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1. What If Ben Franklin Was Our
Health Czar?
The Leonard David Institute of Health Economics
University of Pennsylvania
Friday, February 19, 2010
2. Prevention in Health Reform
• Does prevention save money?
• Bias against prevention
• Clinical vs Community
• Future of health care, aging and economics
3.
4. Prevention of Diabetes Complications
• Huang and O’Grady, Health Affairs
• 10 and 25 year model
• Serious, common, costly
• 10 year 59% of costs offset
• 25 year 89% if costs offset
9. Trends of Elvis Presley Impersonators
Source: Caen H, San Francisco Chronicle; October 27, 1993.
1977 37
1993 48,000
2010 2,500,000,000
10. An Aging Population
Percentage of U.S. Population over Age 65
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population.
Washington, DC: Watson Wyatt Worldwide, 1996
0
5
10
15
20
25
1930 1950 1970 1990 2010 2030 2050
Year
Percent
11. Worker-to-Retiree Ratio Drops
Source: Eugene Streuerle and Adam Carasso, Urban Institute. Based on data from the 2001
Social Security Trustees Report. USA Today, December 4, 2001.
Projected Number of Workers Paying into Social Security Fund
Compared with Number of Retirees Withdrawing from the Fund
0
1
2
3
4
5
6
7
8
9
1955 1980 2005 2030 2050
8.6
3.4
2.0
projected
12. Smoker
Overweight
Inactive Ratio
11% 58% 5.5
Source: Jones et al. Arch Intern Med 2002;162:2565–71
Non Smoker
Normal Weight
Active
Predicted Likelihood of Developing Coronary Heart
Disease, Stroke, or Diabetes by Age 65
Men, Aged 50
13. Disability Index,* by Age and Health Risk
†
University of Pennsylvania Alumni
63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78
0.0
0
0.0
5
0.1
0
0.1
5
0.2
0
0.2
5
0.3
0
DisabilityIndex
Age
* Progression of disability was postponed by approximately 7 years in low risk vs. high risk.
† Risk based on body mass index, smoking, exercise; 0-3 point scale for each; low = 0–2
points, moderate = 3–4 points, high = 5–9 points.
Note: A disability index of 0.1 = minimal disability.
Source: Vita et al. N Engl J Med 1998;338(15):1035–41
High risk
Moderate risk
Low risk
14. Health, Life Expectancy & Health Care Spending
Among the Elderly
Health Status Life Lifetime Medical Average Annual
At Age 70 Expectancy* Expenditures Expenditures
No Limitations 14.3 $136,000 $9,500
One or More 11.6 $145,000 $12,500
Limitations
Net +32%
Adapted from Lubitz et al., NEJM 2003; 349: 1048-55.
*At age of 70, additional number of years estimated to live
