Prescription drug spending: the impact of age and chronic disease status.

Abstract

OBJECTIVES: The purpose of this study was to examine how pharmaceutical expenditures vary by age and the presence of chronic health problems. METHODS: Data from the 1987 National Medical Expenditure Survey were used to obtain nationally representative estimates of outpatient prescription drug expenditures for the noninstitutionalized population and the fraction of total health expenditures used to purchase medications for age-chronic disease population subgroups. RESULTS: Although the elderly make up 12% of the population, they account for 34% of total pharmaceutical expenditures. Pharmaceutical expenditures are 9% of total expenditures for children, 13% for nonelderly adults, and 23% for the elderly. Among nonelderly adults, approximately one third have at least one chronic condition and account for over two thirds of drug expenditures. Among the elderly, 36% have three or more chronic conditions and account for 57% of drug expenditures for this group; 41% of total drug expenditures are for cardiovascular or renal drugs. CONCLUSIONS: Significant pharmaceutical spending is for treatment of chronic conditions, which subjects insurance coverage to adverse selection and could affect the design of prescription drug benefit packages. Current enrollees in Medicare risk management plans who have drug benefits may face significantly higher out-of-pocket expenses for pharmaceuticals if capitation rates are cut as a means of controlling Medicare program expenditures.

The Economic Burden of Health Care, Funeral, and Burial Expenditures at the End of Life

“…Third party payments covered only 81% of that total with the remaining $172.4 billion being paid out-of-pocket by consumers (U.S. Bureau of the Census 1998). Research has shown that these out-of-pocket health care expenditures increase with age (Acs and Sabelhaus 1995;Cutler and Meara 1998;Hitschler 1993;Rubin and Koelln 1993) and chronic disease status (Mueller, Schur, and O'Connell 1997). Could these increases in outof-pocket health care expenditures associated with age and chronic disease status be a factor that contributes to the increased risk that a newly widowed individual will experience a substantial decline in needs-adjusted income?…”

Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil

“…A maioria dos estudos de utilização de medicamentos relata o uso de um número médio de quatro medicamentos por idoso 4,5,6,7,8,9 . O perfil de utilização de medicamentos por idosos acarreta em gasto elevado com a aquisição dos mesmos em comparação ao observado nas demais faixas etárias 10,11 .…”

“…A maioria dos estudos de utilização de medicamentos relata o uso de um número médio de quatro medicamentos por idoso 4,5,6,7,8,9 . O perfil de utilização de medicamentos por idosos acarreta em gasto elevado com a aquisição dos mesmos em comparação ao observado nas demais faixas etárias 10,11 .Os gastos com medicamentos utilizados pelos idosos são concentrados em determinadas categorias terapêuticas. Considerando o primeiro nível de classificação Anatomical Therapeutical Chemical (ATC) 12 dos medicamentos, as categorias sistema cardiovascular, sistema nervoso e trato alimentar e metabolismo são responsáveis pela maior parte dos gastos por idosos 13,14,15 .…”

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

“…Multiple morbidity often increases older adults' economic vulnerability (Mueller, Schur, & O'Connell, 1997;Bierman & Clancy, 2000;Crystal, Johnson, Harman, Sambamoorthiu, & Kumar, 2000;Stroupe, Kinney, & Knieser, 2000;Tu, 2004). Because those individuals who endure the greatest frequency of multiple morbidities tend to be those with the fewest financial resources, multiple morbidity can pose a significant burden to older adults with lower incomes.…”