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The Value of Investment in Health Care_图文


The Value of Investment in Health Care
Better Care, Better Lives

The increase in health spending is a frequent topic of debate…
U.S. Health Care Expenditures per Person (2000 U.S. $)
$4,461 $3,541

$2,207

Source: Health United States 2002, Consumer Price Index (All Items)

1980

1990

2000

…but the value of this investment is seldom part of the discussion.

CBO Issues Warning on Rising Health Care Costs

Senate Republicans in Albany Eye Big Medicaid Cuts

Medicare Revamp Fails to Cure Angst Over Costs

New evidence finds our nation’s health care dollars are well spent.
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Overall, each additional health dollar spent produced a return of $2.40-$3.00 in:
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Deaths avoided Increased longevity

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Advances in care have improved outcomes and quality of life in common diseases
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Heart attack Type-2 Diabetes

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Stroke Breast cancer

Experienced Research Team
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MEDTAP International – global health services research firm
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Bryan R. Luce, Ph.D., M.B.A
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Founder, Chairman, MEDTAP International Former Director, Office of Research and Demonstrations, US Health Care Financing Administration Director, Center for Health Policy, Law and Management, Duke University Global Director of Health Economics, RTI Health Solutions

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Frank Sloan, Ph.D.
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Josephine Mauskopf, Ph.D.
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Multi-faceted Research Approach
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Overall value of investment 1980 to 2000
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Dollar value of gains in annual population health outcomes versus… …the increase in annual health care expenditures

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Focus on four common diseases:

Heart attack, type 2 diabetes, stroke, and breast cancer ? Advances in care ? Improvements in outcomes ? Overall value of investment for the Medicare population ? Value of specific medical breakthroughs

Conservative Estimates
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Estimates of value:
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Value of gain of 1 year of life = $100,000* Value of less disability and increased productivity not in overall estimate

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Benefits and harms of non-health care changes even out**

*Source: Nordhaus (2002), Blomquist (2001) **e.g. smoking, obesity, exercise, environment

Overall Value of Investment: Findings
Since 1980, per capita expenses are up $2,254, but: ? Overall death rate is down 16% ? Life expectancy from birth is up by 3.2 years ? Disability rates are down 25% for people over 65* ? 56% fewer days are spent in the hospital

Health gains of $2.40 to $3.00 per dollar invested

*Value of this improvement not quantified.

Overall Value of Investment: Findings

Where would we be in 2000 without healthcare advances?

470,000 more deaths
2.3 million more disabled persons

$2254 per capita in savings

206 million more days in hospital

Findings: Four Common Diseases

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Heart attack Type 2 Diabetes Stroke Breast Cancer

Why these four?
U.S. Population Affected by Conditions Studied, ? Common conditions in millions, 2003
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High disability and death rates ? Nearly all at risk for one of these 7.6 diseases 4.7 ? Medical 2.2 breakthroughs have improved outcomes Heart Type 2 Stroke Breast ? Value of investment Attack Diabetes Cancer not documented Source: American Heart Association; www.diabetes.org; www.cdc.gov/nchs
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Heart Attack

Heart Attack: Advances in Care
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Improvements in drug therapy
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Blood flow restored more quickly (clot-busters) Blockages better prevented (anti-platelets, cholesterol lowering drugs) PTCA reopens arteries—more effective, less invasive Stents keep blood vessels open Electrocardiograms and diagnostic imaging provide more rapid, precise diagnoses

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Advances in surgical techniques
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Advances in diagnostic technologies
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Heart Attack: Advances in Care
In the 1970s… ? 5-7 days in critical care; 3-4 weeks in general ward ? Complete bed rest for several weeks ? Minimal understanding of risk factors/ preventive measures Today… ? Total hospital stay of 5-7 days
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People up and around within days Key risk factors like cholesterol and hypertension are routinely managed

Heart Attack: Improvement in Outcomes
Death Rate Due to Heart Attack
(Age-adjusted, per 100,000)
345.2

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186.9

Mortality cut nearly in half Death within 30 days cut from 1 in 4 to 1 in 8

1980

2000

Source: www.cdc.gov/nchs

Costs and Outcomes for Medicare Heart Attack Patients
Value of improved outcomes: $28,632 (12% gain in life expectancy) -minus-$26,093 Increase in treatment costs*: (Medicare plus out-of-pocket)

$2539
Net benefit in dollars:

Value of $1.10 per dollar invested
*Five-year costs 1985-1989 versus 1995-1999, Medicare plus out-of-pocket Source: Analysis of Medicare Part A and Part B and National Long-Term Care Survey data (1982-2000)

Heart Attack: Value of Specific Medical Breakthroughs
Breakthroughs vs. Current Standard Treatment Range in Value per Dollar Invested
$38.44
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$1.42

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As Much As

Beta-blockers Mobile coronary care units Statin therapy Angiography Rt-PA Angioplasty w/stenting

At Least

Source: Published literature

Type 2 Diabetes

Type 2 Diabetes: Advances in Care
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Improvements in drug therapy
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Insulin therapy lasts longer and is more convenient New classes of drugs with fewer side effects Hemoglobin A1c testing and glucose monitoring kits allow more accurate, less invasive readings Laser surgery and vitrectomy procedures treat eye disease Dialysis and transplant surgery lengthen and improve life

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Advances in diagnostic technologies
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Advances in surgical techniques
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Type 2 Diabetes: Advances in Care
In the 1970s…
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Today…
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Insulin agents shortacting; inconvenient dosing schedules Frequent needles sticks to test glucose levels
Limited understanding of need to control blood pressure and cholesterol Limited treatment options for complications

