Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?

English version

Autoři: Joelle H. Fong ^aff001
Působiště autorů: Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore ^aff001
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222539

Souhrn

Background

Little is known about the impact of different types of chronic diseases on older adults’ out-of-pocket healthcare spending and whether certain diseases trigger higher spending needs than others.

Methods

We use data from the 2014 Health and Retirement Study representing a weighted population of 35,939,270 Medicare beneficiaries aged 65+. Generalized linear models are applied to estimate the effect of different chronic diseases on total out-of-pocket expenditure, adjusted for demographics, socio-economic status, physical health, and other factors. We also decompose total spending by expenditure categories (inpatient, non-inpatient, and prescription drug spending). Sensitivity analysis is performed using a younger sample of older adults aged 50–64.

Results

Cardiovascular disease, diabetes, hypertension and cancer, induce significantly higher adjusted out-of-pocket spending among older adults than other conditions. These results hold regardless how the spending differences are assessed (absolute or percentage terms). For Medicare beneficiaries, cardiovascular disease is associated with an excess out-of-pocket spending of $317 per year, followed by diabetes ($237), hypertension ($150), and cancer ($144). Prescription drug spending is singularly the most important driver of additional expenses for cardiovascular disease, diabetes and hypertension, while non-inpatient services spending accounts for the bulk of increased spending among those with cancer.

Conclusions

Our finding that major noncommunicable diseases impact individuals’ out-of-pocket medical spending differentially–and that service drivers of increased spending may be heterogeneous across disease types–suggest that health professionals and policymakers should recognize that certain chronic diseases exert greater financial toll on the elderly. Interventions to promote more cost efficient healthcare services and consumer choices can help older adults better cope with these expensive long-lasting conditions and reduce the overall burden of noncommunicable diseases.

Klíčová slova:

Social sciences – Political science – Public policy – Medicare – Economics – Health insurance – Medicine and health sciences – Endocrinology – Endocrine disorders – Metabolic disorders – Cardiovascular medicine – Cardiovascular diseases – Health care – Health economics – Quality of life – Activities of daily living – Vascular medicine – Blood pressure – Hypertension – Public and occupational health – Socioeconomic aspects of health – People and places – Population groupings – Age groups – Elderly

Zdroje

1. Centers for Disease Control and Prevention. The state of aging and health in America 2013. Atlanta (GA): Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

2. Ward BW, Schiller JS, Goodman RA. Peer reviewed: multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014 Apr 17;11:E62. doi: 10.5888/pcd11.130389 24742395

3. American Cancer Society. Cancer treatment & survivorship facts & figures 2016–2017. Atlanta (GA): The Society; 2016.

4. Centers for Medicare & Medicaid Services. Chronic conditions among Medicare Beneficiaries, Chart Book 2012. Baltimore (MD): Centers for Medicare & Medicaid Services; 2012.

5. Langa KM, Fendrick AM, Chernew ME, Kabeto MU, Paisley KL, Hayman JA. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health. 2004 Mar;7(2):186–94. doi: 10.1111/j.1524-4733.2004.72334.x 15164808

6. Schoenberg NE, Kim H, Edwards W, Fleming ST. Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. Gerontologist. 2007 Aug 1;47(4):423–37. doi: 10.1093/geront/47.4.423 17766664

7. Paez KA, Zhao L, Hwang W. Rising out-of-pocket spending for chronic conditions: a ten-year trend. Health Aff. 2009 Jan;28(1):15–25.

8. Davidoff AJ, Erten M, Shaffer T, Shoemaker JS, Zuckerman IH, Pandya N, et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer. 2013 Mar 15;119(6):1257–65. doi: 10.1002/cncr.27848 23225522

9. Cubanski J, Swoope C, Damico A, Neuman T. How much is enough? Out-of-pocket spending among Medicare beneficiaries: A chartbook [Internet]. Menlo Park (CA): Kaiser Family Foundation; 2014 [cited 2019 Jan 18]. Available from: http://kff.org/report-section/how-much-is-enough-out-of-pocket-spending-among-medicare-beneficiariessection-1.

10. Narang AK, Nicholas LH. Out-of-pocket spending and financial burden among Medicare beneficiaries with cancer. JAMA Oncol. 2017 Jun 1;3(6):757–65. doi: 10.1001/jamaoncol.2016.4865 27893028

11. Li R, Barker LE, Shrestha S, Zhang P, Duru OK, Pearson-Clarke T, et al. Changes over time in high out-of-pocket health care burden in US adults with diabetes, 2001–2011. Diabetes Care. 2014 Jun 1;37(6):1629–35. doi: 10.2337/dc13-1997 24667459

12. Kang HA, Barner JC. Out-of-pocket healthcare expenditures among patients with chronic obstructive pulmonary disease. Value Health. 2015 May 1;18(3):A269.

13. Stewart ST. Do out-of-pocket health expenditures rise with age among older Americans?. Gerontologist. 2004 Feb 1;44(1):48–57. doi: 10.1093/geront/44.1.48 14978320

14. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 2009 Sep;28(5):w822–31.

15. Chi C, Lee JL, Tsai SL, Chen WY. Out-of-pocket payment for medical care under Taiwan's National Health Insurance system. Health Econ. 2008 Aug;17(8):961–75. doi: 10.1002/hec.1312 18004793

16. Hu TW, Ong M, Lin ZH, Li E. The effects of economic reform on health insurance and the financial burden for urban workers in China. Health Econ. 1999 Jun;8(4):309–21. 10398524

17. Akincigil A, Zurlo K. The economic burden of out-of-pocket medical expenditures before and after implementation of the Medicare prescription drug program. Newton (MA): Boston College, Center for Retirement Research; 2015. Report No: 2015–28.

