EPID 624 - Epidemiology of Chronic Diseases- Spring 2018

Health Care Costs & Chronic Disease


As health expenditures increase due to costs of various diseases treated, the increasing costs of new medicines for chronic diseases, and enrolment of millions of additional people into the insurance system, it is important considering health policy and access to care for people with chronic diseases that we think about the cost in in terms of the framework of the entire nation, both non-governmental and governmental, local, state and federal expenditures. Read Viewpoint from JAMA about costs of care, particularly the third highlight. Another perspective of health spending in the US is this additional Viewpoint from JAMA. Also look at the next figure comparing per capita healthcare spending by country.

ww spending

Also look at this recent update from the Commonwealth Foundation, as well as this 2016 report. And note that our policy makers fail to look at the way we compare to the rest of the world in excessive spending for health care to the detriment of all other social "good". Now look at the graphic below which shows the cost of high-risk pools to the various states for coverage of medical costs. Note that in no case did the premium cover the costs.


Basic Data from Wikipedia on US Economy, scan this information using the first sentence as your basic reference. After the first paragraph scroll down to the table of contents and select the section on Health Care (section 13) with emphasis on the fourth paragraph. While the data in this paragraph is from 2008 nothing has changed in the ensuing eight years.

Go to KaiserFF to review the health spending explorer.  Take the short tutorial provided on the KFF site and then review the rest of the data.. You may find some useful discussions at the Center for System Change, There is good reference material attached as well, Also go to the updated website at MATHEMATICA Policy Research Using the Link in the HSC Website and Click on the Health link see additional data.

Reference: National expenditure data

Federal Spending in Billions, Compare the data for health care with all else.

GDP for USA From the World Bank. The Gross Domestic Product or GDP is a measure of all of the services and goods produced in a country over a specific period, classically a year.

The GNP: Gross National Product Gross national product (GNP) is the market value of all the products and services produced in one year by labor and property supplied by the citizens


GDP_USA by year


Federal Spending in Billions, Compare the total for health care with all else.


The following graphic looks at federal health expenditures by type and includes items not seen as part of the federal budget expenditures under health not seen in the 2nd graphic

Patient expenses

The original Data shown below can be found at http://www.usgovernmentspending.com/federal_budget_detail_fy16bs12015n_10#usgs302

On the original graphic you can expand any of the rows to examine in more detail



Rising Health Care Costs

unable to afford care

Also look at the AMA's View of National Expenditures (from all sources) on Medical Care
Read the AMA policy Report.

All source spending.

Scan Appendix E from IOM on Dying in America, and Chapter 6 of IOM study on Payment Systems at End of Life.

Unhealthy America: The Economic Burden

The Cost of Chronic Disease

Do you believe Americans have a disconnect between price & quality.

IOM study on Health Care Change (scan only, too much to read in depth, unless you want to).

CBO Testimony on Controlling Health Care Costs, 2008, in particular Pages 4, 7, 10, 11, 16, an d 18 thru 20.

Review JAMA Viewpoint on Global Spending Slowdown & the U.S.

Hastings Center Report. You might want to dip into a collection of papers from the HC on the topic.

Medical Technology & costs

With all the discussion we have had about costs, and the potential effects of the APA, and changes in next four years with the new policy group in charge in Washington how much difference does this make the outcome among those who are trying to help? At the end of 2016 several papers on the rising cost of health services the United States were published including changes over the last 20 years. then this comment on the article by Ezekial Emanuel, as well as an article from the New York Times and an editorial from JAMA wondering if we are spending our healthcare dollars appropriately. finally look at this article from the March 24 BMJ this case is about how decisions made about who determines who pays for what kind of treatment..Finally this economic review from Bloomberg which looks at mortality data by economic classes is worth reviewing to see how it fits in with our consideration of chronic diseases and behaviors. The figures/graphs at the end are fine while avoiding the section on on the math of the analysis makes makes it easier reading..

Header Selection

Student Headers