Health Affairs: U.S. policy, spending neglects chronic diseases

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In the past 20 years, Medicare expenditures are increasingly going toward treating and managing chronic conditions. But according to a report published online in the Feb. 18 issue of Health Affairs, U.S. policy makers have inadequately adjusted to these trends and need to better implement prevention and treatment programs.

"The U.S. health system remains predicated on providing acute, episodic care that is inadequate to address the altered patterns of disease now facing the American public," the authors wrote.

In 1987, the largest segment of Medicare spending focused on inpatient services related to heart disease. In 2006, this number shifted and focused on the rise of patients with chronic diseases, including heart conditions, hyperlipidemia, arthritis and chronic obstructive pulmonary disease (COPD).

According to the report, Medicare spending is expected to “exceed the rate of growth in federal revenues and the overall economy” and reach numbers of $879 billion annually by 2018, increasing on average 7 percent each year.

Kenneth E. Thorpe, PhD, of Emory University in Atlanta, and colleagues evaluated chronic disease incidence and spending of the 10 most expensive conditions in the Medicare population in 1987, 1997 and 2006 from data drawn from the National Medical Expenditure Survey and the Medical Expenditure Panel Survey.

Researchers found the top 10 most expensive conditions for Medicare beneficiaries were: heart conditions, trauma-related disorders, cancer, mental disorders, osteoarthritis and joint disorders, COPD, kidney disease, hyperlipidemia, diabetes metillus and hypertension.

These medical conditions accounted for almost half of inflation of Medicare spending over the 20-year span, 47 percent from 1987 to 1997 and 51 percent from 1997 to 2006.

The researchers found that heart disease had the biggest growth share between 1987 and 1997, accounting for 14 percent of Medicare expenditures. Between 1997 and 2007, Medicare trends showed that chronic diseases accounted for the largest expenditures and are over a third of the rise in Medicare costs.

"Over the past decade, chronic disease management programs have proliferated in the private sector and are common in the Medicaid and Medicare Advantage programs. But they are notably absent in traditional fee-for-service (FFS) Medicare," the authors wrote.

Between 1997 and 2006, Medicare spending on prescription drugs rose to a quarter of overall spending while prescription costs for the top-ten chronic conditions were 13 percent of this rise.

Currently, ambulatory care services and prescription drugs for these chronic conditions consume the most Medicare spending. The authors said programs to address the changing trends that put chronic conditions in the spotlight must be implemented.

"As Congress and the Obama administration, along with providers, insurers, and consumers, continue their efforts to reshape the U.S. health system, they must address these changed health needs through evidence-based preventive care in the community, care coordination and support for patient self-management," the authors concluded.