Patients with at least one chronic condition spend more than five times of those with no chronic conditions. Increase the number of chronic conditions to five or more, and people have 25 times the inpatient hospital spending — the high-priced line item in the medical bill.

Bottom line: “By the late 20th century and continuing into the 21st century, the major reason for mortality and morbidity in the United States and other industrialized countries has become chronic disease.”

In Chronic Conditions: Making the Case for Ongoing Care, Dr. Gerard Anderson of Johns Hopkins quantifies the relationship between chronic disease and health spending. The report is sponsored by the Partnership to Fight Chronic Disease, a Who’s Who of health stakeholders including professional associations (from American Academy of Family Physicians to ), patient advocacy (Alzheimer’s Foundation of America and American Cancer Society, et. al.), (health plans (e.g., Aetna and United Health Group), lobbyists to the industry (AdvaMed to the U.S. Chamber of Commerce), and providers (Cleveland Clinic, among others).

Those with more than one chronic illness are the frequent-fliers of the health system. They consume most of the resources and generate most of the costs to the system. People with five or more chronic conditions see an average of almost 14 different physicians and fill 50 prescriptions in a year. Because of the frequency of visits to specialists and the way they are compensated, care for the chronically ill is poorly coordinated. Until the U.S. health system organizes incentives for doctors and other providers to coordinate care across different settings, the cost burden of the chronically ill will increase and further plague the American health economy.

In 2004, 26 percent of all Americans had two or more chronic conditions. As baby boomers age, the number of people living with chronic conditions will dramatically grow.

According to a survey of physicians, two-thirds feel unprepared to deal with educating patients with chronic conditions, coordinating in-home and community services, and managing the social aspects of chronic care. Furthermore, doctors believe that poor care coordination produces poor outcomes.


There are negative financial impacts on families who have a member with multiple chronic conditions. In 2002, Gallup found that nearly one-half of people with serious chronic conditions made gradual payments over time, and 38% took money from savings and other assets. Fully one-third applied for government aid. I would argue that these challenges are far greater in the current consumer-health financing climate, five years later, notwithstanding the implementation of Medicare Part D for prescription drugs (see my recent posts on plastic’s growing role in health care and the emergence of the MedFICO score in health care for insights into this growing consumer financial burden).

This chartbook was first issued in 2002, and followed up in 2004. It was funded by Pharmaceutical Research and Manufacturers of America (PhRMA), the pharmaceutical lobby organization.

Health Populi’s Hot Points: The recommendations issued earlier this week by the Commonwealth Fund in Bending the Curve target the cost and coordination challenges of chronic care in America. In particular, adopting and implementing several Fund strategies would provide the antidote to the chronic care cost spiral documented by the Partnership to Fight Chronic Disease: these include promoting health information technology, funding medical effectiveness research, promoting patient shared-decision making, promoting health and prevention efforts, aligning incentives for quality, and strengthening primary care.

Both the Commonwealth’s and the Partnership’s reports should be required reading for the 2008 Presidential candidates. There is no reforming US health care without addressing the ever-growing reality of chronic health care.

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