Chronic Disease

Gerard AndersonProfessor

Johns Hopkins University

“The lives of far too many people in the world are being blighted and cut short by non-

communicable chronic diseases such as heart disease, stroke, cancer, chronic respiratory disease and diabetes. This is no longer only

happening in high income countries... Globally, of the 58 million deaths in 2005,

approximately 35 million will be as a result of non-communicable chronic diseases. They are

currently the major cause of death among adults in almost all countries.”-Former Director General of WHO,

Lee Jong-wook

118

125

133

141

149

157

164

171

100

110

120

130

140

150

160

170

180

1995 2000 2005 2010 2015 2020 2025 2030

Year

Num

ber o

f Peo

ple

With

C

hron

ic C

ondi

tions

(mill

ions

)

• In 2000, 125 million Americans had one or more chronic conditions.

• Between 2000 and 2030, the number of Americans with chronic conditions will increase by 46 million people.

The Number Of People In US With Chronic Conditions Is Increasing Rapidly

Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

23%

12%

6%

4% 4%

0%

5%

10%

15%

20%

25%

30%

1 2 3 4 5+

Number of Chronic Conditions

Perc

ent o

f All

Am

eric

ans

One In Four Americans Has Multiple Chronic Conditions

69%

75%

65%

64%

17%

17%

26%

27%

25%

13%

7%

9%

9%

8%67%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Children with LowerRespiratory Disease

Children with Disordersof Teeth and Jaw

Children with EyeDisorders

Children with Asthma

Children with UpperRespiratory Disease

Condition Alone Condition+1 Condition+2

Source: Medical Expenditure Panel Survey, 2004.

Children with Chronic Conditions Generally Have a Single Condition

17%

37%

15%

33%

23%

25%

29%

26%

28%

28%

18%

14%

24%

16%

21%

15%

10%

15%

10%

14%

25%

11%

20%

13%

15%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Adults with Arthritis

Adults with ChronicRespiratory Infection

Adults with Disorders oflipid metabolism

Adults with UpperRespiratory Disease

Adults with Hypertension

Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+

Source: Medical Expenditure Panel Survey, 2004.

Most Adults With A Chronic Condition Have More Than One Condition

12%

16%

13%

17%

20%

21%

20%

21%

21%

25%

19%

22%

21%

21%

38%

36%

38%

35%

26%11%

7%

6%

9%

4%

21%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Seniors with DiabetesMellitus

Seniors with EyeDisorders

Seniors with HeartDisease

Seniors with Arthritis

Seniors with Hypertension

Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+

Source: Medical Expenditure Panel Survey, 2004.

Seniors With A Chronic Condition Rarely Have A Single Condition

Health Care Spending for People without Chronic Conditions

Health Care Spending for People with Chronic Conditions

Source: Medical Expenditure Panel Survey, 2004.

People With Chronic Conditions Accounted For 85 Percent Of All Health

Care Spending In 2004

85%

15%

Percent of Health Care Total Spending by Number of Chronic Conditions

2 Chronic

Conditions 18%

3 Chronic

Conditions 14%

4 Chronic

Conditions 12%

1 Chronic Condition

20%

0 Chronic

Conditions 15%5+ Chronic

Conditions 21%

Source: Medical Expenditure Panel Survey, 2004.

Sixty-Five Percent Of Health Care Spending Is On People With Multiple

Chronic Conditions

Source: Medicare Standard Analytic File, 2004.

1 Chronic Condition3%

4 Chronic Conditions12%

3 Chronic Conditions10%

2 Chronic Conditions6%

0 Chronic Conditions1%

5+ Chronic Conditions68%

Percent of Medicare Expenditures

Two-Thirds Of Medicare Spending Is For Beneficiaries With Five Or More

Chronic Conditions

$994

$2,753

$5,062

$7,381

$10,091

$16,819

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

0 1 2 3 4 5+

Number of Chronic Conditions

Ave

rage

Per

Cap

ita H

ealth

Car

e Sp

endi

ng

Source: Medical Expenditure Panel Survey, 2004.

Health Care Spending Increases With The Number Of Chronic Conditions

Source: Medicare Standard Analytic File, 2001.

1 8 1938

71

123

191

269

359

455

697

0

100

200

300

400

500

600

700

800

0 1 2 3 4 5 6 7 8 9 10+

Number of Chronic Conditions

Hos

pita

lizai

tons

for A

mbu

lato

ry C

are

Sens

itive

Con

ditio

ns P

er

1000

Med

icar

e B

enef

icia

ries

Age

s 65

+

Poor Care Coordination Leads To Unnecessary Hospitalizations

• Ambulatory care sensitive conditions (ACSCs) are conditions for which timely and effective outpatient primary care may help to reduce the risk of hospitalization.

24%

34%

34%

36%

44%

49%

54%

0% 10% 20% 30% 40% 50% 60%

Unnecessary nursing home placement

Experience of unnecessary pain

Patients not functioning to potential

Unnecessary hospitalization

Adverse Drug Interactions

Emotional problems unattended

Receipt of contradictory information

Adv

erse

Out

com

es

Percent of Physicians Who Believe that Adverse Outcomes Result from Poor Care Coordination

Physicians Believe That Poor Care Coordination Produces Bad Outcomes

46%43%

59%

71%

57%

46%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Total White Non-White Hispanic Uninsured Insured

Perc

ent o

f Peo

ple

with

Ser

ious

Chr

onic

Con

ditio

ns

Rep

ortin

g Th

at T

hey

Did

Not

Rec

eive

Nee

ded

Car

e

Source: Serious Chronic Illness Survey, conducted by the Gallup Organization, 2002.

People With Serious Chronic Conditions Believe

They Do Not Receive Needed Treatment

Problems To Overcome

Clinical research – complicated patients excluded form clinical trials Medical education – specialty not coordinated care is focus of medical school curriculumPayment and delivery systems- acute not chronic care orientationQuality measurement- care coordination and multiple chronic problems