Americans with five or more chronic conditions make up 12% of the population but account for 41% of total health care spending, according to a new report from the RAND Corporation. In an article posted on the RealClear Health website, Dr. Kenneth Thorpe, whose organization, the Partnership to Fight Chronic Disease, supported the study, discusses its findings.
According to Thorpe, if current trends persist, chronic diseases will claim millions of lives and cost trillions of dollars in the United States. To lower that toll, health care organizations need to promote prevention efforts and to improve access to recommended care for those who are already diagnosed.
The RAND study found that in 2014, the latest data available, 32% of people with five or more chronic conditions visited an emergency department (ED) at least once. Thorpe points out that an ED visit costs more than $1,200 on average. “Multiply that by several million visits, and the costs pile up,” he said.
Moreover, the sickest patients require more prescriptions. In 2014, people with five or more chronic conditions filled nearly six times the number of prescriptions than did people with one or two chronic diseases, according to the RAND report.
The study found that, between 2008 and 2014, the prevalence of multiple chronic conditions was higher among adults 65 years of age or older (81%) compared with those aged 45 to 64 years (50%) and those aged 18 to 44 years (18%). Just over 100 million Americans have multiple chronic conditions, and 54 million of them are women. Non-Hispanic whites had a higher reported prevalence of chronic conditions than other racial or ethnic groups. One reason could be that nonwhite racial/ethnic groups have historically had less access to insurance and health care services, making it less likely that their conditions would be diagnosed or treated, the report suggests.
In 2014, hypertension (27%) and high cholesterol (22%) were the most common chronic conditions in the U.S, followed by mood disorders (12%), diabetes mellitus (10%), and anxiety disorders (10%), the study found. Between 2008 and 2014, the prevalence of hypertension increased by 2.5% among men, and anxiety disorders increased by 4.4% among women. The reported prevalence of mental health conditions also increased.
The RAND study also found that Americans with five or more chronic conditions spend 14 times more on health services than do people with no chronic conditions, with most of that additional spending going to office visits, inpatient visits, and prescriptions.
In addition, spending on health care services increases with the number of chronic conditions but varies by insurance type, according to the report. For example, the average annual Medicare expenditure for a person with five or more chronic conditions is $17,640 compared with $1,973 for a person with no chronic conditions. Similarly, the average annual expenditure for a person with five or more chronic conditions who has private insurance is $18,351 compared with $1,533 for a person with no chronic conditions.
“If we hope to save lives and avoid such staggering costs, we must undertake key reforms to help patients manage and prevent chronic diseases,” Thorpe says. For example: