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Congressional Budget Office Presentation to the Center for Health Policy, Stanford University A Federal Perspective on Health Care Policy and Costs Peter.

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Presentation on theme: "Congressional Budget Office Presentation to the Center for Health Policy, Stanford University A Federal Perspective on Health Care Policy and Costs Peter."— Presentation transcript:

1 Congressional Budget Office Presentation to the Center for Health Policy, Stanford University A Federal Perspective on Health Care Policy and Costs Peter Orszag Director September 16, 2008

2 Federal Spending Under CBO’s Alternative Fiscal Scenario Percentage of Gross Domestic Product

3 Sources of Growth in Projected Federal Spending on Medicare and Medicaid Percentage of GDP

4 Excess Cost Growth in Medicare, Medicaid, and All Other Spending on Health Care MedicareMedicaidAll OtherTotal 1975 to 19902.9 2.42.6 1990 to 20051.81.31.41.5 1975 to 20052.42.22.02.1 Percentage Points

5 Before We All Get Too Depressed…  Embedded in the nation’s central long-term fiscal challenge appears to be a substantial opportunity  Can we reduce health care costs without impairing health outcomes?

6 Medicare Spending per Beneficiary in the United States, by Hospital Referral Region, 2005

7 Variations Among Academic Medical Centers UCLA Medical Center Massachusetts General Hospital Mayo Clinic (St. Mary’s Hospital) Biologically Targeted Interventions: Acute Inpatient Care CMS composite quality score81.585.990.4 Care Delivery―and Spending―Among Medicare Patients in Last Six Months of Life Total Medicare spending50,52240,18126,330 Hospital days19.217.712.9 Physician visits52.142.223.9 Ratio, medical specialist / primary care2.91.01.1 Use of Biologically Targeted Interventions and Care-Delivery Methods Among Three of U.S. News and World Report’s “Honor Roll” AMCs Source: Elliot Fisher, Dartmouth Medical School.

8 Variations Among Academic Medical Centers Supply-Sensitive Care: Days in the Hospital for Patients During the Last Six Months of Life Source: John Wennberg, Dartmouth Medical School.

9 The Relationship Between Quality of Care and Medicare Spending, by State, 2004 Composite Measure of Quality of Care, 100 = Maximum

10 The Effect of Automatic Enrollment on Initial Participation Rates in Companies with 401(k) Plans Source: Nesmith, Utkus, and Young. Percent

11 The Placebo Effect: Antidepressants Source: Kirsch and Sapirstein (1998).

12 The Placebo Effect: Fitness Outcomes from “Perceived” Exercise Source: Crum and Langer (2007).

13 The Placebo Effect: The Effect of Price on Effectiveness Source: Waber and others (2008). Mean Difference

14 Shifting Professional Norms: Catheter Infections in Michigan ICUs After Instituting a Checklist Mean Rate of Infection per 1,000 Catheter Days Source: Provonost and others (2006).

15 Consumption of Fresh vs. Stale Popcorn from a Medium-Sized (120 g) Container Source: Wansink and Kim (2005).

16 Influence of Container Size on the Consumption of Fresh Popcorn Source: Wansink and Kim (2005).

17 Influence of Container Size on the Consumption of Stale Popcorn Source: Wansink and Kim (2005).

18 Some Behavioral Avenues for Reform in Federal Nutrition Programs  20 percent of Americans participate in a federal nutrition program  Supplemental Nutrition Assistance Program –Disbursing benefits more frequently could reduce stockpiling and bingeing  School Lunch Program –Placing healthier foods at the front of cafeteria lines could increase their prominence and consumption –Decreasing the size of tables could reduce distraction-driven overeating

19 Increase in Life Expectancy, and Increase in Difference in Life Expectancy by Economic Status Source: Data from Singh and Siahpush (2006) and CDC. Years

20 CBO’s Activities in Analyzing Health Care  New Hires and Expanded Staffing –New deputy assistant director (Keith Fontenot) in the Budget Analysis Division –Increase in health staff agencywide from 30 FTEs to 50 FTEs –FY 2009 plans  Reports and Analysis in 2008 –Critical Topics in Health Reform –Health Options

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