These selected abstracts provide brief
background information on national perspectives of the looming crisis in
chronic care.
Increasing Costs of Chronic Care May Bring on
Funding Crisis in Health System- -
Bill Ingram in the Medical Tribune, 1996.
Chronic care for often co-existing disease states
is an emerging monster, eclipsing the cost and scope of specific, acute-disease
care, according to health-care policy experts.
"We are moving from a predominance of
short-term-care-oriented conditions to a predominance of conditions that
require ongoing, multidimensional, high-cost care," said Richard
Bringewatt, president of the National Chronic Care Consortium.
Diane Rowland, vice president of the Kaiser Family
Foundation, observed, "I think we're going to face a huge crisis in
trying to stick with the status quo to finance chronic care in the future. We
need to look at the structure of benefits, and figure out how to shift funds
between chronic and acute care."
Chronic Diseases: The Nation's Leading
Causes of Death -- Drug Benefit Trends, 1998.
Chronic diseases are the nation's leading
killers, responsible for more than 70% of all deaths. Many of the 1.7 million
deaths among Americans from chronic diseases each year are in large part
preventable by changes in lifestyle and timely screening.
The medical care costs for persons with chronic
diseases total more than $400 billion annually, or more than 60% of total
medical care expenditures.
Much of the chronic disease burden is preventable.
Effective prevention measures exist today to curtail the illnesses,
disabilities, and unnecessary or early deaths caused by these diseases. In
addition to changes in lifestyle, tools are at hand to detect certain chronic
diseases in their early stages, when treatment is most effective.
Social Security Disability Trends --
Social Security Monthly Benefit Database, and 1998 Annual Statistical
Supplement.
Social Security disabled worker, disabled
widow(er) and disabled child beneficiaries have increased from 4.8 million in
1994 to 5.6 million in 1998, a growth of 17 percent over this 4-year period.
The number of Supplemental Security Income (SSI)
recipients remained stable over this period but numbered an additional
6.6-to-6.7 million people with disabilities from 1996 to 1998.
In New York State, as of December 1997, there were
452,343 disabled SSI recipients under 65 years of age and 312,617 Social
Security disabled workers beneficiaries under 65 year old.
Diagnostic groups reported for New York
State's disabled workers show that 24.9 percent had mental disorders
(other than retardation), 24.2 percent had musculoskeletal system diseases,
12.6 percent had circulatory system diseases, and 9.3 percent had nervous
system and sense organs diseases. Each of three other diagnostic groups
- -
mental retardation, injuries, and endocrine, nutritional and metabolic
- -
accounted for an additional 5 percent of the disabled worker
beneficiaries.
Older and Younger People with
Disabilities -- Administration on Aging Fact Sheet, 1998
As the population ages, more Americans will have
illnesses and chronic conditions that limit their ability to carry out ordinary
tasks - -
bathing, rising from a chair, opening a window, and walking to the
grocery store. With a current life expectancy of 75 years, newborns, today, can
expect to experience an average of 13 years with an activity limitation.
Because the 85 plus group is the fastest growing segment of the population,
many Americans may live with activity limitations for 20 years or more.
According to Chronic Care in America,
"In 1995, one in six Americans - -
41 million people - -
had a chronic condition that inhibited their lives to some degree." The report
says, "At least 9 million people with disabilities need help either with
personal care or home management (40 percent are under age 65)."
According to the report, in 1994, nearly 40
percent of the elderly not living in institutions - -
12 million seniors - -
were limited by chronic conditions. Of these, 3 million (about 10
percent of all elderly) were unable to perform such activities as bathing,
shopping, dressing, or eating.
The direct costs of medical services for persons
with chronic conditions, according to the report, amounted to $425 billion in
1990, and 65 percent of those costs were for hospital care and physician
services (39 percent to hospitals and 25 percent to physicians).
The Looming Crisis: Facts-at-a-Glance
-- American Health Care Association, 1998.
From 1960 to 1994, the "oldest old"
population (persons aged 85 and over) increased by 274 percent, compared with a
100 percent increase for the 65 and over, and 45 percent for the total
population.
From 1994 to 2020, America's 85 and older
population is projected to double to 7 million.
In 1994, 7.3 million Americans needed long term
care services. By 2000, the number will rise to 9 million.
The elderly and their families represent the
largest single group of purchasers of long term care, spending almost $36
billion out of pocket, or nearly 40 percent of the total $91 billion
expenditures for long-term care in 1995.
Over 70 percent of single individuals and 50
percent of couples with one partner in a nursing home are impoverished within a
year.
The Looming Crisis: Long Term Care and Baby
Boomers -- American Health Care Association, 1998.
The baby boom generation - - those born between
1946 and 1964 - - is uniquely affected
by the growing dilemma of long term health care.
The retirement of the baby boom generation will
coincide with tremendous advances in medical science and, with that, longer
lives. And though the baby boomers may retire with the largest nest eggs in
history, they will be forced to apply much of their hard-earned savings toward
the long term care these medical advances warrant.
"The current system of financing and
delivering long term care for the baby boomer generation is badly broken,"
according to a report by the Urban Institute.
The Looming Crisis: Long Term Care Financing
Reform -- Paul R. Willging, Executive Vice President, The
American Health Care Association, 1998.
The future is clear. Medicaid cannot and will not
be able to continue as our nation's primary source of financing long term
care. This federal-state welfare system, which pays the nursing home bills for
two out of three Americans, is beyond repair. Comprehensive long term care
financing reform is the only cure.
Today, most older Americans simply cannot afford
the $41,000 annual average cost of nursing home care or the average $89
per-visit fee charged by a Registered Nurse for home care. Most Americans do
not believe they will ever need long term care. Consequently, few take steps to
plan for that possibility, believing Medicare will provide for their needs.
Medicare, of course, will not. It only provides limited long term care, so
government help for most Americans comes only when they exhaust their personal
savings and are forced onto a welfare program.
Our [the American Health Care Association's]
plan is based on four key principles which state that, as a nation, we
must:
- Transform long term care from a welfare program
to a health care program;
- Coordinate long term care private resources
with Medicare and Social Security;
- Encourage personal and family responsibility
for long term care; and,
- Maximize quality and control costs through
market competition and consumer choice.
If you have questions or comments about this article,
or questions for its author(s) and do not have a direct contact,
please e-mail them to
feedback@cacad.org
|
|
