Cost of Chronic Illness

  JAMA Article: Persons with Chronic Conditions: Their Prevalence and Costs
Catherine Hoffman, ScD; Dorothy Rice; Hai-Yen Sung, PhD; "Persons with Chronic Conditions: Their Prevalence and Costs," JAMA, November 13, 1996; Vol 276, No. 18, pg. 1473.
The authors of this article note at the outset that "chronic health conditions, a general term that includes both chronic diseases and impairments, have been ... the leading public health concern since the 1920s." Despite this long standing concern and the fact that 90 million persons in the U.S. have chronic conditions, "our health care system remains firmly rooted in episodic and acute care."
The study sought to determine "(1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct cots (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death)."
The study found the following:
   In 1987, over 88 million non-institutionalized Americans (46% of persons who had identified a health condition associated with medical care use or disability days) had 1 or more chronic conditions in 1987.
   When we include the 1.5 million people living in nursing homes, the total amounts to 90 million persons with chronic conditions.
   In 1995, the number or people with 1 or more chronic illnesses was estimated to be almost 100 million.
   Rates of chronic conditions were highest among the elderly, where 88% had at least one chronic condition.
   However, chronic conditions were prevalent in all ages. For example, 12 million or 1 in 4 children younger than 18 years had a chronic condition. More than one third of young adults aged 18-44 years and two-thirds of middle aged adults aged 45-64 years had at least 1 chronic condition.
   The costs of health care services and supplies for noninstitutionalized persons with chronic conditions totaled over $272 billion in 1987. While 46% of persons reported chronic conditions, they accounted for 76% of the direct medical care costs in the U.S.
   The majority of people with chronic conditions are not disabled, but are living normal lives. However, they live with the threat of recurrent exacerbations, higher health care costs, more days lost from work than others, and the elevated risk of long term limitations and disabilities.
   Nearly every family in the U.S. is affected by chronic conditions.
   Our health care delivery system is still largely based on the construct of acute illness and often fails to meet the full needs of people with chronic conditions.
   People with chronic conditions are at greater risk for being underinsured.
   Studies suggest that the provision of community-based services has generally raised health care costs because reductions in institutional care have been more than offset by the increased use of community-based care.