With plans to cut Medicare reimbursement looming on the horizon, the area’s mostly nonprofit hospitals — which serve more and more elderly patients dependent on Medicare for their health coverage — are looking closely at what is driving rising health care costs.
Now, new research published by the Virginia-based Project HOPE foundation shows nearly all of the increases in Medicare spending over the past 15 years can be traced to an increase in the number of patients with multiple, obesity-linked health problems.
According to the study published in the foundation’s journal Health Affairs, the number of Medicare patients treated in a single year for five or more conditions grew from 31 percent in 1987 to more than 50 percent in 2002. By that year, these patients accounted for 76percent of total Medicare spending, up from 52.2 percent in 1987. More than 92 percent of Medicare spending in 2002 was triggered by beneficiaries with three or more chronic illnesses during the year.
The common thread throughout the findings was obesity, said economists Kenneth Thorpe and David Howard, who authored the study. Patients were receiving more aggressive treatment for multiple problems, such as diabetes, high blood pressure and low levels of high-density lipoprotein — HDL, or “good” cholesterol — all conditions associated with increased heart disease and exacerbated or made more likely by being overweight. Obesity rates among all Medicare patients doubled during the period, with spending on those patients almost tripling from 9.4 percent of Medicare spending in 1987 to 25 percent in 2002.
“What this study tells us is that we need to aggressively put in place interventions to deal with obesity and chronic disease prevalence among the elderly to control spending,” Thorpe said.
The study findings are borne out among the patients local nonprofit clinics and hospitals see every day.
“Because of our technology, medical devices and therapeutics such as drugs, patients are living longer,” said Dr. Matthew Mintz, associate professor of medicine at The George Washington University Hospital in D.C. “People used to die of a single disease; now because of their longer life spans, they need treatment for many diseases. This is also much more expensive to treat than a single disease, and I see this all the time with my own patients.”
Mintz agreed obesity was the major risk factor — a problem made worse by what he called a broken U.S. health care system.
“We are not set up as a system to be proactive in preventing these diseases, but instead tend to react as people develop them,” Mintz explained. Given the fast-food choices more readily available to people with fixed or low incomes, “this problem is only going to get worse.”
The Project HOPE foundation, or Health Opportunities for People Everywhere, based in Millwood, Va., sponsors health education programs, policy research, and humanitarian assistance worldwide. It is named for the S.S. HOPE, the world’s first peacetime hospital ship.
Have information about area nonprofits? Contact Frank Sietzen at [email protected].
