Toward a Satellite Account for Health

Ana AizcorbeBEA Advisory Committee Meeting

May 4th, 2007

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The rapid growth in health care expenditures has raised difficult questions.

Source: Bureau of Economic Analysis

How do health expenditures translate into improvements in health?

What are the costs and benefits of treatments to society as a whole?

Expenditures on Health Care,Percent of GDP

7%

8%

9%

10%

11%

12%

13%

14%

15%

16%

1980 1984 1988 1992 1996 2000 2004

perc

ent

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The type of information needed to address these questions is not readily available.

For example,

Nominal expenditures broken down by disease to assess the benefit of treatment

Price measures that accurately reflect increases in the quality of treatments

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BEA plans to develop a Health Satellite Account to respond to these needs.

The satellite account will provide: A reconciliation of health care spending estimates from

the Centers for Medicare and Medicaid Services (CMS) and those from the Bureau of Economic Analysis,

Data on nominal expenditures by disease that are consistent with CMS’s National Health Expenditures Accounts,

Improved price deflators, and Measures for the indirect costs of illness, such as

mortality costs and morbidity costs due to absenteeism.

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Price indexes: Increasing prices are an important driver of cost increases

PCE for medical care grew 9 % per year from 1980-2005.

Over ½ of that growth represents increases in prices, as measured in standard price indexes.

Decomposition of PCE Expenditures on Medical Care, 1980-2005

Population Growth, 1.1%

Inflation, 5.1%

Real PCE, 2.6%

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But existing price indexes have well-known problems.

Price Indexes for Medical Care

0

2

4

6

8

10

12

14

1980 1985 1990 1995 2000 2005

Perc

ent C

hang

e

BEA BLS MCPI

Sensitive to underlying assumptions:

BLS’ Medical Care Price Index (MCPI) focuses on consumer payments

BEA price index relies on indexes from the BLS PPI program

Both have problems accounting for

quality improvements, and reduced cost of treatment

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BEA’s satellite account will include a disease-based price index.

Disease-based price indexes will better account for reductions in cost that arise from the substitution across treatment classes.

These episode-based indexes will be used to construct indexes for expenditures by product class and by industry, as currently reported in the accounts.

The index will not address the problem of accounting for improvements in treatments.

Difficult problem where there is no consensus on the solution.

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Preliminary work on price indexes suggests the issue may be numerically important.

0

1

2

3

4

5

All Diseases

Comparison of Price Indexes for Medical Care, 2001-2003

(compound annual growth rates)

0

1

2

3

4

5

PrescriptionDrugs

Office Visits HospitalOutpatient

HospitalInpatient

Provider-Based

Disease-Based

Source: A. Aizcorbe and N. Nestoriak, “Using Commercially-Defined Episodes of Illness for the Measurement of Health Accounts: A Progress Report,” Paper presented at NBER/CRIW Summer Institute, July 2006

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Progress and PlansTwo-year effort to study data sources and methods

Completed preliminary draft of study on disease-based price indexes.

Continued interaction with members of the academic and statistical communities

Participating in National Academies Panel on Health Accounts Working closely with David Cutler and Allison Rosen’s Health

Accounts Group Maintaining contact with colleagues at CMS, BLS, and other

statistical agencies.

Plan is to develop a detailed proposal for a BEA Health Satellite Account by the end of 2009.