Decomposing Medical-Care Expenditure Growth - PowerPoint PPT Presentation

Loading...

PPT – Decomposing Medical-Care Expenditure Growth PowerPoint presentation | free to download - id: 6fd9a6-MDU4M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Decomposing Medical-Care Expenditure Growth

Description:

Title: PowerPoint Presentation Author: Dunn, Abe Last modified by: Shelly R. Hall Created Date: 1/1/1601 12:00:00 AM Document presentation format – PowerPoint PPT presentation

Number of Views:44
Avg rating:3.0/5.0
Slides: 30
Provided by: Dun146
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Decomposing Medical-Care Expenditure Growth


1
Decomposing Medical-Care Expenditure Growth
Abe Dunn, Eli Liebman, and Adam Shapiro
September 11th, 2014 The views expressed in this
paper are solely those of the authors and not
necessarily those of Bureau of Economic Analysis.

2
Medical-Care Expenditures represents a large
fraction of Personal Consumer Expenditures (PCE)
3
Health spending and price research suggested by
CNSTAT Reports
  • At What Price? Recommendation 6-1 BLS
    should select about 15 to 40 diagnoses from the
    ICD (International Classification of Diseases),
    chosen randomly in proportion to their direct
    medical treatment expenditures and use
    information from retrospective claims databases
    to identify and quantify the inputs used in their
    treatment and to estimate their cost.
  • Accounting for Health and Health
    Care Recommendation 3.4 The Bureau of Economic
    Analysis, working with academic researchers (and
    perhaps other agencies, such as the Centers for
    Medicare Medicaid Services and other parts of
    the Department of Health and Human Services),
    should collaborate on work to move incrementally
    toward the goal of creating disease-based
    expenditure accounts by attempting a proof of
    concept prototype. Using a subgroup of the
    population with good data coverage, the prototype
    would attempt to demonstrate that dollars spent
    in the economy on medical care can be allocated
    into disease categories in a fashion that yields
    meaningful information.

4
BEAs new satellite account will focus on medical
care spending
Example of a Health Account Example of a Health Account Example of a Health Account Example of a Health Account
Inputs Outputs Outputs
Medical Care Spending Health status Health status
Market labor/capital Longevity Longevity
Volunteer labor Quality of life Quality of life
Time invested in own health    
Other consumption items    
Research and development    
Quality of environment    
Source National Research Council. (2005).
Beyond the Market Designing Nonmarket Accounts
for the United States. Panel to Study the Design
of Nonmarket Accounts, K.G. Abraham and C.
Mackie, eds. Committee on National Statistics,
Division of Behavioral and Social Sciences and
Education. Washington, DC The National Academies
Press.
5
Contribution of our work is to redefine the
output of the medical care sector
  • For example
  • Output number of patients treated for cancer
  • Expenditures spending on the treatment of
    cancer
  • Price spending per patient treated for cancer
  • This has implications for the accounts.

6
Implication 1 Spending will be reported by
disease classes
7
Implication 2 Redefining output also implies
new price indexes.
  • The new price indexesare the change in average
    expenditure per episode for each disease
  • They reflect any shifts in
  • services across industries
  • that alter the cost of
  • treating disease.

8
Implication 2 Redefining output also implies
new price indexes.
  • The new price indexesare the change in average
    expenditure per episode for each disease
  • They reflect any shifts in
  • services across industries
  • that alter the cost of
  • treating disease.
  • Disease-based indexes can riseslower than
    traditional serviceprice indexes with shifts in
    treatments

9
Implication 2 Redefining output also implies
new price indexes.
  • The new price indexesare the change in average
    expenditure per episode for each disease
  • They reflect any shifts in
  • services across industries
  • that alter the cost of
  • treating disease.
  • Disease-based indexes can riseslower than
    traditional serviceprice indexes with shifts in
    treatments
  • With increases in utilization, disease-based
    indexes can rise faster than traditional price
    indexes

