Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.

In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved.

Chronically ill persons who are uninsured have higher out-of-pocket medical spending and are five times less likely to see a physician than their insured counterparts.by Wenke Hwang, Wendy Weller, Henry Ireys, and Gerard Anderson ABSTRACT: We examined out-of-pocket medical spending by persons with and without chronic conditions using data from the 1996 Medical Expenditure Panel Survey (MEPS). Our results show that mean out-of-pocket spending increased with the number of chronic conditions. The level of this spending also varied by age and insurance coverage, among other characteristics. Out-of-pocket spending for prescription drugs was substantial for both elderly and nonelderly persons with chronic conditions. As policymakers continue to use cost sharing and design of benefit packages to contain health spending, it is important to consider the impact of these policies on persons with chronic conditions and their families.L arge out-of-pocket expenditures for medical services have been shown to impede access to care, affect health status and quality of life, and leave insufficient income for other necessities. It is important to identify the characteristics of persons who are likely to spend large amounts out of pocket, to assess the impact of policy changes related to health insurance coverage. It is also important to know which services are most likely to generate large out-of-pocket expenditures. A review of the literature, however, reveals a dearth of recent comprehensive national estimates of out-of-pocket spending by the general population and for persons with chronic conditions. The few studies that are available have not identified the characteristics of persons with high out-of-pocket spending and have not examined the wide range of services used by persons with chronic

For elderly individuals with at least 1 chronic medical condition, the presence of a depressive syndrome increased the odds of acute medical service use, suggesting that improvements in clinical management, access to mental health services, and coordination of medical and mental health services could reduce utilization.

Current Medicare capitation payments to managed care plans may not meet the higher expected annual costs of care for beneficiaries with DAT. In turn, physicians (or physician groups) who accept capitation for Medicare beneficiaries with DAT should also consider how capitation rates are established by managed care plans and should learn ways to reduce financial risk.