1. Tracking US healthcare spending; 1996-2013
Kate Muller, MPH &
Joseph Dieleman, PhD

2. Outline Introduction to IHME
Introduction to the IHME disease expenditure project
Spending on US healthcare: 2013 results
Measuring drivers of health care spending increases

3. Institute for Health Metrics and Evaluation
Founded in 2007 to make health metrics more accurate, independent, and comparable.
300+ faculty and staff
Largest health metrics database
Estimates used by NIH, BMGF, WHO, World Bank, and others
Emphasize growth in staff, funding, and stature
Emphasize ambition of data sourcing
Emphasize growing influence

4. The Global Burden of Disease Study
Key goals are comprehensiveness and comparability
Measures all aspects of health loss
2010, 2013, 2015, and now yearly
Future: more subnational estimates
IHME’s flagship project
Comprehensive: over 350 diseases and health risk factors; Comparability: way to compare burden of schizophrenia and liver cancer in nearly every country in the world
Health loss: not just about death, but early death and disability combined

5. GBD 2016: Health loss in the United States
DALY: IHME’s metric of overall health loss
“Disability-adjusted life year”
The years lost to ill health and early death in a population
Takes into account the severity of non-fatal illnesses
One number that captures BOTH what is killing us and what is just making us sick
Preview of 2016 data – out this month in The Lancet
DALYs = our metric of overall health loss
Top 10 causes of DALYs haven’t changed too much in US in last 26 years
Note mix of fatal and non-fatal causes
Preview that some of these causes will show up in Joe’s presentation

6. Project preview: Congressional District Profiles
FYI: I had to cut down the figure to get it to fit on the slide, so there are 7 causes instead of 10
Upcoming project we’re working on
Part of move to more local estimates – counties papers leading to district profiles to be useful for policymakers
Washington 7th = SLU’s district; Pramila Jayapal is the rep
Note several good rankings, but worse-than-average Alzheimer/dementia ranking
Hoping profiles like this will be of use to policymakers
Want to get contact info of people interested in being notified when these profiles go public

7. Outline Introduction to IHME
Introduction to the IHME disease expenditure project
Spending on US healthcare: 2013 results
Measuring drivers of health care spending increases
IHME is not just disease burden – also expenditure. Over to Joe…

8. US Disease expenditure project
Funded by:
Total US health spending
Demographic Framework –
38 age and sex groups
Epidemiological Framework –
155 causes
Type of Care Framework –inpatient, ED, ambulatory, dental, nursing care, pharma, home

9. Published disease expenditure research1 2

10. Most expensive conditions of illness

11. US health case spending: vizhub.healthdata.org/dex/

12. Measuring drivers of health care spending increases
$932.8 billion increase in annual spending from 1996 to 2013, from $1.2 to $2.1 trillion.
Annualized rate of change ( )

13. Measuring drivers of health care spending increases
$932.8 billion increase in annual spending from 1996 to 2013, from $1.2 to $2.1 trillion.
Annualized rate of change ( )

14. Measuring drivers of health care spending increases
Objective: measure the impact of 5 fundamental drivers causing health care spending increases.
Five factors:
Population growth
Population aging
Changes to underlying disease incidence and prevalence
Service utilization
Service price and intensity

15. Measuring drivers of health care spending increases
Ambulatory care
Inpatient care
Prescribed pharmaceuticals
Nursing facility care
Emergency department care
Dental care
Total US health spending

16. Measuring drivers of health care spending increases
Diabetes mellitus
Depressive disorders
Low back and neck pain
Prescribed pharmaceuticals
Ambulatory care
Inpatient care
Nursing facility care
Emergency department care
Other neurological
Hyperlipidemia
Hypertension
Prescribed pharmaceuticals
Ambulatory care
Inpatient care
Nursing facility care
Emergency department care

17. Health spending attributable to modifiable risk factors
Attributable Spending

18. Next steps
Measure spending for each payer group, and update estimates through 2015
Measuring spending for each state
Measure spending for each income group, education group, and race

19. Thank you dieleman@uw.edu And an enormous thank you to:
Maddy Campbell Abigail Chapin
Taylor Matyasz
Christopher Murray
Cody Horst
Alex Reynolds
Zhiyin Li
Ellen Squires