Health Check Up: Data from the US’s Annual Physical

The latest CDC check up on the health of the US population has arrived, and it’s a veritable gold mine of data on health and health care practices. Of special interest in this years report, “Health, United States, 2009,” is a new section on medical technology.

First, some of the good news: The three biggest killers are on the decline: Heart disease mortality by 66% and stroke deaths by 78% compared to the 1950s, and cancer deaths by about 16% since the 1990s. Having browsed these reports every year for nearly a decade, I was drawn to the new data on medical technology, and utilization of healthcare resources, much of which provides suggestive evidence that over-utilization of new technologies and unproven procedures, is a driving force behind ballooning expenditures in US healthcare. Among the findings, between mid-1990s and 2007:

Total knee replacements increased 70%
MRI, PET and CT scan usage tripled, even though doubts remain about their effectiveness
Hospitalization for cardiac care increased 64% while costs for those hospitalizations increased 174%
Spinal fusions, a procedure of especially dubious effectiveness, increased 82% while costs for the procedure increase 189%
Rates of prescription drug use have increased since the 1990’s: from 39% to 47%, including 9% of adults who now always or often use meds to help them sleep. The percentage of people taking three or more prescription drugs has increased from 12% to 21%
In 2007 (the most recent year available) Americans went to the doctor or hospital 1.2 billion times. Though most visits are to the physician’s office, 20% of adults had at least one emergency room visit. Those with households incomes at 200% of the poverty line or less were nearly twice as likely to go to the ER: 30% vs. 18%
Cost and lack of coverage led 8% of Americans to forgo needed care, 10% to forgo necessary prescription drugs, and another 10% to delay needed care.

The report also includes a section showing the massive variation in the amount of care provided for people at the end of their life, which comes from the Dartmouth Atlas of Healthcare. Your chances of having at least one stay in the intensive care unit during the last six months of life, for example, ranges from a high of 45% in California and Illinois and 49% in Florida, to a low of 23% in Vermont and North Dakota and 26% in Oregon. Those differences are attributable to differences in medical practice patterns, since they control for the health and age of the population (so its not simply caused by Florida being home to the elderly and sick, and Vermont being populated by spry young healthy folks.) ICU’s are invasive places, involving extensive treatment and testing which means that more time in the ICU results in greater expenses, and is extremely uncomfortable for patients. And since this measure of intensity only looks at folks who died, the ICU stays aren’t curing anyone of disease.