The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity

Department of Health Policy and Management, Emory University, Atlanta, Georgia, United States
Health Affairs (Impact Factor: 4.97). 09/2006; 25(5):w378-88. DOI: 10.1377/hlthaff.25.w378
Source: PubMed


We examine the impact of the rise in treated disease prevalence on the growth in Medicare beneficiaries' health care spending. Virtually all of this spending growth is associated with patients who are under medical management for five or more conditions. This is traced to both a rise in true disease prevalence and changes in clinical treatment thresholds. Using the metabolic syndrome as a case study, we find that the share of patients treated with medications has increased 11.5 percentage points in less than ten years. This raises important questions about the "fit" of how Medicare pays for services for complex medical management.

Full-text preview

Available from:
  • Source
    • "The consequence is a change in patient profiles with an increase in the prevalence of chronic conditions and polypathology. Thorpe and Howard found evidence of the increased prevalence for the top ten chronic conditions (Heart disease, Mental disorders, Trauma, Arthritis, Hypertension, Cancer, Diabetes, Pulmonary conditions, Hyperlipidaemia and Cerebrovascular disease) for US Medicare beneficiaries from 1987 to 2002 [37]. Other works show how the number of patients with different combinations of chronic conditions is expected to increase in the future [38]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. Data used relate to the population of the county of Baix Emporda in Catalonia for the period 2004--2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was [euro sign]111,936, a third higher than for men, at [euro sign]81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a morbidity classification system. Potential ways of efficiency arose by introducing a time perspective to chronic disease management.
    Full-text · Article · Oct 2013 · BMC Health Services Research
  • Source
    • "Despite the convenience of these localized settings, previous promotional efforts report difficulty in motivating older adults (Mihalko & Wickley, 2003). Less success among older adults may result from their passive approach to health care (Bastiaens, Van Royen, Pavlic, Raposo, & Baker, 2007), their multiple medical needs (Haber, 1994), and/or limited physician time devoted to preventive health (Fried & Guralnik, 1997; Langford, 2004; Thorpe & Howard, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The rising health care costs and increasing older adult population in the United States make preventive medicine for this age group especially crucial. Regular physical activity and fruit and vegetable consumption may prevent or delay the onset of many chronic conditions that are common among older adults. The decisional balance sheet is a promotional tool targeting the perceived pros and cons of behavior adoption. The current study tested the efficiency and effectiveness of a single-day decisional balance sheet program, targeting increased physical activity and fruit and vegetable intake among older adults. Participating adults (N = 21, age = 72.2) who represented a diverse population in Hawaii (Japanese = 5, Filipino = 4, Caucasian = 4, Native American = 1, Native Hawaiian = 1, Hispanic = 1, and Others = 5) were recruited from housing communities and randomized to a decisional balance sheet program adapted for physical activity or fruit and vegetable consumption. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and daily fruit and vegetable intake with the National Health and Nutrition Examination Survey single item instrument. Baseline and follow-up data were collected. Both programs were implemented efficiently, and participants in both groups improved their daily physical activity. The decisional balance sheet for fruit and vegetable consumption appeared less effective. Specific suggestions for similar programs are reported.
    Full-text · Article · May 2012 · Public Health Nursing
  • Source
    • "Discussions about health are frequent topics of conversation among chronically ill older adults, who are typically managing multiple coexisting conditions (Thorpe & Howard, 2006). It is through these conversations that people's perceptions of their illnesses are formed, treatment options are explored, and the pressure to seek or not seek formal medical care exerted (Pescosolido et al., 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Social networks play an important role in helping older adults monitor symptoms and manage chronic conditions. People use verbal discussions to make sense of symptoms, determine their seriousness, and decide whether to seek medical care. In this study, problem-specific social networks called health discussion networks (HDNs) are examined over time among older adults receiving long-term services and supports (LTSS). Data were gathered from older adults who had recently moved into a nursing home (NH) or assisted-living facility (ALF) or who had started to receive home- and community-based services (H&CBS). LTSS recipients identified people with whom they discussed symptoms or disease information, talked over what their physician said, and considered consulting other health-care providers. Data were analyzed for 216 adults with Mini Mental State Examination (MMSE) baseline scores of 20 or higher, and these individuals were interviewed quarterly over a 12-month period. Generalized estimated equations (GEE) were used to model repeated measures of HDN size and composition as a function of baseline age, gender, race, ethnicity, marital status, education, quality of life, setting, number of adult children, and cognitive status. GEE modeling demonstrated that HDN size decreased over time (p = .01) and that the probability of mentioning formal care providers as part of that network increased over time (p = .003). Multivariate predictors of increased HDN size were lower ratings of quality of life (p = .001), having more adult children (p = .04), and higher MMSE scores (p < .0001) after controlling for covariates. Older adults new to receiving LTSS had relatively small HDNs that were mixed networks including family, friends, and formal care providers. This suggests an opportunity for interventions aimed at maintaining and enhancing the HDNs of older adults beyond family members.
    Full-text · Article · Jan 2012 · Health Communication
Show more