10
Selected BEA and BLS research
  • Producing disease-based price indexes, Bradley,
    Cardenas, Ginsburg, Rozental, Velez, Monthly
    Labor Review, 2010
  • Alternative Price Indexes for Medical Care
    Evidence from the MEPS Survey, Aizcorbe, Bradley
    (BLS), Herauf, Kane, Liebman, Pack, Rozental
    (BLS), BEA Working Paper, 2011
  • Changing Mix of Medical Care Services Stylized
    Facts and Implications for Price Indexes,
    Aizcorbe and Nestoriak, Journal of Health
    Economics, May 2011
  • Household Consumption Expenditures for Medical
    Care An Alternate Presentation, Aizcorbe,
    Liebman, Cutler, and Rosen, Survey of Current
    Business, June 2012
  • Feasible methods to estimate disease based price
    indexes, Bradley, Journal of Health Economics,
    2013
  • Calculating Disease-Based Medical Care
    Expenditure Indexes for Medicare Beneficiaries A
    Comparison of Method and Data Choices, Hall and
    Highfill, BEA Working Paper, 2014
  • Decomposing Medical-Care Expenditure Growth,
    Dunn, Liebman, Shapiro, BEA Working Paper
  • Defining Disease Episodes and the Effects on the
    Components of Expenditure Growth, Dunn, Liebman,
    Rittmueller, and Shapiro, BEA Working Paper, 2014

11
Decomposing Medical-Care Expenditure Growth by
Dunn, Liebman, and Shapiro
  • What are the sources of expenditure growth in the
    private health care market from 2003-07?
  • Privately insured health care 60 percent more
    spending than Medicare (NHEA).
  • Use large claims data to analyzes the sources of
    expenditure growth.

12
Expenditure Decomposition
  • What are the sources of expenditure growth?
  • Demographics
  • Prevalence
  • Expenditures per Episode
  • Service Prices
  • Service Utilization

13
Expenditure Decomposition
Exp. Per Capita
Demog. Shift
Adj. Exp. Per Capita
ECI Expenditure Per Capita Index DECI
Demographically-adjusted Expenditure per Capita
Index DEM Demographic Component of Expenditure
Growth
13
14
Expenditure Decomposition
Adj. Exp. Per Capita
MCE
Prevalence
SPI
SUI
PREV Treated Prevalence Index MCE Medical
Care Expenditure Index (Expenditures per
Episode) SPI Service Price Index SUI Service
Utilization Index
14
15
Data
  • Commercially-insured patients from the
    MarketScan Data from Truven Health.
  • Over 4 million enrollees per year.
  • Analyze years 2003-07.
  • Process claims using ETG Symmetry grouper from
    Optum.
  • Each enrollee in the database is
  • Not in a capitated plan.
  • Has a drug benefit plan.
  • Included only if the individual is enrolled for
    the full year.

15
16
Sample Weights
  • Sample
  • Fixed MarketScan Data Contributor
  • Weights
  • Weighted by region, age and sex to match changing
    population demographics.
  • Weighted by region, age, and sex, fixed
    demographics

16
17
Summary Statistics
17
18
Sources of Expenditure Growth
  • Expenditures driven by service prices and
    prevalence. Utilization per episode is flat.
  • After deflating these figures, growth is
    primarily driven by prevalence, not expenditures
    per episode (i.e. disease price).

19
Decomposition
19
20
Expenditure Growth Pattern Is Not Uniform Across
Diseases.
  • Within Disease Category Differences
  • e.g. cardiology related conditions
  • Prevalence growth is high for many early-stage
    illnesses.
  • i.e. hypertension, high cholesterol, obesity and
    diabetes.
  • Prevalence growth is relatively low for late
    stage illnesses.
  • i.e. ischemic heart disease.

21
Decomposition by Disease Category
22
Decomposition by Disease Category
23
Cardiology
24
Orthopedics and Rheumatology
25
Gastroenterology
26
Neoplasms
27
Conclusion
  • Over the 2003-07 period for the commercial
    sector
  • Expenditures primarily driven by service price
    growth, but service price growth does not greatly
    exceed overall inflation.
  • Treated prevalence growth plays an important role
    in real growth in output.
  • Tends in the components of expenditure growth are
    disease-specific.

28
BEA Health Account
  • Release survey article of Health Care Satellite
    Account around December of this year.
    http//www.bea.gov/national/health_care_satellite_
    account.htm
  • Account will incorporate expenditure estimates
    from full population, not just commercial sector.
  • Account will report estimates over a longer
    horizon 2000 to 2010.

29
Future Satellite Account Work
  • New release in 2015 with 2011 and 2012 estimates
  • Creating a longer time series and current
    estimates
  • Evaluate the impact on Industry accounts
  • Evaluate the impact Income accounts
  • Evaluate Quality Adjustment
  • Continue to evaluate data sources MEPS,
    MarketScan, Medicare, along with Medicaid and
    others.
  • Integrate/incorporate/compare BEA/HSA with BLS
    PPI or CPI disease-based indexes (once created)
About PowerShow.com