Expanding the National Health Accounts

Summary

Principal Investigator: David M Cutler
Abstract: The relentless increase in medical care costs in the past half century has fueled intense debate over the value of medical care. Is it worth it for the United States to spend so much on medical care? What could we do to increase the benefits of medical spending relative to the costs? Debate about these issues has been hampered by the lack of good information on the benefits of medical care, and particularly, the link between individual components of medical spending and resulting health improvements. This proposal rests on the fundamental assumption that productivity improvement in medical care can be most effectively achieved by measuring systematically and jointly both the benefits and the costs of medical care, and then comparing the two. We term this National Health Accounts;forming such accounts is the overarching goal of this project. At the broadest level, we have two specific aims: to measure population health alongside medical spending;and to consider the costs and benefits of past changes in medical technology and a range of interventions designed to improve the productivity of the medical system. We propose to realize these goals with five specific research components: (1) tracking population health, including both mortality and quality of life, and decomposing health trends by symptoms and impairments, and underlying diseases;(2) tracking medical spending, with an understanding of spending growth at the disease level, and the cost of particular services;(3), (4), and (5) undertaking detailed study of the costs and benefits of medical interventions in the care of three common conditions in the elderly: cardiovascular disease (including both heart disease and stroke);cancer (lung, colorectal, and breast);and depression. This proposal and its resulting products have dual ends - to further academic inquiry relating to health system value and to orient public policy. We will work with leading academics and members of government agencies to reach both goals. Establishment of a set of national health accounts will allow us as a society to understand which medical interventions improve the health of the U.S. population most efficiently.
Funding Period: 2009-02-01 - 2015-01-31
more information: NIH RePORT

Top Publications

  1. pmc Challenges in building disease-based national health accounts
    Allison B Rosen
    Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
    Med Care 47:S7-13. 2009
  2. pmc Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008
    Margaret C Fang
    Division of Hospital Medicine, University of California, San Francisco Electronic address
    Am J Med 127:608-15. 2014
  3. pmc US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation
    Susan T Stewart
    Susan T Stewart is with the National Bureau of Economic Research NBER, Cambridge, MA she also performed this research in previous positions with the Harvard University Interfaculty Program for Health Systems Improvement PHSI, and the Harvard Initiative for Global Health, Cambridge David M Cutler is with the Department of Economics, Harvard University, Harvard PHSI, and the NBER Allison B Rosen is with the Department of Quantitative Health Sciences and Meyer s Primary Care Institute, University of Massachusetts Medical School, Worcester, and the NBER
    Am J Public Health 103:e78-87. 2013
  4. pmc Trends in depressive symptom burden among older adults in the United States from 1998 to 2008
    Kara Zivin
    Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
    J Gen Intern Med 28:1611-9. 2013
  5. ncbi Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes
    Allison B Rosen
    University of Massachusetts Medical School, Worcester, MA, USA
    Health Aff (Millwood) 32:944-51. 2013
  6. pmc Psychological distress and trends in healthcare expenditures and outpatient healthcare
    Paul A Pirraglia
    Center on Systems, Outcomes, and Quality in Chronic Disease and Rehabilitation, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI 02908, USA
    Am J Manag Care 17:319-28. 2011
  7. pmc Marked reduction in 30-day mortality among elderly patients with community-acquired pneumonia
    Gregory W Ruhnke
    Section of Hospital Medicine, University of Chicago, IL 60637, USA
    Am J Med 124:171-178.e1. 2011
  8. pmc Trends in mortality and medical spending in patients hospitalized for community-acquired pneumonia: 1993-2005
    Gregory W Ruhnke
    Department of Internal Medicine, University of Chicago, Chicago, IL, USA
    Med Care 48:1111-6. 2010
  9. pmc Medical spending differences in the United States and Canada: the role of prices, procedures, and administrative expenses
    Alexis Pozen
    Health Services and Policy Analysis Program, Graduate Division, University of California, Berkeley 94720, USA
    Inquiry 47:124-34. 2010
  10. pmc Trends in thrombolytic use for ischemic stroke in the United States
    Margaret C Fang
    Division of Hospital Medicine, The University of California, San Francisco, San Francisco, California 94143, USA
    J Hosp Med 5:406-9. 2010

