Expose Fake Grassroots Organizations: Net Neutrality Now

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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 ... 

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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.

INSERT RWJF CHART SUMMARY ABOUT HERE

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.

Reference:
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.

YES NO DON’T KNOW

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%

Using Examinations & Testing to Improve Educational Quality

Examinations: Comparative and International Studies

Heyneman & Ransom discuss the critical role of national examinations in policy implementation and educational reform. Eckstein & Noah discuss why it is important to use national examinations in education. The reasons for using examinations include (1) to identify student strengths and weaknesses; (2) to provide feedback to officials regarding these strengths and weaknesses--within and between schools, districts, and regional areas; (3) to certify mastery of the curriculum; and; (4) as an established selection tool used in identifying the brightest students, thus providing students with an opportunity to obtain advanced degrees. The authors feel the last function of national examinations to be the most influential on individual performances “Selection examinations are the most powerful motivational lever in the education sector. . . The power of using national examinations lies in their ability to allocate life chances.”

In addition to using examinations to gauge students strengths and weaknesses, examinations are also used to compare the educational attainment of students with the changing needs of today’s world and global economy. Examinations are also used to initiate curriculum reform, i.e. by changing the material in national examinations, students must shape their learning in order to perform well on national examinations. The authors also discuss how this approach can fail when it is used as a mechanism to bypass the normal route of gaining public support from parents and communities.

Eckstein & Noah discuss the changing views of testing in American Society, and the controversy surrounding the role of examinations within American Society. They point out the opposing view points regarding the use of rigid, structured examinations in schools as a tool which undermines the foundations of American education: to respond to individual creativity, and make learning attractive to America’s children. The authors also point out the limits to this argument, which fails to accept to testing as an important measurement device. They use China as an example of to demonstrate this point: At one point when China eliminated standardized testing from the curriculum, students assessments were based in large part on Political, Religious, or socioeconomic factors with no way to keep such extraneous variables in check with more objective types of evaluation, allowing for extremely subjective and personal interpretations of student achievement.

The issue at hand becomes not whether or not examinations have a critical role in education, but rather what to measure and how. Seeing how examinations are frequently the strongest indicator as to a child’s future academic success and independent functioning, teachers are under significant pressure to teach those skills which will be measured on such examinations. The authors refer to this as the backwash effect of public expectations, since teachers are often more concerned with a student’s performance on the exam than the relevance of the materials on the exam. When their is a discrepancy in what teachers and students see as useful knowledge, and the skills which are being tested on the exam, this no doubt has a negative effect on what is being taught and what is being learned in schools.

Reference: Examinations: Comparative and International Studies
Max A Eckstein & Harold J. Noah / Eds. Stephen P Heyneman & Angela W Ransom

TIDES OF CHANGE

It seems painfully obvious to me now that the only way out was through….

If had known then what I know, I would not have wasted so much precious time searching for the source of my profound sadness. I have realized that the events leading me into this circle of despair must no longer guide me through life if I am to escape the memories of my past. Now, it is time to focus on the answers and ask a different question…

I have spent years asking myself, “How did I get here?”

Today I am wondering, “Now how the fuck do I get out?”