Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

Abstract

Purpose: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. Design and Methods: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiplemorbidity constellations on these expenses. We paid particular attention to the most common disease constellations-hypertension, arthritis, and heart disease. Results: An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-ofpocket expenditures ($2,164 in 1998, increasing by 104% to $3,748 in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations. Implications: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact outof-pocket spending moves us closer to effective interventions to support vulnerable elders.

A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology

“…1,2 Because of the negative consequences and high cost associated with multimorbidity, it has received growing interest in the primary care literature over the past few years and is now acknowledged by some as a research priority. [3][4][5][6][7] At a time when several countries are undergoing major primary care reforms, multimorbidity appears to be a driver of change as it implies a shift in health services from the singledisease paradigm from which the majority of medical knowledge arises to a more holistic view of patients and a "generalist approach" to care. 8 Unlike single chronic diseases or conditions for which strong epidemiologic data are available, however, results for multimorbidity vary widely among studies, making it diffi cult to determine whether differences among countries and locations and between the general and primary care populations are real or due to a wide variety of methodologic issues.…”

A Systematic Review of Cost-of-Illness Studies of Multimorbidity

“…Additionally, out-of-pocket (OOP) expenditures ranged fro m $49 [40] to $6,858 [27], wh ich was lower than public 12 insurance costs. Children with three or mo re life-threatening co mplex chronic conditions in their last year of life had …”

“…Six studies followed an incidence-based approach [27,29,36,44,42,33,34], and twenty studies calculated 1 prevalence-based healthcare costs [23, 24, 3, 25-28, 13, 35, 30, 31, 41, 37, 38, 45, 39, 46, 40, 32, 43]. Lifetime costs 2 were estimated in only one study [36], and unfortunately, specific mu ltimo rbid ity-related costs were unavailable.…”

Investigating the Outcomes of a Physical Activity Program offered to Older Adults in South Florida and Understanding the Correlates of Completion

“…According to a study by Wolff et al an older adult with four or more conditions were 99 times more likely to be hospitalized for an ambulatory care sensitive condition than an individual without any chronic condition (Wolff, Starfield, & Anderson, 2002). Similar results were reported by other researchers (Condelius, Edberg, Jakobsson, & Hallberg, 2008;Lochner & Cox, 2013;Schoen, Osborn, How, Doty, & Peugh, 2009;Schoenberg, Kim, Edwards, & Fleming, 2007;Starfield, Lemke, Herbert, Pavlovich, & Anderson, 2005;Thorpe, Ogden, & Galactionova, 2010). Chronic conditions also pose a deleterious effect on the health of older adults by affecting their daily activities and perceived quality of life (Rothrock et al, 2010;Schafer et al, 2010).…”