Cost and Impact of Spine Conditions

1. Cost and Impact of Spine Conditions Bone and Joint Decade Conference Washington, D.C. October 23, 2009 Edward Yelin, Ph.D. University of California, San Francisco

2. Outline • Compare characteristics of persons with spine conditions and other forms of musculoskeletal conditions to population at large. • Show health care utilization and costs over time for spine conditions • Describe earnings losses of persons with spine conditions • Summarize economic impacts in nation as a whole

3. Data Source for Estimations • Data reported here from 1996-1998 and 2002-2004 Medical Expenditures Panel Survey (MEPS) • MEPS is a Federal survey administered to stratified, random sample of population • Includes quarterly interviews to track health care utilization • Based on self-report of conditions (some editing by coders) • Probably results in some underreporting due to non-response and coders listing more general category when symptom reports and self-report of diagnosis ambiguous

4. Number & % with Spine Conds., Non-Spine Conds., & All Forms of Musc. Conds., U.S., 1996-1998 vs. 2002-2004

5. Age Distribution of Total Population, Those with Spine and Non-Spine Conds. and All Forms of Musc. Conds.,U.S., 2002-2004

6. Costs of Spine Care, by Type of Service, U.S. 1996-1998 vs. 2002-2004 (2004 $’s) 1996-1998 2002-2004 (15%) (14%) (35%) (34%) (13%) (20%) (36%) (32%) Total: $4,756 Total: $5,923

7. Annual Growth in Units of Health Care from Spine Conditions, U.S., 1996-1998 to 2002-2004 Ambulatory MD Visits Ambulatory Non-MD Visits Rx Filled Home Health Care Days Hospital Discharges

8. Growth in Average Costs of Spine and Non-Spine Conds. and All Forms of Musc. Conds., U.S., 1996-1998 vs. 2002-2004 (billions of 2004 $’s) +49% +49% +49% +38% +42%

9. Percent with Any, Average Number, and Total Number of Health Care Encounters for Spine Conditions,by Type, U.S., 2002-2004

10. Direct Costs of Spine, Non-Spine, and All Musc. Conds., as %GDP, U.S., 1996-1998 vs. 2002-2004 +42% +19% +33%

11. Earnings Losses of Persons 18-64 with Work History and Spine, Non-Spine, and All Musc. Conds., as %GDP and Per Worker, U.S., 2002-2004 $5976 $4618 Per Worker Loss $1871 24.3m 49.1m 73.3m Number Workers

12. Direct Costs and Earnings Losses of Persons with Spine, Non-Spine, and All Musc. Conditions as %GDP, U.S., 2002-2004

13. Summary-I • Number with spine conditions grew faster (19%) than rest of those with musc. conditions (13%) or than population as a whole (7%) over last decade. • Higher proportion of those with spine conditions are in prime working ages than U.S. population (78 vs. 63%). • Smaller proportion elderly than those with non-spine conditions. • Average health care costs grew in real terms by 25% over a decade (from $4756 to $5923/year) • Rx costs grew by 88% (from $638 to $1200/year) • Ambulatory care and inpatient costs relatively constant

14. Summary-II • Ambulatory visits to non-physicians another fast growing component • Average medical care costs of spine conditions increased by 49% over decade (vs. 38% for remainder of musc. Conditions). • Spine conditions have total impact due to medical care and earnings losses of 2.1% of GDP. • A recession defined by decrease of 1% of GDP. • Current recession has had average impact of about 2-3% decrease over its course. • Spine conditions have impact equivalent to severe recession, but in perpetuity.

15. Summary-III • Relatively small proportion of total impact of spine conditions due to earnings losses. • Only 7% fewer persons with spine conditions are employed than “expected” (90 vs. 83%) • Most of the employment impact of spine conditions probably due to temporary, not permanent work loss

16. Conclusions • Medical care costs of spine conditions increasing rapidly • Growth of prescriptions accounts for much of increase • Economic impact of spine conditions, 2.1% of GDP, equivalent to permanent, severe recession