Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans with Chronic Conditions

Using data from the 2001–05 Medical Expenditure Panel Survey, this study shows that nearly 40 percent of nonelderly adults with three or more chronic conditions had out-of-pocket expenses and premiums exceeding five percent of income for two consecutive years, compared with 20 percent of people who had a single chronic condition and 14 percent who had no chronic conditions. Prescription drug spending accounts for over half of the out-of-pocket spending by individuals who have multiple chronic conditions and who have had persistently high financial burdens that last two years or more. The prevalence of persons with persistently high financial burdens is likely to increase in the future, because of expected increases in prescription drug costs as well as chronic disease prevalence.

Health Care Experts Examine Top Performing, Low Cost Communities

The Institute for Healthcare Improvement, working with The Dartmouth Institute, Harvard Medical School, the Brookings Institution and the Fannie Rippel Foundation, invited representatives from 10 high-performing communities that spend less and have better quality of care to examine best practices. The communities were chosen based on per capita Medicare costs, federal hospital performance data, and patient satisfaction data.  In most of the communities, hospitals work closely with doctors. In addition, most of the health systems use electronic medical records to track patients and improve care, encourage a culture of restraining spending, and involve physicians in changing health care delivery systems and collaborating with competitors to help patients. All the communities were dominated by nonprofit health systems.

While the session didn't focus on the congressional health proposals, most in attendance stressed the need to change the Medicare payment system from a fee-for-service system, to a system under which providers are paid for an entire episode of care or for all the needs of a population over time. Other common themes that emerged included: Strong leadership, the importance of care coordination, and an emphasis on of health care data and data sharing.

The Burden of Health Care Costs for Working Families -- Implications for Reform

On June 2, 2009, President Barack Obama's Council of Economic Advisers released a report examining the economic case for health care reform, in which they underscored the importance of cost containment to the long term sustainability of any reform. However, despite widespread recognition of the importance of containing costs, political support for this agenda is limited by the fact that those who shoulder the financial burden of maintaining the current system — primarily, working families — are not fully aware of that burden's impact. The analysis provides a series of scenarios that provide illustrative examples of this impact of health expenses on the household finances and standards of living of families of varying income level.

Effects Of Childhood Obesity On Hospital Care And Costs, 1999–2005

Hospitalizations of children and youth with a diagnosis of obesity nearly doubled between 1999 and 2005, researchers report in an article published on the Health Affairs Web site (web exclusive). Recent data suggest that the prevalence of obesity among children and youth stayed relatively constant over this period. Nevertheless, the social and economic costs of pediatric obesity increased. Hospitalizations of children and youth ages 2–19 with a primary or secondary diagnosis of obesity increased from 21,743 in 1999 to 42,429 in 2005. Total costs for children and youth with obesity-related hospitalizations increased from $125.9 million in 2001 to $237.6 million in 2005, measured in 2005 dollars.

Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

This study was a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. The researchers conclude that the risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics (such as: extreme values of body-mass index, age, sex, race, ethnic group, and other coexisting conditions). In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. This study has the potential to impact decision making in the treatment of extreme obesity.

Beyond Information -- Exploring Patient Preferences

This commentary explores how physicians might reconcile the imperative to provide patient centered care with the complex ways in which clinicians and patients construct preferences. The authors contend that respecting and responding to patient preferences — the hallmark of patient-centered care — means eliciting, exploring, and questioning preferences and helping patients construct them. The focus of the commentary is not to describe or provide examples of how shared decision making is effective, but rather to inform physicians on how they can more effectively engage patients in constructing preferences in the face of uncertainty, informed by understanding how patients and clinicians think in complex and unforeseen health situations.