CHRONIC ILLNESS: STUDY FINDS COSTLY ‘EPIDEMIC’
More than one-third of the U.S. population -- 100 millionThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
Americans -- are afflicted by chronic illnesses that account for
nearly three-quarters of the country's health care expenditures,
according to a study in the JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION (JAMA). According to the study, the direct cost of
chronic illness was $425 billion in 1990, with the indirect costs
-- such as lost days of work -- totalling $234 billion. In
addition, the University of California at San Francisco study
projected that the number of Americans with chronic illnesses
would continue to increase as the population ages, "reaching
nearly 150 million by 2030, costing the nation $798 billion a
year in direct health care costs" (Russell, SAN FRANCISCO
HOW HIGH?: The study found that 88% of the elderly had a
chronic condition, but "they actually accounted for only about a
quarter of all persons living in the community with chronic
conditions." Working-age adults between 18 and 64 years old
accounted for 60% of noninstitutionalized people with chronic
conditions; one in four children (12 million) under age 18 had a
chronic condition. The authors used data from the 1987 National
Medical Expenditure Survey of 34,459 people and 1987 U.S. Census
data (Hoffman et al, JAMA, 11/13 issue). For the study, chronic
conditions were defined as "persistent and recurring illnesses
that cannot be cured," ranging from "arthritis, diabetes and
asthma to heart disease, mental retardation and cancer"
BREAKING POINT: The authors write, "We believe that the
sheer number of Americans with chronic conditions and the health
care costs they incur have reached a threshold whereby both
health care providers and policymakers are not facing health care
financing issues, but they must deal with how to transform our
health care delivery system so that it better meets the needs of
those living with chronic conditions" (JAMA, 11/13 issue). Dr.
Lewis Sandy, vice president of the Robert Wood Johnson
Foundation, which funded the study, said, "For the most part, the
way health care is organized, delivered and paid for in this
country is based on an acute care system that emphasizes 'curing'
disease." He said that people with chronic illness require "a
broad scope of social, community and personal services as well as
medical and rehabilitative care that will help them live with
their chronic conditions" (CHRONICLE, 11/13). However, NEW YORK
TIMES reports that the study's authors "held out little hope that
costs could be controlled by providing care to people in their
own homes or in the community rather than in nursing homes and
other institutions." The authors said that other studies have
suggested that providing community-based services "has generally
raised health care costs because reductions in institutional care
have been more than offset by the increased use of community-
based care" (Pear, 11/13).
CAREGIVING: The study found that 22% of the costs of caring
for those with chronic conditions are "borne by individuals," 75%
of whom are women, and by 2030, "the supply of potential
caregiving people will drop to half of what it was in 1990." Co-
author Dorothy Rice said, "What we need is a mix of personal
assistance, custodial care services, housing and transportation"
(Levy, USA TODAY, 11/13).