Press Release

For More Information, Contact:
Andrea Zuercher, Health Affairs, 785-842-2611
Janet Firshein, Burness Communications, 301-652-1558


HOLD FOR RELEASE UNTIL
Tuesday, November 13, 2001


MANAGEMENT OF CHRONIC ILLNESSES POSES COMPLEX PROBLEMS
FOR U.S. HEALTH CARE SYSTEM

Treatment Alone For Five Conditions Costs $62 Billion A Year;
Uninsured Are Hardest Hit, According To New
Health Affairs Studies

WASHINGTON, D.C. - Five common chronic conditions - mood disorders, diabetes, heart disease, high blood pressure, and asthma - exact a massive financial burden on millions of Americans, racking up a total of more than $62 billion a year in treatment costs alone, according to a study published today in the November/December issue of the journal Health Affairs.

A second Health Affairs study illustrates the effects of out-of-pocket treatment costs for chronic conditions on the uninsured, while a third study suggests a way to expand access for young adults with disabilities and chronic conditions, who are particularly vulnerable to being uninsured.

This issue of Health Affairs explores in detail the impact, treatment, and costs of chronic conditions from a variety of perspectives. Among the topics addressed:

• The failure of medical care to meet patient needs in chronic care management
• Lessons learned from regulating nursing homes in the United States
• Consumer choice and home-based services for people with chronic health problems
• Translating research evidence to treatment action as a way to improve chronic illness care
• The need for a solution to the financing of long-term care


Study Underscores National Economic Burden of Five Chronic Conditions


A study led by Benjamin Druss, of the departments of psychiatry and public health at the Yale School of Medicine, found that one-quarter of the U.S. population has one or more of five chronic conditions - mood disorders, diabetes, heart disease, asthma, and high blood pressure -- which cost more than $62 billion for direct health services alone in 1996. Almost half of U.S. health care costs in 1996 were borne by people with one or more of those conditions, according to the study.

The researchers found that although each of the five conditions carried a substantial financial burden, they also carried unique characteristics and patterns of service use driving those costs. For example, the primary cost driver for high blood pressure is its prevalence - more than twice that of any of the other four conditions. Diabetes, on the other hand, exemplifies how related illnesses such as infections, peripheral vascular disease, and microvascular damage combine to exact a tremendous clinical and financial burden.

"A good deal of research and policy on chronic illness has focused on the common features shared by these conditions, such as the degree to which they impair function and the relative inadequacy of the U.S. health care system in treating them," Druss said. "This study's findings serve as a reminder that different conditions also have unique features resulting in distinct clinical and health policy challenges. If we are to improve the care of individuals with chronic conditions, we must be able to understand and address both the similarities and the differences."

Co-investigators for this study were Steven Marcus, of the School of Social Work at the University of Pennsylvania; Mark Olfson, of the Department of Psychiatry at Columbia University; Terri Tanielian, of RAND Health; and Lynn Elinson and Harold Alan Pincus, both of the Department of Psychiatry, University of Pittsburgh.

Data Analysis Breaks Down Out-Of-Pocket Costs Of Chronic Illnesses

In a study investigating out-of-pocket medical spending for chronic conditions, researchers found that chronically ill persons who are uninsured have higher-out-of-pocket costs and are five times less likely to see a physician than their insured counterparts. Fifteen percent of uninsured people with at least one chronic condition and 6 percent of uninsured persons with more than one chronic condition did not see a doctor during the study year, compared with fewer than 3 percent and 1 percent, respectively, of privately insured persons.

Mean out-of-pocket spending varied by type of insurance coverage and age, and increased with the number of chronic conditions. The researchers' analysis showed that among people 65 and older, mean out-of-pocket spending was highest for prescription drugs ($397), followed by dental services ($145). Among those under 65, mean out-of-pocket spending was highest for physician office visits ($104.) The study also found that families with chronically ill members were 2.6 times more likely than other families to spend $1,000 out of pocket annually for medical care.

"As policymakers continue to use cost sharing and design of benefit packages to contain health spending, it is important to consider the impact of these policies on persons with chronic conditions and their families," the researchers wrote.

The study was conducted by Wenke Hwang and Wendy Weller, of the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health; Henry Ireys of Mathematica Policy Research; and Gerard Anderson of Johns Hopkins.

Researcher Urges New Insurance Eligibility Standards For Young Adults With Special Health Needs

Young adults with disabilities and chronic conditions face serious health care challenges because they tend to have high uninsurance rates and because Medicaid and Medicare are frequently not open to them. Almost 22 percent of adults ages 19 to 29 with disabilities are uninsured, versus a much lower proportion - less than 13 percent - for similarly disabled children, according to this analysis by Eliot Fishman, of the Institute for Medicare Practice at the Mount Sinai School of Medicine. His research identified significant shortfalls in existing coverage policy for young adults with special health needs, who start to "age out of coverage" when they turn 19.

Fishman notes that although disability currently is defined around a person's capacity to work, employability does not guarantee insurability. Federal legislation allows states to offer Medicaid to employed people with disabilities, but few states have chosen to exercise that option and those that have experimented with it so far have experienced disappointing results. Still, Fishman writes, "these Medicaid changes do move us toward a more basic solution: replacing employability with insurability and dependence on health interventions as the eligibility standards for public coverage for adults."

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the November/December 2001 issue will be provided free to interested members of the press. Address inquiries to Jackie Graves at Health Affairs, 301-656-7401, ext.255, or via e-mail, press@healthaffairs.org. Selected articles from this issue are available free on the journal's Web site, www.healthaffairs.org.

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