18. Wong CY, Greene J, Dolja‐Gore X, van Gool K. The rise and fall in out-of-pocket costs in Australia: An Analysis of the Strengthening Medicare Reforms. Health Econ. 2017 Aug;26(8):962–79. doi: 10.1002/hec.3376 27385166

19. Crystal S, Johnson R, Harman J, Sambamoorthi U, Kumar R. Out-of-pocket health care costs among older Americans. J Gerontol Soc Sci. 2000;55(1):S5I–62.

20. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff. 2001 Nov;20(6):267–78.

21. Lopez AD, Williams TN, Levin A, Tonelli M, Singh JA, Burney PG, et al. Remembering the forgotten non-communicable diseases. BMC Med. 2014 Dec;12(1):200.

22. Noncommunicable Diseases Progress Monitor 2017 [Internet]. Geneva (CH): World Health Organization; c2019 [cited 2019 Jan 3]. Available from: www.who.int/nmh/publications/ncd-progress-monitor-2017/en/.

23. Health and Retirement Study. Sample sizes and response rates [Internet]. Ann Arbor: University of Michigan; 2017 [cited 2019 Jan 18]. Available from: https://hrs.isr.umich.edu/sites/default/files/biblio/Response/Rates_2017.pdf.

24. Kaye HS, Harrington C, LaPlante MP. Long-term care: Who gets it, who provides it, who pays, and how much?. Health Aff. 2010 Jan 1;29(1):11–21.

25. Goldman DP, Zissimopoulos J, Lu Y. Medical expenditure measures in the health and retirement study. Forum Health Econ Policy. 2011 Apr 1;14(3):4. doi: 10.2202/1558-9544.1267 24049512

26. Manning W, Morris C, Newhouse J, Orr L, Duan N, Keeler E, et al. A two-part model of the demand for medical care.: preliminary results from the health insurance study. In: Van der Gaag J, Perlman M, editors. Health, economics, and health economics. North-Holland: Amsterdam; 1981. p. 103–123.

27. Duan N, Manning WG, Morris CN, Newhouse JP. A comparison of alternative models for the demand for medical care. J Bus Econ Stat. 1983 Apr 1;1(2):115–26.

28. McCullagh P, Nelder JA. Generalized Linear Models. 2nd ed. London: Chapman Hall/CRC; 1989.

29. Hosmer DW, Lemeshow S. Applied logistic regression. New York: John Wiley & Sons; 1989.

30. Manning WG, Mullahy J. Estimating log models: to transform or not to transform?. J Health Econ. 2001 Jul 1;20(4):461–94. 11469231

31. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015 Dec 8;112(49):15078–83. doi: 10.1073/pnas.1518393112 26575631

32. American Heart Association. Cardiovascular disease: A costly burden for America (Projections through 2035). Washington (DC): The Association; 2017.

33. Lee JT, Hamid F, Pati S, Atun R, Millett C. Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis. PLoS One. 2015 Jul 8;10(7):e0127199. doi: 10.1371/journal.pone.0127199 26154083

34. Ladusingh L, Mohanty SK, Thangjam M. Triple burden of disease and out of pocket healthcare expenditure of women in India. PloS One. 2018 May 10;13(5):e0196835. doi: 10.1371/journal.pone.0196835 29746506

35. Lu K, Yuan J, Wu J. Out-of-pocket spending and financial burden of prescription drugs for diabetes: 2007–2010. Value Health. 2014 May 1;17(3):A262.

36. Himmelstein DU, Warren E, Thorne D, Woolhander S. Illness and injury as contributors to bankruptcy. Health Aff. 2005;24(1):570.

37. Dranove D, Millenson ML. Medical bankruptcy: Myth versus fact. Health Aff. 2006 Feb 28;25(2):w74–83.

38. Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016 Dec 27;316(24):2627–46. doi: 10.1001/jama.2016.16885 28027366

39. Sakharkar P. Health care expenditures, prescription drug cost, and out-of-pocket spending among adults with chronic disease condition combinations in the United States. Value Health. 2016 May 1;19(3):A14.

40. Hendershot E, Murphy C, Doyle S, Van-Clieaf J, Lowry J, Honeyford L. Outpatient chemotherapy administration: decreasing wait times for patients and families. J Pediatr Oncol Nurs. 2005 Jan;22(1):31–7. doi: 10.1177/1043454204272539 15574724

41. Song X, Brouillette M, Gatta F, Cristino J, Arellano J, Qian Y. Literature review on total medical costs and cost components of oncology care in the United States. Value Health. 2014 May 1;17(3):A81.

42. Numico G, Cristofano A, Mozzicafreddo A, Cursio OE, Franco P, Courthod G, et al. Hospital admission of cancer patients: avoidable practice or necessary care?. PLoS One. 2015 Mar 26;10(3):e0120827. doi: 10.1371/journal.pone.0120827 25812117

Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?

Souhrn

Background

Methods

Results

Conclusions

Klíčová slova:

Zdroje

PLOS One

INSIGHTS from European Respiratory Congress

Současné pohledy na riziko v parodontologii

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií