Here’s what we’re buy­ing as we spend tril­lions on health Within a decade, about a fifth of the U.S. econ­omy will con­sist of med­i­cal care

The Denver Post - - NATION & WORLD - By Carolyn Y. John­son

Amer­i­can health care spend­ing, mea­sured in tril­lions of dol­lars, bog­gles the mind. Last year, we spent $3.2 tril­lion on health care — a num­ber so large that it can be dif­fi­cult to grasp its scale.

A new study, pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion re­veals what pa­tients and their in­sur­ers are spend­ing that money on, break­ing it down by 155 dis­eases, pa­tient age and cat­e­gory — such as phar­ma­ceu­ti­cals or hos­pi­tal­iza­tions. Among its find­ings:

• Chronic — and of­ten pre­ventable — dis­eases are a huge driver of per­sonal health spend­ing. The three most ex­pen­sive dis­eases in 2013: di­a­betes ($101 bil­lion), the most com­mon form of heart dis­ease ($88 bil­lion) and back and neck pain ($88 bil­lion).

• Yearly spend­ing in­creases aren’t uni­form: Over a nearly two-decade pe­riod, di­a­betes and low back and neck pain grew at more than 6 per­cent per year — much faster than over­all spend­ing. Mean­while, heart dis­ease spend­ing grew at 0.2 per­cent.

• Med­i­cal spend­ing in­creases with age — with the ex­cep­tion of new­borns. About 38 per­cent of per­sonal health spend­ing in 2013 was for peo­ple over 65. Girls be­tween 1 and 4 years old ac­counted for $2,000 in an­nual spend­ing; older women 70 to 74 years of age ac­counted for $16,000.

The anal­y­sis pro­vides some in­sight into what’s driv­ing one par­tic­u­larly large statis­tic: Within a decade, close to a fifth of the Amer­i­can econ­omy will con­sist of health care.

“It’s im­por­tant we have a com­plete land­scape when think­ing about ways to make the health care sys­tem more ef­fi­cient,” said Joseph Diele­man, an as­sis­tant pro­fes­sor at the In­sti­tute for Health Met­rics and Eval­u­a­tion at the Univer­sity of Wash­ing­ton who led the work.

The data show that the pri­mary driv­ers of health­care spend­ing vary con­sid­er­ably. For ex­am­ple, more than half of di­a­betes care is spend­ing on drugs, while only about 4 per­cent of spend­ing on low back and neck pain was on phar­ma­ceu­ti­cals. Gen­er­ally, more spend­ing is done on el­derly peo­ple, but about 70 per­cent of the spend­ing on low back and neck pain was on work­ing-age adults. Such in­sights pro­vide a way to find the driv­ers of growth in health care spend­ing and to launch strate­gies to con­trol it.

“Data like this con­tin­ues to draw at­ten­tion to the fact a lot of these pro­pos­als be­ing dis­cussed about con­trol­ling health-care costs re­ally don’t ad­dress the un­der­ly­ing is­sue, which is ris­ing dis­ease preva­lence,” said Ken Thorpe, a pro­fes­sor of health pol­icy at Emory Univer­sity who was not in­volved in the study but has done sim­i­lar re­search. “You see this rise in chronic dis­ease spend­ing — much of it po­ten­tially pre­ventable.”

Most of the dis­cus­sion of health care in Amer­ica has fo­cused on ac­cess to in­sur­ance, but the spend­ing break­down shows that the big­gest op­por­tu­ni­ties may come in pre­vent­ing dis­ease.

The re­searchers also an­a­lyzed spend­ing on pub­lic health and pre­ven­tion. In a separate editorial, Ezekiel Emanuel, a former health care ad­viser to Pres­i­dent Barack Obama, pointed out that the largest pub­lic health spend­ing was on HIV. But fewer than 7,000 Amer­i­cans died be­cause of HIV/AIDS in 2014 and it ranked 75th on the list of dis­eases by per­sonal health ex­pen­di­tures.

“Few pub­lic health dol­lars fo­cus on life­style con­di­tions that ul­ti­mately con­trib­ute to the ma­jor­ity of chronic ill­nesses seen to­day,” Emanuel wrote. Low back and neck pain, for ex­am­ple, ranked low on the list of pub­lic health ex­pen­di­tures with $140 mil­lion in pub­lic health fund­ing, but high on the list of health care spend­ing. To­bacco con­trol re­ceived $340 mil­lion in pub­lic health spend­ing, but smok­ing con­trib­utes to sev­eral dis­eases that drive health care spend­ing.

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