Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?

Abstract

BackgroundLittle is known about the impact of different types of chronic diseases on older adults’ out-of-pocket healthcare spending and whether certain diseases trigger higher spending needs than others.MethodsWe use data from the 2014 Health and Retirement Study representing a weighted population of 35,939,270 Medicare beneficiaries aged 65+. Generalized linear models are applied to estimate the effect of different chronic diseases on total out-of-pocket expenditure, adjusted for demographics, socio-economic status, physical health, and other factors. We also decompose total spending by expenditure categories (inpatient, non-inpatient, and prescription drug spending). Sensitivity analysis is performed using a younger sample of older adults aged 50–64.ResultsCardiovascular disease, diabetes, hypertension and cancer, induce significantly higher adjusted out-of-pocket spending among older adults than other conditions. These results hold regardless how the spending differences are assessed (absolute or percentage terms). For Medicare beneficiaries, cardiovascular disease is associated with an excess out-of-pocket spending of $317 per year, followed by diabetes ($237), hypertension ($150), and cancer ($144). Prescription drug spending is singularly the most important driver of additional expenses for cardiovascular disease, diabetes and hypertension, while non-inpatient services spending accounts for the bulk of increased spending among those with cancer.ConclusionsOur finding that major noncommunicable diseases impact individuals’ out-of-pocket medical spending differentially–and that service drivers of increased spending may be heterogeneous across disease types–suggest that health professionals and policymakers should recognize that certain chronic diseases exert greater financial toll on the elderly. Interventions to promote more cost efficient healthcare services and consumer choices can help older adults better cope with these expensive long-lasting conditions and reduce the overall burden of noncommunicable diseases.

Managing the multifaceted nature of type 2 diabetes using once‐weekly injectable GLP‐1 receptor agonist therapy

“…Importantly, direct, diabetes‐related medical costs vary per patient, depending on the relative severity of a person's condition, the frequency of medical appointments, the pharmacologic interventions (Table 2) required to manage blood glucose levels and the degree of monitoring required to do so safely 8,72,76 . As such, out‐of‐pocket costs to the individual may differ 76 dependent on the highly variable retail value of different medications 8 and on their healthcare coverage/insurance plan 77 . Diabetes‐related costs can therefore remain very high for some individuals, to the extent that one in four Americans with T2D taking insulin reported reducing their dosage or stopping it altogether because they simply could not afford it 77,78 …”

“…Compared with other pharmacologic agents used for T2D that have a generic alternative available, the QW GLP‐1 RAs continue to be one of the more expensive treatment options available in terms of direct wholesale cost (Table 2). 8 Due to differences in out‐of‐pocket expenses and insurance coverage, 76,77 such wholescale costs may not be directly relevant to patients 8 . Also, as discussed, direct medical cost of diabetes treatment is just one component contributing to the economic impact on patients.…”

Do chronic illnesses and poverty go hand in hand?

“…The findings of another research depict that, households are more likely to spend 11% of their total household budget on healthcare and medications, whereas 50% of the occupants tend to spend 7% of their monthly per capita consumption expenditure on different illnesses [ 39 ]. Fong [ 40 ] describes that out of all NCDs, diabetes, cancer, cardiovascular disease and hypertension account for majority of the out-of-pocket medical spending especially among the elderly population. Also, flaws in health financing systems, unreliable and undependable medicines supply schemes as well as poor prescribing practices can be recognised as obstructions in accessing medications [ 41 ].…”

Analysis of the Economic Burden of Noncommunicable Diseases in Dalian City of China, Based on the “System of Health Accounts 2011”

“…Previous work was focused on speci c types of NCDs or speci c regions of the world [24][25][26], although this can provide a more accurate intervention scheme for a certain NCDs, it is easy to waste resources if it is not grasped at a higher level because there are more people have more than one type of NCDs [18], and there are more types of NCDs. In this study, we collected expenditure information of NCDs patients in Dalian and used "System of Health Account 2011" (SHA 2011) to count each part of curative expenditure [27][28].…”