Health Status Health Behavior and Variability in Healthcare Spending RADM Penelope Slade-Sawyer, P.T., M.S.W. Department of Health and Human Services (DHHS)

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

• 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

Two thirds of Medicare spending is for people with five or more chronic conditions

Percent of Healthcare Spending for Individuals with chronic conditions by type of insurance

People with Multiple Chronic Conditions are much more likely to be hospitalized

Spending for inpatient hospital care increases with the number of chronic conditions

Healthcare Spending Increases with the Number of Chronic Conditions

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

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

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

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

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)

Glen P Mays, Sharla A. Smith. Geographic Variation in Public Health spending: correlates and consequences. Public Health Services and Systems Research. 2009.

*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

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

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

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

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.

County Level Estimates of Diagnosed Diabetes — Percentage of Adults in Texas, 2005

County Level Estimates of Diagnosed Diabetes — Percentage of Adults in Colorado, 2005

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

By changing the way they live, Americans could change their personal health status and the health landscape of the Nation dramatically.