DOC News November 1, 2006
Volume 3 Number 11 p. 12
© 2006 American Diabetes Association
Obesity and Other Chronic Conditions Drive Medicare Spending Increases
Preventive-care models needed for multiple comorbidities
Neil Versel
Rampant growth in Medicare spending reflects the growing number of obese
patients receiving treatment for multiple related conditions, a recent study
indicates, and should change the discourse about Medicare's future, the
researchers say.
"Clearly, increases in obesity levels play a role," the authors
conclude. "Many obese people have multiple morbidities such as
hyperlipidemia, diabetes, and hypertension." Obesity has doubled among
the Medicare population since 1987, they report, but spending on obese
patients has tripled.
"The orientation of where we need to focus has to change quite
substantially," says co-author Kenneth E. Thorpe, PhD, chairman of the
Department of Health Policy and Management at Emory University's Rollins
School of Public Health in Atlanta. He suggests that the rising prevalence of
obesity with other comorbidities necessitates a shift away from the
traditional fee-for-service system toward one that encourages prevention.
In a recent analysis of publicly available data published in Health
Affairs, Thorpe and fellow Emory scholar David H. Howard write:
"Virtually all of the growth in spending from 1987 to 2002 can be traced
to the 20-percentage-point increase in the share of Medicare patients
receiving medical treatment for five or more conditions during a year. The
factors responsible for these trends are likely to continue, leading to
further increases in spending and intensifying the financial pressures on
Medicare."1
The authors draw their conclusions in part on an examination of insulin
resistance, obesity, hypertension, and dyslipidemia—symptoms sometimes
grouped together under the controversial banner of "metabolic
syndrome." The share of noninstitutionalized Medicare patients with such
conditions being treated with medication has jumped by 11.5 percentage points
in less than a decade, they say.
In 1987, 31% of all Medicare beneficiaries were treated for five or more
different conditions and accounted for 52.2% of total spending; 5 years later,
slightly more than half the beneficiaries had at least five health conditions
and represented 76.2% of spending. In 2002, almost 93% of all spending on
Medicare beneficiaries was for patients with three or more conditions.
According to Thorpe and Howard, the findings highlight the need to develop
models and standards of care that address patients with multiple complex
comorbidities. In turn, lifestyle modification strategies and care
coordination will require changes in how Medicare covers treatment and
interacts with providers.
"The Medicare program, in terms of how services are paid for, is not
equipped to handle this population," Thorpe says. He says the growing
health crisis among the "near elderly" —aging baby boomers
nearing Medicare eligibility—will only exacerbate the problem unless
policymakers bring the 40-year-old program in line with today's realities.
References
1. Thorpe KE, Howard DH: The rise in spending among Medicare
beneficiaries: The role of chronic disease prevalence and changes in treatment
intensity. Health Aff. Published online at
http://content.healthaffairs.org/cgi/reprint/hlthaff.25.w378v1
August 22, 2006, DOI 10.1377/hlthaff.25.w378. Accessed August
31, 2006.[Abstract/Free Full Text]
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