aff (Millwood). 2006;25(5):w378-88. DOI: 10.1377/ hlthaff.25.5.w378.
7. Roehrig C, Miller G, Lake C, Bryant J. National health spending by medical condition. Health Aff (Millwood). 2009;28(2):w358-67. DOI: 10.1377/ hlthaff.28.2.w358.
8. Total spending by the civilian noninstitutionalized population in 1996 and 2006 was derived from the National Health Expenditure Accounts, while the Medical Expenditure Panel Survey was used to allocate this spending across medical conditions. Total spending in the latter tends to understate total civilian noninstitutionalized spending as derived from the former. The ratio of Medical Expenditure Panel Survey spending to civilian noninstitutionalized spending (derived from the National Health Expenditure Accounts) varies from year to year with no obvious trend. It was 0.83 in 1996 and 0.77 in 2006. During this period the high was 0.83 (1996 and 2003), and the low was 0.76 (2000).
9. Question ordering was altered, starting with the 2007 panel, in a way that affected the comparability of medical condition responses to previous years.
10. Details of this methodology are available in an appendix to our previously published article (see Note 7), available online at http://content.healthaffairs.org/content/28/2/w358/suppl/DC2.
11. We defined the treated prevalence of a condition as the share of the population treated for a condition during the year in question, following the approach taken by Thorpe et al.; see Note 6.
12. Twenty-eight Clinical Classification System codes had zero prevalence in either 1996 or 2006. These were excluded from the rest of our analysis.
13. The interaction term was allocated using an algorithm that has been applied previously in the literature. Our approach mirrors that outlined in Note 20 of Thorpe et al.; see Note 6.
14. We moved hyperlipidemia from en- docrine to circulatory because of its close association with the latter. The Agency for Healthcare Research and Quality Clinical Classification System moved Alzheimer's disease from nervous system to mental disorders. Smaller International Classification of Diseases, Ninth Revision (ICD-9), chapters are subsumed under "Other Categories."
15. Cohen JW, Krauss NA. Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Aff (Millwood). 2003;22(2):129-38.
16. For information on the National Health Expenditure Accounts, see Martin A, Lassman D, Whittle L, Catlin A. Recession contributes to lowest rate of growth in health spending in five decades. Health Aff (Millwood). 2011;30(1):11-22.
17. Spending analyzed in this study accounts for roughly 70 percent of personal health expenditures. Half of the excluded spending is attributable to institutionalized populations and active-duty military. The other half includes dental care and spending that we were unable to allocate to a medical condition.
18. Cohen JW, Cohen SB, Banthin JS. The Medical Expenditure Panel Survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care. 2009; 47(7 supp):S44-50.
19. For a more detailed discussion of the strengths and limitations of our general approach, see the article cited in Note 7.
20. Between 1996 and 2006 the proportion of the population treated for esophageal disorders increased by a factor of seven (from 0.7 percent to 5.2 percent) and for hyperlipidemia by a factor of 3 (from 3.4 percent to 10.6 percent).
21. The average is 18 percent for the civilian noninstitutionalized population (excluding dental and other unallocated services).
22. Dubois RW, Dean BB. Evolution of clinical practice guidelines: evidence supporting expanded use of medicines. Dis Manag. 2006;9(4): 210-23.
23. Previous research has focused on subsets of populations and medical conditions. See, for example, Thorpe et al., Note 6.
24. Schroeder S. Stranded in the periphery-the increasing marginalization of smokers. N Engl J Med. 2008;358:2284-86.