Lecture 9 - 9/28/99
Benefit of a Favorable Cardiovascular Risk-Factor Profile in Middle Age
with Respect to Medicare Costs
Daviglus, Martha et al.
Why Assigned?
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Cohort study (versus cross section)
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Shows effect of health on utilization of services and on downstream (Medicare)
expenditures
Methods
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Chicago Heart Association Detection Project in Industry screened about
40,000 employees during 1967-73
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Limited sample for this study to persons 40-64 at baseline
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Got various clinical indicators at baseline
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Medicare claims data on Medicare payments from HCFA
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Defined 3 baseline health groups: (1) low risk (none of 6 risk factors);
(2) 1-6 risk factors; 1-3 major risk factors
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Risk factors: high cholesterol; high blood pressure; current smoker; EKG
abnormalities; diabetes; heart attack
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Major risk factors: high cholesterol; high blood pressure; current smoker
(excluded persons with other 3 risk factors)
Results: Baseline Characteristics (Table 1)
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Average ages in late 40s and early 50s
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Vast majority of persons had at least 1 risk factor (could be used very
low thresholds, such as for blood pressure)
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See statistics on other variables
Results: Medicare Charges for Inpatient and Outpatient Care and Measures
of Use
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Total annual charges for men for 3 groups: $3,200; $4,800; $4,600
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Total annual charges for women for 3 groups: $1,700; $3,600; $3,300
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Hospital days for men: 2.6; 3.3; 3.2
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Hospital days for women: 1.9; 2.9; 2.7
Further Look at Medicare Charges by Baseline Risk Factors (Table 3)
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No risk factors, men: $800 for cardiovascular; $400 for cancer; $3,300
total
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3 major risk factors, men: $2,100 for cardiovascular; $900 for cancer;
$6,100 total
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Women charges much lower for various risk groups
Conclusion
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Health in middle age predicts spending by Medicare on behalf of elderly
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Even see increase for disease (cancer) for which no specific risk factor
measured
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Policy implications--discuss
Managed Care
