By LEE BOWMAN
Scripps Howard News Service
August 25, 2006
The study, published online this week by the journal Health Affairs, examines trends in annual Medicare spending and caseloads between 1987 and 2002.
Kenneth Thorpe, chairman of health-policy management at Emory University's School of Public Health, and David Howard, an assistant professor in the department, found that in 1987, 31 percent of Medicare patients were receiving treatment for five or more conditions; by 2002, that share had risen to 50.2 percent.
Better diagnostic tools and more options for treating chronic diseases of aging appear to be part of a trend toward doctors aggressively treating the elderly.
Obesity also appears to be a major factor behind the spending increases. The study found that while obesity rates among Medicare patients doubled during the 15-year period, spending on obese patients tripled, to account for 25 percent of the total.
The share of normal-weight patients being treated for five or more conditions also grew, and their share of spending increased by 20 percent.
Thorpe and Howard say one explanation for the spending increases is that "physicians are more aggressively targeting healthier beneficiaries over time."
In 2002, nearly 60 percent of the Medicare patients being treated for five or more conditions reported being in "good" or "excellent" health, compared to just 33 percent in 1987.
The researchers focused on metabolic syndrome, a cluster of cardiovascular-related risk factors that affect nearly half of Medicare patients, as a case study of how treatment is becoming more aggressive.
During the first half of the study period, 57 percent of beneficiaries with metabolic syndrome were also treated for diabetes, high blood pressure or low levels of high-density lipoprotein (good cholesterol). These are all conditions associated with the metabolic disorders. By the final four years of the review, 68 percent of the patients were treated for at least one of the related conditions.
"Physicians are more aggressively treating these patients now, which in the interim is driving up spending. But the real question is whether treatment is improving quality of life and increasing longevity," the researchers said.
Medicare's success at extending lifespan may mean increased costs in the long run, "as increases in longevity for people with chronic conditions prolong the period over which they incur high costs year-in and year-out," the authors write.
Specifically, six chronic health conditions accounted for two-thirds of the rise in Medicare spending between 1987 and 2002 - mental disorders (mainly depression and anxiety); heart disease, arthritis and three conditions linked to metabolic syndrome - high blood pressure, diabetes and low "good" cholesterol levels.
The researchers argue that Medicare's payment system needs to be overhauled to reimburse for more services that can keep chronic conditions from getting to the point of expensive hospital care.
With more people growing obese and often developing diseases of aging well before age 65, Thorpe said, "we need interventions that go beyond what current Medicare policy does, to reach the 'near elderly' and work with people before they approach the age of Medicare eligibility to fight obesity and chronic disease."
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