Medicare Beneficiaries With Multiple Chronic Conditions 99 Times More Likely to be Hospitalized

Better Coordinated Primary Care Could Reduce Hospitalizations and Costs

Medicare beneficiaries with four or more chronic conditions such as asthma, arthritis, diabetes, or hypertension are 99 times more likely to experience one or more potentially preventable hospitalizations than those without a chronic condition, according to a study conducted by the Johns Hopkins Bloomberg School of Public Health. The study is published in the November 11, 2002, edition of the Archives of Internal Medicine and is the first to evaluate on a nationwide scale the risk for incurring a potentially preventable hospitalization for people with chronic conditions.

“Our research shows that 82 percent of Medicare beneficiaries have at least one chronic condition; 65 percent have multiple chronic conditions and account for 95 percent of all Medicare expenditures,” explained co-author Gerard Anderson, PhD, professor of Health Policy and Management and International Health at the Johns Hopkins Bloomberg School of Public Health. Dr. Anderson is also national program director for Partnership for Solutions, a Robert Wood Johnson Foundation national program to improve the care and quality of life of Americans with chronic health conditions. He added, “Many costly hospitalizations are preventable with better care and coordination of primary care services. Currently, our health care system is focused on providing acute care and not managing ongoing chronic conditions.”

For the study, Dr. Anderson and colleagues, Barbara Starfield, MD, MPH, professor of health policy and management, and Jennifer L. Wolff, MHS, doctoral candidate in health services research at the Johns Hopkins Bloomberg School of Public Health, analyzed the health records of 1.2 million randomly selected Medicare beneficiaries from 1999. All of the beneficiaries were age 65 or older and enrolled in fee-for-service coverage with both Medicare Part A and Part B.

After adjusting for the influence of age, gender, and other factors, the researchers found that the rate of preventable hospital admissions for ambulatory care sensitive conditions among individuals increased with the number of chronic conditions as did the number of impatient admissions for patients with preventable complications. Of the 1.2 million study participants, 459,658 were admitted to the hospital for treatment during the study period.

Study results also showed that the per capita Medicare expenditures increased for beneficiaries with the number of chronic conditions. Expenditures went from $211 for beneficiaries with no chronic conditions to $2,394 for individuals with two chronic conditions, to $4,701 for those with three chronic conditions, and up to $13,973 for those with four or more chronic conditions.

“We have a medical care system which is not designed to care for people with multiple chronic conditions and we are paying for that failure,” added Dr. Anderson.

“Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly” was written by Jennifer L. Wolff, MHS, Barbara Starfield, MD, MPH, and Gerard Anderson, PhD. It appears in the November 11, 2002. edition of Archives of Internal Medicine.

The study was supported by the Partnership for Solutions, a national program of the Robert Wood Johnson Foundation.