More effective options for insulin; long acting and more convenient Glucose tests without puncturing the skin
Better management of all aspects of disease reduces chances of complications Surgical options for diabetic eye and kidney disease improve quality of life

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Type 2 Diabetes: Improvement in Outcomes
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Advances support tight management of disease; better outcomes**
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*Higher incidence—linked to increased rates of obesity—has led to increased mortality rates (up 39%) **eye, kidney, and nerve disease

Tight glucose control decreases mortality by 10%, complications** by 25% Tight blood pressure control decreases mortality by 32%, heart failure by 56%, stroke by 44% Gains in employment and productivity with drug therapy to manage disease

Costs and Outcomes for Medicare Type 2 Diabetes Patients
Value of improved outcomes: $16,930 (7% gain in life expectancy) -minus-$11,337 Increase in treatment costs*: (Medicare plus out-of-pocket) $5,593
Net benefit in dollars:

Value of $1.49 per dollar invested
*Five-year costs 1985-1989 versus 1995-1999, Medicare plus out-of-pocket Source: Analysis of Medicare Part A and Part B and National Long-Term Care Survey data (1982-2000)

Type 2 Diabetes: Value of Specific Medical Breakthroughs
Breakthroughs vs. Current Standard Treatment Range in Value per Dollar Invested
$36.00
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$3.00

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Tight control of glucose, blood pressure, and cholesterol Statins Ace inhibitors Screening and treatment of diabetic retinopathy

At Least
Source: Published literature

As Much As

Stroke

Stroke: Advances in Care
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Improvements in drug therapy
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Blood flow restored more quickly (clot-busters) Better-tolerated, more effective drugs to control blood pressure PTCA reopens arteries—more effective, less invasive Carotid endarterectomy clears plaque in carotid arteries

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Advances in surgical techniques
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Advances in diagnostic technologies
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Improvements in brain imaging, such as weighted imaging, magnetic resonance angiography

Stroke: Advances in care
In the 1970s…
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Today…
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Treatment options limited; disability rates high Typical discharge to nursing home
Limited diagnostic technologies Limited surgical options for prevention

With rt-PA more stroke victims resume normal life Acute and subacute rehabilitation widely available
New imaging technologies offer faster more precise diagnosis Carotid endarterectomy and implanted microcoil devices can prevent stroke

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Stroke: Improvement in Outcomes
Death Rate Due to Stroke
(Age-adjusted, per 100,000)

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96.2

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60.8

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Mortality cut by 37 percent Faster diagnosis Stroke-related disability after 3 months reduced by up to 30 percent with rtPA

1980

2000

Source: www.cdc.gov/nchs

Costs and Outcomes for Medicare Stroke Patients
Value of improved outcomes: $24,903 (10% gain in life expectancy) -minus-$16,035 Increase in treatment costs*: (Medicare plus out-of-pocket) $8,868
Net benefit in dollars:

Value of $1.55 per dollar invested
*Five-year costs 1985-1989 versus 1995-1999, Medicare plus out-of-pocket Source: Analysis of Medicare Part A and Part B and National Long-Term Care Survey data (1982-2000)

Stroke: Value of Specific Medical Breakthroughs
Breakthroughs vs. Current Standard Treatment Range in Value per Dollar Invested
$6.00

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$2.00

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Clopidogrel Ticlopidine rt-PA* Carotid endarterectomy*

At Least
Source: Published literature

As Much As
*Yields a savings in treatment costs

Breast Cancer

Breast Cancer: Advances in Care
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Improvements in drug therapy
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Adjuvant chemotherapy – more tolerant, less toxic Better-tolerated hormonal treatments Breast-conserving surgery Less-invasive biopsy Earlier diagnosis

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Advances in surgical techniques
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Advances in diagnostic technologies
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Breast Cancer: Advances in Care
In the 1970s…
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Today…
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Chemotherapy required hospitalization
Chemotherapy poorly tolerated Mastectomies were the norm Few drug therapies existed

90% of chemotherapy is outpatient
New drugs reduce nausea Breast conserving surgery performed with reconstruction New drugs offer higher cure rates and less toxicity

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Mammography not in widespread use

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Routine mammography leads to earlier

Breast Cancer: Improvement in Outcomes
Death Rate Due to Breast Cancer
(Age-adjusted, per 100,000)
32.3 25.4

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Mortality cut by 21 percent Five-year overall survival rates increased from 76.9% to 86.6% Risk of developing metastatic disease declined from 40% to 15%

1980

2000

Costs and Outcomes for Medicare Breast Cancer Patients
Value of improved outcomes: $22,341 (8% gain in life expectancy) -minus-$4,676 Increase in treatment costs*: (Medicare plus out-of-pocket) $17,665
Net benefit in dollars:

Value of $4.80 per dollar invested
*Five-year costs 1985-1989 versus 1995-1999, Medicare plus out-of-pocket Source: Analysis of Medicare Part A and Part B and National Long-Term Care Survey data (1982-2000)

Breast Cancer: Value of Specific Medical Breakthroughs
Breakthroughs vs. Current Standard Treatment Range in Value per Dollar Invested
$36.81
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$3.27

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Letrozole Breast-conserving surgery Biennial mammography Adjuvant chemotherapy Stereotactic core biopsy

At Least

As Much As

Source: Published literature

Policy Recommendations
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HHS should include a measure of health benefits gained in its annual report on health care spending Further study is needed on the role of innovation in improving health Employers and health care providers should account for the benefits of a healthier workforce Discussions of coverage for uninsured should consider value of investing in health care for all Americans—not just the costs



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