A newly published chart book released by the Robert Wood Johnson Foundation and the Johns Hopkins School of Public Health provides updated data on chronic conditions and their impact on individuals, families, and the U.S. health care system. Since the previous release of this chart book in 2002, the outlook on chronic conditions has worsened. Today, nearly half of all Americans live with some form of chronic condition; an estimated 145 million people, which beats out the original projects by more than 10 million. The chart book advocates for a renewed focus on preventive measures, earlier recognition of the disease, and disease management strategies that promote functionality and autonomy.
A large percentage of individuals live with multiple conditions that require them to obtain a diverse array of care. These co-morbid illnesses create coordination of care issues because the current health system creates disincentives for health care providers to communicate across care settings. Additionally, the current payment model used by insurance companies operates on a medical necessity criteria that require health improvements to result from care. This forces many people to pay increasing sums out-of-pocket for care related to chronic health conditions. As chronic conditions continue to skyrocket, these costs will continue to escalate.
Prevalence: From 1995 to 2010, the number of people living with chronic illnesses has increased from 118 million to 141 million. This number is estimated to increase to 171 million in 2030. Part of this rise in chronic conditions relates to increased lifespan. From the year 2000 to 2010, the percentage of adults aged 65 or older grew from 12.4% to 13% and is expected to grow to 20% in the next 30 years. The older people become, the more likely they are to develop chronic conditions (e.g., functional disabilities, hypertension, etc.). Currently, it’s estimated that 60% of adults 65 and older have hypertension. In real numbers, as the proportion of this age group grows, so will the numbers of people with hypertension. Moreover, 28% Americans have at least two chronic conditions at once, a percent that increases with age.
Impact on Health Care Systems: The authors of the report note that people with chronic conditions are the heaviest users of the health care system, utilizing all major services more often than individuals without chronic disorders (e.g., hospitalizations, office visits, home health care, and prescription drugs) and thus receive the most costly form of care at higher rates. For example, the authors note that two-thirds of prescriptions are filled by people with chronic conditions. This results in about 84% of total health care spending in the U.S. today.
The largest of all groups of people with chronic conditions are insured through private payers, estimated to be 78 million. This accounts for about three-quarters of health care spending in the private insurance market. Medicaid numbers are slightly higher at 80%. In terms of spending, this means that an individual with one chronic condition is about three times more expensive to care for than someone without one; a number that increases exponentially to 17 times greater for someone with five co-morbid conditions.
Impact on Individuals and Families: The average out-of-pocket costs for health care for people with chronic conditions are greater than $1,000 per year. Our service-delivery system offers poor coordination of care for people with chronic conditions, driving this cost up even further for individuals.
Poor care coordination leads to unnecessary service use and duplication. This disorganization increases costs and uncertainty for the individual patient. By being referred to multiple specialists, transferred from a hospital to a nursing home, and obtaining duplicate diagnostic tests, patients often receive conflicting information and opinions. Under this environment, decision-making is difficult for the patient, who is looking out for his/her own health and financial interests. All of this spills over to the family members who care for individuals living with chronic conditions. Family and friends invest considerable time and resources to the care of loved ones living with chronic illnesses. The economic value actually outpaces that of the care for chronic conditions themselves, which translates into lost time at work, stress, and role conflicts for the family caregiver.
Many physicians don’t believe that the current system is functional for people with chronic conditions. Payment schemes and physician training are currently inadequate to help individuals obtain needed care and coordinate care across multiple care providers. In response to the increasing burden that chronic conditions are placing on individuals, their families, and the health care system more generally, the authors suggest that the harsh realities of chronic illness care get reflected in health care reforms. Coupling a chronic care model of financing and care delivery with enhanced supports for family caregiving is imperative as Americans move into a future where the population is significantly older and at greater risk of chronic health conditions.
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