A STUDY OF FEDERAL SPENDING ON DIABETES: AN OPPORTUNITY FOR FEDERAL LEADERSHIP IN DIABETES

Transcription

1 A STUDY OF FEDERAL SPENDING ON DIABETES: AN OPPORTUNITY FOR FEDERAL LEADERSHIP IN DIABETES Conducted for the National Changing Diabetes sm Program (NCDP), a program of Novo Nordisk by Marsha Gold and Ronette Briefel Mathematica Policy Research June 19, 2007

2 The Bottom Line! The federal government bears high costs ($80 billion annually) to treat diabetes and its complications spending far more on treatment than on efforts to prevent diabetes or lessen its impact.! Almost every federal department has some policy or program with an influence on diabetes and its complications.! We can do better to more effectively leverage federal spending to reduce the human and economic toll from diabetes. 1

3 What We Did - I! Reviewed key documents relevant to diabetes.! Developed a logic model highlighting key points of diabetes progress and how individuals, the health system, and community factors affect them.! Identified and summarized federal departmental roles and responsibilities and their relevance to diabetes. 2

4 What We Did - II! Used traditional cost of illness methods to estimate FY 2005 federal spending on treatment and disability payments for those with and without diabetes.! In other words, we estimated the extra cost incurred by people with diabetes in federal treatment and disability programs.! Used budget analysis to account for other diabetes related spending to encourage effective care, prevent disease and complications, conduct surveillance and research, and support federal food assistance programs. 3

5 Federal Activity Relevant to Diabetes - I! Prevention, Education and Assistance Programs: Diabetes focused work concentrated in CDC, NIH, and the Indian Health Service. Broader efforts at disease prevention and health promotion are more widely distributed (HHS, USDA, DOT, HUD, DOI, etc.) and not specific to diabetes.! Medical Treatment and Disability Compensation: Medicare, Medicaid/SCHIP, Veterans Health Administration, DoD s TRICARE, FEHBP, Indian Health Service, Social Security Administration and others. 4

6 Federal Activity Relevant to Diabetes - II! Policy and Regulatory Authority: Dietary guidelines (USDA/HHS); ERISA, Family and Medical Leave Act and disability policy (DOL); health claims and advertising (FTC); food and drugs (FDA); personal and business income tax policy (IRS).! Research and Monitoring: NIH (various Institutes); other HHS agencies, USDA, VA, and DoD; national data systems (NCHS, AHRQ, Census Bureau, Labor and others); and FDA and other regulatory efforts. 5

7 Additional (Federal Program) Costs to Treat Those with Diabetes Versus Without! $79.7 billion, including $77.2 billion in extra federal medical spending and $2.5 billion in SSDI/SSI disability payments due to diabetes.! $80 billion is more than the budget of the Department of Education.! $77 billion extra medical spending is 12 percent one in eight dollars of all federal health care spending. 6

8 Diabetes Treatment Related Costs by Agency Additional Federal Spending on Medical Care for Those With Diabetes vs. Without, FY 2005 FEHB 3% DOD 4% VA 7% Other <1% Medicaid (fed share) 6% Medicare 79% Total federal program spending = $77.2 billion Source: MPR analysis using cost of illness approach. Note: Excludes any spending on prevention and screening that is the same for those with and without diabetes. 7

9 Distribution of Prevention Spending Diabetes Specific 6% a USDA 23% CDC 11% Other 19% Other HHS 41% Total = $3.9 billion, including $3.7 billion in other programs related to physical activity, diet, and obesity. a Source: MPR analysis of federal spending, FY a In addition, a portion of NIH s $1.1 billion spending in diabetes research goes to support diabetes education and prevention. These funds are included in other parts of the estimates. 8

10 $3.1 Billion in Federal Funds Supports Research, Monitoring, and Regulation Relevant to Diabetes RESEARCH AND MONITORING (in billions) Research NIH diabetes related research a NIH research on related risk factors for diabetes Other relevant research in HHS (AHRQ, CMS, CDC) Other relevant research outside HHS (USDA, Other) Statistical Systems to Support Monitoring Related regulation (e.g., FDA, FTC, Commerce) $3.053 $2.604 $1.055 $0.814 $0.076 $0.659 $0.159 $0.290 Source: MPR analysis of federal spending, FY a Includes NIH spending for diabetes education and prevention. 9

11 Federal Spending on Food Assistance Programs! About $48.9 billion is spent, mainly by USDA, on food programs (in addition to nutrition guidance).! $16.5 billion is directly for food and $32.4 billion is spent on food stamps.! Key programs include Food Stamps, WIC, Child Nutrition Programs (e.g., School Meals), HHS Nutrition Services for Older Persons, and others. 10

12 Opportunities at Multiple Points! Integrate prevention and effective care into treatment programs to reduce complications.! Leverage families, communities, schools, and the workplace to encourage prevention, detection, and early treatment of diabetes.! Use existing federal funds in housing, transportation, and other programs to build environments that encourage physical activity.! Draw upon the large amount spent on food assistance programs to promote healthy eating and physical activity. 11

13 Areas for Future Consideration 1. The federal government should take steps to get the most out of current spending in medical and treatment programs. 2. The federal government should lead by example and effectively promote the health of its workforce. 3. The federal government should enhance interdepartmental coordination and more effectively apply its resources to reduce the risk factors for and complications of diabetes within the U.S. population. 12

14 Appreciations to NCDP We appreciate the support of Novo Nordisk s National Changing Diabetes Program for the work and the active involvement of Dana Haza and Malene Cortelius. We also appreciate the guidance of the Advisory Panel that NCDP set-up for this program. 13

15 Thanks also to the MPR Project Team and Support Staff! Tom Croghan! Cheryl Fahlman! Sue Felt-Lisk! Allison Hedley! Meredith Lee! Melissa Neuman! Katherine Gruene-Segersten! Craig Thornton! Bob Weathers! Felita Buckner 14