Title: The Value of Knowing: National Health Accounts
1The Value of Knowing National Health Accounts
- David M. Cutler, Harvard University
2Questions We Need to Answer
- US medical spending has doubled as a share of GDP
since 1975. Is it worth it? - Where should we spend our research dollars most
productively? - Which country is best at hockey?
3What is Needed?
- A way to tell what is happening in the medical
sector, and what its worth.
4The Health Sector
- Outputs
- Population health
- By demographic group
- Inputs
- Medical spending
- By disease
- Behaviors
- Smoking, obesity
- Environment
- Genetics
5The Analogy GDP
- Inputs Factor payments
- Wages paid to workers
- Raw materials
- Return to capital
- Output GDP
- Overall
- Consumption, investment, and government spending
- By industry
6What Were Up To
- Outputs
- Population health
- Inputs
- Medical spending
- Behaviors
- Environment
- Genetics
The industry in medical care is the disease
7More on the Rationale
- The BLS should develop a research program to
look beyond its current "market basket" framework
for the CPI - We strongly endorse a move in the CPI away
from the pricing of health care inputs to an
attempt to price medical care outcomes. - - The Boskin Commission
8The Idea of a Satellite Account
We recommend the development of satellite
accounts to report on selected activities not
included in the conventional accounts. Satellite
accounts can link to the existing economic
accounts as appropriate, but also expand into
areas that the NIPAs do not cover. - Beyond
the Market
9Medical Spending
10Medical Spending Big Challenges
- The industry
- MI vs. Diabetes
- Prevention vs. screening vs. treatment
- The data
- They dont give conditions unless people say they
are why they sought care. - We know what we spend on diabetes, but not what
the average diabetic spends. - The level of analysis
- What disease to attribute to an office visit for
a hypertensive diabetic with a past MI?
11Cost Model Approach
- Annual spending condition categories e
- Note that this is a person-based method rather
than an encounter-based method.
12Taking it Back Farther
CHD
Spending
Diabetes
Cancer
13Population Health
14Components of Population Health
- Mortality
- Quality of life
151. Official mortality data are problematic
- Accuracy of diagnosis coding is in doubt
- Doesnt get at risk factors (obesity) or
precursor diseases (diabetes)
16Mortality model approach
- Estimating models of mortality, similar to
spending - Prob die condition categories e
- With these and the disease / risk factor
transition models, we will have a way to
determine true cause of death
172. Quality of Life
Health
Domain 1 Symptoms / Impairments
Domain 2 Symptoms / Impairments
Domain 3 Symptoms / Impairments
Disease 1
Disease 2
Disease 3
18Trend in Quality of Life, 1987-2004
Increased obesity
19Symptoms/impairments with largest decrements
20Disease Models
21A Catalog
CHD Huge improvements medical care plays big role (published in Health Affairs)
Stroke Large decline in mortality from stroke not clear why
Cancer Models have been developed need to use to answer this question
PNA Large decline in mortality, likely related to better medical care
Depression No change in lifetime prevalence but big reduction in current prevalence
22What Will We Learn? My Guesses
- By and large, technological advance has been very
important and cost effective - In recent years, obesity trends have
significantly increased spending and lowered
health - May have overwhelmed technology in parts