Americans spending more on healthcare: report

NEW YORK (Reuters Health) - Americans spent about 40 percent more out of their own pockets for healthcare over the past decade, according to a report in the latest issue of the health policy journal Health Affairs. An increase in chronic conditions, especially diabetes and high blood pressure — not just among the “oldest old” but among baby boomers and older adults — is to blame, researchers say.

“Chronic conditions are more than just a health issue for the elderly. They are a household economics issue for every American,” lead co-author Kathryn Paez said in a statement. “Taking the time and making the effort to prevent diseases such as high blood pressure and diabetes will save Americans money and increase their quality of life,” Paez, a research scientist at the Silver Spring, Maryland-based Center for Health Policy and Research, Social and Scientific Systems, added.

Paez and colleagues compared 1996 and 2005 out-of-pocket healthcare costs using data from the national Medical Expenditure Panel Survey, which represents 292 million Americans.

They found that the average annual out-of-pocket spending on healthcare rose from $427 in 1996 to $741 in 2005. This represents a 39.4 percent inflation-adjusted increase in healthcare spending assumed directly by the consumer for things like insurance co-payments, deductibles, and other related medical items not covered by health insurance.

Prescription medications, by far, were the costliest out-of-pocket expenditures. According to Paez and colleagues, Americans over age 65 with multiple chronic diseases spent an average of $1,292 per year on prescription drugs in 2005 - more than five times more than what they spent on office visits. “The new Medicare Part D drug benefit may mitigate the financial burden of drug costs for this group,” the researchers say.

The greatest spike in spending occurred among people with multiple chronic conditions such as high blood pressure and diabetes. Between 1996 and 2005, reports of multiple chronic diseases roles 9.7 percentage points among Americans between 45 and 64 years old.

Whites reported having more chronic conditions than other races and women were more likely than men to report having at least one chronic medical condition, the results show.

Poor, near-poor and low-income Americans who did not receive Medicaid spent double what Medicaid recipients spent for care. This finding, Paez and colleagues say, highlights the need to expand coverage to non-elderly adults who are unable to obtain insurance through employers or other means. This is the group that is “increasingly developing chronic conditions while becoming more likely to be uninsured,” they note.

Because many chronic ailments stem from poor lifestyle habits and get better as lifestyle habits improve, health insurance benefits and healthcare reform should include incentives for people to adopt lifestyle practices that reduce the risk of chronic conditions and improve health, Paez and colleagues conclude.

“Employers are increasingly recognizing the value of wellness programs and making them available to employees. However, more dramatic and systematic efforts are needed to induce a societal shift where primary and secondary prevention is considered a basic benefit and healthy lifestyles are the cultural norm,” they wrote.

SOURCE: Health Affairs, January/February 2009.


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