The Impact of Chronic Disease and the Uninsured on the U.S. Health Care System

Transcription

1 The Impact of Chronic Disease and the Uninsured on the U.S. Health Care System Amanda M. Navarro, MPH Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention CSG Annual Spring Meeting June 11, 2007

2 Centers for Disease Control and Prevention

3

4 Objectives Summarize data related to: Demographic and chronic disease trends Health care expenditures The uninsured and its impact on health Highlight other key issues to consider: Health care access and quality Environmental factors

5

6 Leading Causes of Death United States, 2004 Heart Disease Cancer Stroke Chronic lower respiratory disease Unintentional Injuries Diabetes Alzheimer s disease Influenza/pneumonia Kidney Disease Percentage (of all deaths) Source: National Center for Health Statistics, CDC.

7 Number of People with Multiple Chronic Conditions will Increase by 1/3 in 20 Years million 81 million Source: Partnership for Solutions, 2003

8 Chronic Disease Disparities Heart disease death rates 30% higher for African- Americans than whites; stroke death rates 41% higher. American Indian and Alaska Native, African American, and Hispanic adults are twice as likely as White adults to have diabetes Vietnamese American women have a higher cervical cancer rate than any other ethnic group (5 times non-hispanic white women.) Source: National Center for Health Statistics, CDC.

9 Diabetes * Trends Among U.S. Adults, BRFSS 1990, 1995, and No Data <4% 4% 6% 6% 8% 8% 10% >10% Sources: Mokdad et al., Diabetes Care 2000;23(9): ; JAMA 2001;286(10):

10 Diabetes Trends Puerto Rico Source: Behavioral Risk Factor Surveillance Survey, CDC.

11 International Comparison of Spending on Health, Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP United States Germany Canada France Australia United Kingdom Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, United States Germany Canada France Australia United Kingdom

12 83% of all Health Care Spending Involved People with Chronic Conditions in 2001 Uninsured 72% Privately Insured 74% Medicaid 83% Medicare 98% Percentage of Spending on People with Chronic Conditions Source: Medical Expenditure Panel Survey, 2001, and Partnership for Solutions

13 Diabetes: A Costly Public Health Problem $98 Billion 1997 Increasing Economic Burden $132 Billion 2002 Persons without diabetes Health Care Costs Per Capita 2002 $2,560 $13,243 Persons with diabetes

14 Uninsured Trends BRFSS 2002 and Source: Behavioral Risk Factor Surveillance Survey, CDC.

15 Uninsured Rates Are Highest Among Hispanics and African Americans, 2005 Percent of adults ages Insured now, time uninsured in past year Uninsured now Total White African American Hispanic

16 Adults Without Insurance Are Less Likely to Get Preventive Screening Tests Percent of adults Insured all year Insured now, time uninsured in past year Uninsured now Pap test Colon cancer screening Mammogram

17 Adults Without Insurance Are Less Likely to Be Able to Manage Chronic Conditions Percent of adults ages with at least one chronic condition* Insured all year Insured now, time uninsured in past year Uninsured now Visited ER, hospital, or both for chronic condition Skipped doses or did not fill prescription for chronic condition because of cost

18 Lacking Health Insurance for Any Period Threatens Access to Care Percent of adults ages reporting the following problems in past year because of cost: Insured all year Insured now, time uninsured in past year Uninsured now Did not fill a Did not see Skipped Had medical Any of the four prescription specialist when medical test, problem, did access needed treatment, or not see doctor problems follow-up or clinic

19 Many Americans Have Problems Paying Medical Bills or Are Paying Off Medical Debt Percent of adults ages who had the following problems in past year: Total Insured all year Uninsured during the year Not able to pay medical bills Contacted by collection agency* Had to change way of life to pay medical bills Medical bills/ debt being paid off over time Any medical bill problem or outstanding debt

20 Adults Without Insurance Are Less Likely to Have a Regular Doctor or Rate Their Quality of Care Highly Percent of adults ages Insured all year Insured now, time uninsured in past year Uninsured now Regular doctor Quality of care from doctors "excellent" or "very good"

21 Adults Without Insurance Wait More Time to See Doctor When Sick Percent of adults who reported waiting six or more days for an appointment when sick or needed medical attention Total White Black Hispanic Above average Below average Insured Uninsured Race/ethnicity Income Insurance status

22 Adults Without Insurance Experience Poor Doctor Patient Communication Percent of adults (ages 18+) reporting health providers sometimes or never listen carefully, explain things clearly, respect what they say, and spend enough time with them Total 11 White Black Hispanic Asian AI/AN %+ of poverty <100% of poverty * 9 16 Private insurance Uninsured ** Urban Rural

23 Mandatory Reimbursement for Breast Cancer Screening, 1981

24 Mandatory Reimbursement for Breast Cancer Screening, 1989

25 Mandatory Reimbursement for Breast Cancer Screening, 2000

26 Support Policies and Legislation: Mandatory Insurance Coverage for Screening 1981 Mammography No mandatory insurance coverage for screening mammography. Mandatory insurance coverage for screening mammography. Source: National Cancer Institute State Cancer Legislative Database Program, Bethesda, MD, 2004.

27 Prevalence of Women Who Never Had a Mammogram, 40 Ages 40 and Older BRFSS Nationwide Median % Source: Behavioral Risk Factor Surveillance System, CDC

28 Providing Health Coverage Is Only One Piece of the Puzzle There are other issues to consider related to health care access and quality: Gaps in coverage Type and use of preventive services Coordination and continuity of care Accessibility Cultural competency and health literacy

29 The world we live in profoundly affects our health.

30 Within Our Grasp

31 Contact Information: Amanda M. Navarro, MPH Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention