Spending and service use among people with the fifteen most costly medical conditions, 1997

Health Affairs

Volumn 22, Issue 2, 2003, Pages 129-138

  Cohen, Joel W ^a   Krauss, Nancy A ^a  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE DISEASE; ARTICLE; CHRONIC DISEASE; CLASSIFICATION; COMORBIDITY; ECONOMICS; FAMILY SIZE; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH CARE QUALITY; HEALTH INSURANCE; HEALTH SERVICES RESEARCH; HUMAN; MEDICAID; MEDICARE; ORGANIZATION; STATISTICS; UNITED STATES;

ACUTE DISEASE; CHRONIC DISEASE; COMORBIDITY; FAMILY CHARACTERISTICS; FINANCING, PERSONAL; HEALTH EXPENDITURES; HEALTH PRIORITIES; HEALTH SERVICES RESEARCH; HUMANS; INSTITUTE OF MEDICINE (U.S.); INSURANCE, HEALTH; MEDICAID; MEDICARE; QUALITY ASSURANCE, HEALTH CARE; UNITED STATES; UNITED STATES AGENCY FOR HEALTHCARE RESEARCH AND QUALITY;

EID: 0037364996     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.2.129     Document Type: Article

References (24)

1. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academy Press, 2001).
2. See, for example, B.G. Druss et al., "Comparing the National Economic Burden of Five Chronic Conditions," Health Affairs (Nov/Dec 2001): 233-241;
3. and B.G. Druss et al., "The Most Expensive Medical Conditions in America," Health Affairs (July/Aug 2002): 105-111.
4. C. Hoffman et al., "Persons with Chronic Conditions: Their Prevalence and Costs," Journal of the American Medical Association 276, no. 18 (1996): 1473-1479;
5. T. Baker et al., "Challenges to Identifying Actual Case-Mix Complexity and Total Treatment Charges," Disease Management 10, no. 4 (1997): 91-96;
6. E. Yellin et al., "A National Study of Medical Care Expenditures for Respiratory Conditions," European Respiratory Journal 19, no. 3 (2002): 414-421;
7. and T.A. Hodgson and A.J. Cohen, "Medical Care Expenditures for Diabetes, Its Chronic Complications, and Its Comorbidities," Preventive Medicine 29, no. 3 (1999): 173-186.
8. For further information on the survey, see J.W. Cohen et al., "The Medical Expenditure Panel Survey: A National Health Information Resource," Inquiry (Winter/Spring 1996-1997): 373-389.
9. Full documentation for Public Use File (PUF) HC-020 and PUF HC-018 is available from Agency for Healthcare Research and Quality, "MEPS HC-020: 1997 Full Year Consolidated Data File," www.meps. ahrq.gov/Puf/PufDetail. asp?ID=36 (9 December 2002).
10. Using the 1997 MEPS files provided the largest relevant sample sizes for this type of analysis. In addition to having oversamples of people with impairments and those predicted to have high medical expenditures, the overall 1997 sample size was approximately 50 percent larger than for the 1996 or 1998 MEPS. For a detailed description of the 1997 MEPS household sampling methodology, see S.B. Cohen, Sample Design of the 1997 Medical Expenditure Panel Survey Household Component, MEPS Methodology Report no. 11, AHRQ Pub. no. 01-0001 (Rockville, Md.: AHRQ, 2000).
11. N. Krauss and B. Kass, "Comparison of Household and Medical Provider Reports of Medical Conditions" (Paper presented at the Joint Statistical Meetings, Indianapolis, Indiana, August 2000).
12. Clinical Classification Software was formerly called Clinical Classification for Health Policy Research. See A. Elixhauser et al., Clinical Classifications for Health Policy Research: Hospital Inpatient Statistics, 1996, Health Care Utilization Project, HCUP-3 Research Note, Pub. no. 98-0049 (Rockville, Md.: AHRQ, 1998).
13. Collapsed CCS codes were reviewed by Healthcare Cost and Utilization Project (HCUP) staff at AHRQ. Codes were aggregated into the following categories: heart disease, 96, 97, 100-108; cancer, 11-45; trauma, 225-236, 239, 240, 244; mental disorders, 65-75; pulmonary conditions, 127-134; diabetes, 49, 50; hypertension, 98, 99; cerebrovascular disease, 109-113; arthritis, 201-204; pneumonia, 122; kidney disease, 156-158, 160, 161; endocrine disorders, 48, 51, 52, 54-58; skin disorders, 197-200; back problems, 205; and infectious diseases, 1-9.
14. For a detailed description of the MEPS Medical Provider Component, see S. Machlin and A. Taylor, Design, Methods, and Field Results of the 1996 Medical Expenditure Panel Survey Medical Provider Component, MEPS Methodology Report no. 9, Pub. no. 00-0028 (Rockville, Md.: AHRQ, 2000).
15. In cases where emergency department visits were immediately followed by an inpatient hospital stay, the emergency department expenses are included with inpatient hospital expenses.
16. Note that the population covered by the survey excludes people in institutional living arrangements, such as nursing homes. Thus, not all types of health care spending are represented, and some payment sources, such as Medicaid, which covers a large portion of nursing home expenditures, may be underrepresented as well.
17. Standard errors for all of the estimates presented are available from the authors on request. Send e-mail to Joel Cohen, jcohen@ahrq.gov.
18. Although spending estimates in Exhibit 1 represent some double-counting as a result of the inability to identify the primary reason for a provider visit, analyses limited to principal diagnoses would produce an underestimate of diagnoses that tend to be secondary such as hypertension or dementia. See D.S. May et al., "Surveillance of Major Causes of Hospitalization among the Elderly, 1988," Morbidity and Mortality Weekly Report 40 (SS-1) (1991): 7-17.
19. Medical care spending for the U.S. civilian noninstitutionalized population totaled $553 billion in 1997. This is less than the amount reported in the Centers for Medicare and Medicaid Services' (CMS's) National Health Accounts, largely because of differences in the scope of the populations and services included. For a thorough analysis of these differences, see T. Selden et al., "Reconciling Medical Expenditure Estimates from the MEPS and the NHA, 1996," Health Care Financing Review 23, no. 1 (2001): 161-178.
20. F.R. Lichtenberg, "Are the Benefits of Newer Drugs Worth Their Cost? Evidence from the 1996 MEPS," Health Affairs (Sep/Oct 2001): 241-251.
21. M.L. Berk and A.C. Monheit, "The Concentration of Health Care Expenditures, Revisited," Health Affairs (Mar/Apr 2001): 9-18.
22. As noted previously, these spending estimates are not mutually exclusive, and spending for care of people with multiple conditions is included in each condition category.
23. Note that this ranking is based on annual spending. A ranking by lifetime spending might introduce some rare conditions that are not prevalent enough to be adequately represented in the survey and could change the rankings.
24. K. Levit et al., "Inflation Spurs Health Spending in 2000," Health Affairs (Jan/Feb 2002): 172-181.