Research Grants

  1. CENTER FOR GASTROINTESTINAL BIOLOGY AND DISEASE
    Robert S Sandler; Fiscal Year: 2013

Detail Information

Publications16

  1. pmc Challenges in building disease-based national health accounts
    Allison B Rosen
    Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
    Med Care 47:S7-13. 2009
    ..Measuring spending on diseases is critical to assessing the value of medical care...
  2. pmc Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008
    Margaret C Fang
    Division of Hospital Medicine, University of California, San Francisco Electronic address
    Am J Med 127:608-15. 2014
    ..Stroke is a major cause of morbidity and mortality. We describe trends in the incidence, outcomes, and risk factors for stroke in the US Medicare population from 1988 to 2008...
  3. pmc US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation
    Susan T Stewart
    Susan T Stewart is with the National Bureau of Economic Research NBER, Cambridge, MA she also performed this research in previous positions with the Harvard University Interfaculty Program for Health Systems Improvement PHSI, and the Harvard Initiative for Global Health, Cambridge David M Cutler is with the Department of Economics, Harvard University, Harvard PHSI, and the NBER Allison B Rosen is with the Department of Quantitative Health Sciences and Meyer s Primary Care Institute, University of Massachusetts Medical School, Worcester, and the NBER
    Am J Public Health 103:e78-87. 2013
    ..We used data from multiple national health surveys to systematically track the health of the US adult population...
  4. pmc Trends in depressive symptom burden among older adults in the United States from 1998 to 2008
    Kara Zivin
    Department of Veterans Affairs, National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
    J Gen Intern Med 28:1611-9. 2013
    ..Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown...
  5. ncbi Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes
    Allison B Rosen
    University of Massachusetts Medical School, Worcester, MA, USA
    Health Aff (Millwood) 32:944-51. 2013
    ..Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset...
  6. pmc Psychological distress and trends in healthcare expenditures and outpatient healthcare
    Paul A Pirraglia
    Center on Systems, Outcomes, and Quality in Chronic Disease and Rehabilitation, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI 02908, USA
    Am J Manag Care 17:319-28. 2011
    ..To determine whether trends in psychological distress exist in the United States and whether trends in healthcare expenditures and outpatient visits were associated with psychological distress...
  7. pmc Marked reduction in 30-day mortality among elderly patients with community-acquired pneumonia
    Gregory W Ruhnke
    Section of Hospital Medicine, University of Chicago, IL 60637, USA
    Am J Med 124:171-178.e1. 2011
    ..Over the last 2 decades, patient characteristics and clinical care have changed. To understand the impact of these changes, we quantified incidence and mortality trends among elderly adults...
  8. pmc Trends in mortality and medical spending in patients hospitalized for community-acquired pneumonia: 1993-2005
    Gregory W Ruhnke
    Department of Internal Medicine, University of Chicago, Chicago, IL, USA
    Med Care 48:1111-6. 2010
    ..To understand the effect of efforts to improve quality and efficiency of care in CAP, we examined the trends in mortality and costs among hospitalized CAP patients...
  9. pmc Medical spending differences in the United States and Canada: the role of prices, procedures, and administrative expenses
    Alexis Pozen
    Health Services and Policy Analysis Program, Graduate Division, University of California, Berkeley 94720, USA
    Inquiry 47:124-34. 2010
    ..Administration accounted for the largest share of this difference (39%), followed by incomes (31%), and more intensive provision of medical services (14%). Whether this additional spending is wasteful or warranted is unknown...
  10. pmc Trends in thrombolytic use for ischemic stroke in the United States
    Margaret C Fang
    Division of Hospital Medicine, The University of California, San Francisco, San Francisco, California 94143, USA
    J Hosp Med 5:406-9. 2010
    ..Recent guidelines and regulatory agencies have advocated for increased tPA administration in appropriate patients, but it is unclear how many patients actually receive tPA...
  11. pmc Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis
    Michele Heisler
    Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48113 0170, USA
    Med Care 48:87-94. 2010
    ..Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths...
  12. ncbi Forecasting the effects of obesity and smoking on U.S. life expectancy
    Susan T Stewart
    Harvard University Interfaculty Program for Health Systems Improvement, Boston, MA, USA
    N Engl J Med 361:2252-60. 2009
    ..Having a better understanding of the joint effects of these trends on longevity and quality of life will facilitate more efficient targeting of health care resources...
  13. ncbi Incidence and mortality of hip fractures in the United States
    Carmen A Brauer
    Division of Orthopedic Surgery, University of Calgary, Alberta Children s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8
    JAMA 302:1573-9. 2009
    ..Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care...

Research Grants30

  1. CENTER FOR GASTROINTESTINAL BIOLOGY AND DISEASE
    Robert S Sandler; Fiscal Year: 2013
    ..Through all of its activities, the Center improves communication, promotes collaboration, develops careers and generally enriches the intellectual climate for digestive disease research. ..