The prevalence of chronic conditions and medical expenditures of the elderly by chronic condition indicator (CCI)

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Abstract

The aim of this study was to understand the prevalence of chronic conditions and medical expenditures of the elderly for health care planning development of chronic conditions. This research is based on the representative sample (N = 114,873) of seniors over 65 years nationwide. The CCI by the U.S. Agency for Healthcare Research and Quality (AHRQ), and clinical classifications software (CCS) were adopted to determine chronic condition diagnosis codes and classify the diseases. The results are presented by descriptive and multiple regression analysis. The chronic condition prevalence for seniors is 70.4% and the medical expenditures for seniors with chronic conditions accounts for 92.7% of the total medical expenditures for seniors, while 25% of the medical expenditure is spent on 8.2% of seniors who have five chronic conditions and above. Chronic conditions suffered by the elderly, in the order of its prevalence, are hypertension (36.1%), COPD (23.7%), and cataracts (16.7%). From the viewpoint of annual average medical expenditures, cardiovascular diseases rank the most costly diseases, with average medical expenditures as high as $4291. Urinary disease and diabetes ranks the second and the third most costly with an average expenditure of $3644 and $3594. This research showed that the average medical expenditure for seniors with chronic conditions is 5.4 times higher compared with seniors without chronic conditions. It is recommended to further study the characteristics of the target population that spends the most in medical expenditures to outline a more beneficial disease management model, reduce avoidable medical costs and achieve the goal of saving medical resources.

Introduction

With the rapidly growing senior population and prevalence of chronic conditions and functional disorders, the issue of exhausted medical and long-term care resources begins to receive international attention. In the process of disease transition, chronic conditions have replaced infectious disease to become the biggest challenge for medical and health care systems. The ten leading causes of death in 2005, according to statistics of the Department of Health in Taiwan, indicate the following diseases are chronic conditions: malignant tumors, cerebrovascular disease, heart disease, diabetes, chronic liver disease, nephritis, and hypertension. According to a research report from Milken Institute in the U.S., medical treatment for chronic conditions costs $300 billion each year and 1 trillion in productivity in the U.S. (DeVol and Bedroussian, 2007). It indicated chronic conditions as the major disease affecting health of the citizens at present, and in the future, this issue is of concern worldwide.

Many researches have confirmed that current medical expenditures mostly focus on the issue of chronic conditions (Hoffman et al., 1996, Monane et al., 1996, Druss et al., 2001, Wolff et al., 2002, Cohen and Krauss, 2003, Weiner et al., 2003, Yu et al., 2003, Perkins et al., 2004). Based on Medical Expenditure Panel Survey (MEPS), the prevalence of chronic conditions for seniors is as high as 88%, while the cost of their medical treatment for chronic conditions accounts for 75% of the total medical expenditures (Hoffman et al., 1996). Medicare data indicates that 82% of the elderly have chronic conditions, with an annual average medical expenditure of $5115 USD, while the medical expenditure for seniors without chronic conditions is only $211, $1154, $2394, $4701, and $13,973 for seniors with one, two, three, four or more chronic conditions, respectively (Wolff et al., 2002). It is estimated that 99% of total medical expenditure are spent on seniors with chronic conditions (Chronic Conditions: Making the Case for Ongoing Care, 2002).

There are no conclusive results in terms of prevalence of different chronic conditions and resource utilizations. Some researches indicate 49% of the entire sample cases suffer from heart disease costing 57% of the entire medical expenditure. Diabetes ranks the second, which accounts for 16% of the total cases, costing 18% of the expenditure (Weiner et al., 2003). Researches showed hypertension is widely suffered by 36.8% of the veterans, while spinal cord nerve damage ranks the first in terms of the average medical expenditures, as high as $26,735 per year (Yu et al., 2003). Analysis of MEPS data by Cohen and Krauss (2003) indicated that, among the most costly major medical conditions, 66.2% of the total medical expenditure spent on seniors who joined Medicare for cerebrovascular condition, 44.6% and 44.3% spent for heart disease and kidney disease, respectively and 34.4% spent for seniors with arthritis. Druss et al. (2001) found that the most costly medical conditions are as follows: hypertension, emotional disorder, asthma, diabetes and heart disease.

Based on the above research results, seniors with chronic conditions are the major population in terms of costing medical resources. Health care for chronic condition has become the most significant medical expenditure worldwide, especially for seniors. Chronic conditions are particularly major health and medical issues encountered by the general public, while there is not yet a comprehensive disease management to effectively reduce the percentage of medical expenditure for chronic conditions. Many researches indicated that chronic conditions have impact on medical systems. However, there are some limitations in past studies as follows. First, the major population of chronic conditions is the elderly, yet several studies only focused on small samples or persons who are insured, instead of using a representative sample to understand the prevalence of chronic conditions for seniors and the utilization of medical resources. Second, previous research data are mostly from hospital records, interview surveys and registration files. Data from different sources have limitations on use. For example, hospital records only include information of patients treated at that hospital, which cannot generalize to public. Interview surveys have the issue of memory bias, and registration files only contain data concerning medical treatment instead of personal information, such as characteristics in social demography, disability and other factors that might have effect on medical expenditure. Thus, it is easy to make mistakes in making inferences for analysis. Third, many studies only focused on the cost of special chronic conditions (McNamara et al., 2001, Zhang et al., 2003), while there is little research interested in the medical expenditures spent on every kind of chronic conditions (Schoenberg et al., 2007).

Approximately 80% of the seniors over 65 years of age have at least one chronic condition (Department of Health, Executive Yuan, 1999), but it is difficult to find data showing medical expenditures of chronic conditions in Taiwan. Following the world trend of a rapidly growing aging population, this research aims to use a nationwide representative sample for senior populations, and information from national health insurance claims to understand the percentage of medical expenditure for seniors with chronic conditions and provide references for future planning of chronic conditions health care system.

Section snippets

Subjects and methods

The data of this research were based on the “Assessment of National Long-term Care Need in Taiwan” program of the Department of Health, and a two-phase survey. The data were collected from face-to-face questionnaire interviews with assistance from the Bureau of the Health Promotion Population and Health Survey Research Center, Department of Health. Led by an excellent research team, the staff surveyed townships across Taiwan, and collected high quality data. The first-stage survey used three

Results

Among the sample of 114,873 seniors over 65 years, 94.6% of the cases (N = 108,680) used medical services, at least once, in the year the interview was conducted. The distributions of gender, age, health care model, condition of disability, social benefit status, and their residence in towns and counties, for seniors who used medical service are as shown in Table 1. Males are a little more than females; 63% of the seniors are in the age group of 65–74; 98.7% of the elderly live at home, while

Discussion and conclusions

The above results indicate that, the prevalence rate of chronic conditions for seniors over 65 is 70.4%, which is lower than the prevalence rate of chronic condition for American seniors (82–88%), and past survey results in Taiwan (Hoffman et al., 1996, Department of Health, 1999, Wolff et al., 2002). But our data show similar results to the prevalence rate (74.0%) of chronic conditions for seniors over 65 by using the 2000 National Health Insurance academic research database (Liang, 2004). The

Conflict of interest statement

None.

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As of August 2010 new affiliation: Christian University to School of geriatric nursing and care management in Taipei Medical University.

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