ShareThisAmericans like to think of themselves as fundamentally healthy, able to run out and clear a field, build a log cabin or race a 5K whenever so moved.
But various estimates by the government indicate that anywhere from 90 million to 133 million of us are living with at least one chronic illness or condition.
Those illnesses cause major limitations to the ability to work or carry out ordinary daily functions for at least 25 million Americans. And 7 of every 10 Americans who die each year succumb to a chronic illness.
Of course, the fact that the other 100 million plus don't die from their chronic illness each year is a testament to the prowess of modern medicine.
But caring for people with chronic illness also consumes more than 75 percent of the greater than $2.2 trillion the United States shells out for health care each year.
Legions of health policy experts have found lots of things to blame for the chronic care crisis. Better health care and nutrition have made it rare for Americans to die from many ailments that cut lives short a few generations back. But lifestyle, environment and diet have also set more of us up for diabetes, high blood pressure and heart disease, often barely into midlife.
Yet most of our systems for the delivery of -- and payment for -- health services are organized to care for people with illness or injury of short duration. Figuring out ways to make the system work better, and possibly, cheaper, for people with chronic conditions is one of the biggest challenges of health care reform at the national and state level.
New research out this week demonstrates that chronic illness also hits hard at personal as well as national economies.
Out-of-pocket spending for health care has gone up an average of 40 percent for consumers in the past decade, researchers report in the latest issue of the journal Health Affairs. And while older Americans are more likely to have more than one chronic condition and bear a higher share of out of pocket spending, the increases hit people from middle age onward.
"Chronic conditions are more than just a health issue for the elderly. They are a household economics issue for every American," said Kathryn Paez, lead author of the report and a senior research scientist with the Center for Health Policy and Research, Social and Science Systems in Silver Spring, Md.
High out-of-pocket expenses, which most often involve prescription drug co-pays or deductibles, have especially serious consequences for people with chronic illness, Paez said. Many attempt to skimp on doses to save money, but wind up in poorer health and needing even more expensive, ongoing care as a result.
The severity of the situation is underscored by a new survey released by AARP last week, which found that 22 percent of adults 45 and older told interviewers they had delayed seeing a doctor because of cost concerns, 21 percent had cut back on other expenses to afford health care, and 16 percent had had to dip into retirement or other savings to pay for health care.
The share of medical costs borne by consumers -- health insurance premiums, co-insurance and deductibles for other services -- are also on the rise. And some research indicates that with many doctors and other providers limiting the insurance networks they'll work with, more families are being forced to seek care outside those networks, pushing out-of-pocket costs even higher.
For many families, generic versus brand name means a difference between a $5 or less co-pay or spending many times that for a name brand prescription every month.
Another Health Affairs report on national spending noted that out-of-pocket costs grew by 5.3 percent in 2007, to $268.6 billion, compared to 3.3 percent growth in 2006. That represents 6 percent of all household income, and was driven by retail drug cost inflation, as well as higher charges for nursing home care, medical supplies and care delivered in clinics and urgent care centers.
Some health insurance plans are adjusting payments to cover more preventive care and expanding the definition of preventive to better cover drugs for chronic conditions like diabetes, asthma, high blood pressure or cholesterol, recognizing that they too benefit from keeping patients out of the hospital and able to lead active lives.
But it's still rare to find a plan that will cover more than one or two wellness or preventive trips to a doctor or clinic in a year. Much of the time, managing long-term illness remains undervalued.
On the Net: http://www.healthaffairs.org
(E-mail Scripps Howard News Service health and science writer Lee Bowman at bowmanl(at)shns.com.)
The Medical Journal
