Abstract and Introduction
Abstract
Introduction The increase in chronic health conditions among Medicare beneficiaries has implications for the Medicare system. The objective of this study was to use the US Department of Health and Human Services Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries.
Analysis We analyzed Centers for Medicare and Medicaid Services administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program in 2010. We included approximately 31 million Medicare beneficiaries and examined 15 chronic conditions. A beneficiary was considered to have a chronic condition if a Medicare claim indicated that the beneficiary received a service or treatment for the condition. We defined the prevalence of multiple chronic conditions as having 2 or more chronic conditions.
Results Overall, 68.4% of Medicare beneficiaries had 2 or more chronic conditions and 36.4% had 4 or more chronic conditions. The prevalence of multiple chronic conditions increased with age and was more prevalent among women than men across all age groups. Non-Hispanic black and Hispanic women had the highest prevalence of 4 or more chronic conditions, whereas Asian or Pacific Islander men and women, in general, had the lowest.
Summary The prevalence of multiple chronic conditions among the Medicare fee-for-service population varies across demographic groups. Multiple chronic conditions appear to be more prevalent among women, particularly non-Hispanic black and Hispanic women, and among beneficiaries eligible for both Medicare and Medicaid benefits. Our findings can help public health researchers target prevention and management strategies to improve care and reduce costs for people with multiple chronic conditions.
Introduction
The increase in chronic health conditions among Medicare beneficiaries has far-reaching implications for the Medicare system. Among Medicare beneficiaries, not only are hypertension, high cholesterol, heart disease, and diabetes highly prevalent, but most beneficiaries have multiple chronic conditions. Medicare beneficiaries with multiple chronic conditions are the heaviest users of health care services, including such high-cost services as hospitalizations and emergency department visits, which translates into increased Medicare spending. For example, the two-thirds of beneficiaries with 2 more chronic conditions accounted for 93% of Medicare spending, and the one-third with 4 or more chronic conditions accounted for almost three-fourths of Medicare spending.
Although research has focused on chronic conditions such as hypertension, diabetes, and heart conditions, the US Department of Health and Human Services (HHS) Initiative on multiple chronic conditions calls for the need to enhance the understanding of chronic condition comorbidities. The HHS Initiative's strategic framework on multiple chronic conditions offers an organizing structure to address multiple chronic conditions through research, interventions, and health care management and indicates the need to increase the evidence base on the epidemiology of multiple chronic conditions.
The objective of this study was to use the HHS Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries. In combination with the other articles in this issue of Preventing Chronic Disease that address multiple chronic conditions, this study begins to fill the gaps and improve our understanding of the prevalence of multiple chronic conditions across different populations using different data sources.