Tuesday, October 27, 2009

Cost & Prevalence of Chronic Conditions in the United States

Statistics: Chronic Conditions Costs & Prevalence

Please forgive formatting errors: This document was created in 1996 and Blogger did not enter into my formatting plans... This was one of the most difficult posts for me publish because it was written before I incurred the debt of the population I was studying.

This is where I left off... perhaps someone has an idea where I can pick it back up...

Elyssa Durant/eds. October 27, 2009  13 years from the original date of creation... and life goes on ... 

There is no effective system to care for those with chronic conditions in the United States; as a result, much of the care that is available is fragmented, inappropriate, and difficult to obtain. In comparison with acute conditions, chronic conditions call for a

different kind of care: an integrated network of professional expertise. Chronic conditions do not always get worse; the health status of a person with a chronic condition can improve, deteriorate, or shift in either direction. The goal of chronic care is not to cure; rather, it should help individuals with chronic conditions maintain independence and a high level of functioning.

Problems encountered by people with chronic conditions

38% Cannot afford a service

19% Service not available when needed

15% Cannot easily get to a service

13% Quality of service so poor, won’t use it

11% Cannot find needed medical service

SOURCE: Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation.

The disproportionate use of health care by those with chronic conditions is consistent across all age groups, as might be expected given their greater health needs. Almost all (96%) of home care visits, 83% of prescription drug use, 66% of physician visits, and 55% of emergency department visits were made by persons with chronic conditions.

Payers: Over 40% of the direct health care costs for persons with chronic conditions were paid through public funds (Medicare, Medicaid, and other state and local medical assistance programs) in 1987. In contrast, public funds paid for less than 20% of the treatment for persons with acute conditions (Figure 2). Among the chronically ill or impaired, private insurance covers about a third of health care, while it covers 45% of the costs of persons with acute conditions.

Using the most recent data source available, we found that 90 million Americans had one or more chronic conditions in 1987. If the same age- and sex-adjusted rates of chronic conditions are applied, we estimate that the number of persons with chronic conditions in 1995 was almost 100 million.

The magnitude of this figure is important for several reasons:

1. First, because the number of persons with disabilities due to chronic conditions is more commonly and regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majorities of persons with chronic conditions are not disabled, but are living normal lives. However, they live with the threat of recurrent exacerbations, higher health care costs, more days lost from work than others, and the risk of long-term limitations and disabilities.

2. Second, persons with chronic conditions are at greater risk for being underinsured, particularly those with more than one chronic condition. Short and Banthin estimate 29 million nonelderly people with private health insurance are at risk of being underinsured defined as a function of a family's risk of incurring high out-of-pocket costs for medical services relative to their family income. We found that a disproportionately large majority of all direct health care services, including physician visits, prescription use, and persons with chronic conditions use costly hospitalizations. Their per capita costs are over 3 times higher than those of persons without chronic conditions are. Consequently, they are at greatest risk of unaffordable high out-of-pocket costs.


Persons with co morbidities are particularly at risk of finding themselves underinsured; their per capita costs are 2-1/2 times higher than persons with only one chronic condition are. Furthermore, high utilization rates make persons with chronic conditions less attractive to managed care plans that typically cover more services, including preventive care, with less cost sharing. Depending on the adequacy of their health benefits, even middle-income families (for example, a household income of $40,000) could quickly incur out-of-pocket costs in excess of 10% of their incomes if the only expense incurred in a year was to cover their 10% share for a surgery and hospitalization costing $50,000.

Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation
The Chronic Care Perspective. The Robert Wood Johnson Foundation
[available: http://www.rwjf.org/library/chronic/chrcare/introfact2.htm]

Figure 1. Categories of disabling chronic conditions

Source: Institute of Medicine, 1991

categories of conditions diagnostic condition codes proportion of people

mobility limitations arthritis, paralysis 38%

chronic diseases asthma, cancer, diabetes 32%

sensory limitations blindness, hearing impairment 8%

mental limitations senility, mental retardation 7%

other conditions 15%

Chronic Care in America: A 21st Century Challenge. The Robert Wood Johnson Foundation.

Figure 2. People with chronic conditions report on their service system.

Source: Unpublished data from The Gallop Organization, 1992.


Understand services you are eligible for? 47% 47% 5%

Understand how to use the services you are eligible for? 60% 32% 8%

Know who provides what services? 57% 38% 5%

Feel it takes more effort to use these services than they are worth to you? 36% 48% 16%

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Elyssa D. Durant, Ed.M.