Medicare spending, caseloads studied

Obesity rates among Medicare patients doubled in the last 15 years.
SCRIPPS HOWARD
More than half of Medicare patients are being treated for five or more chronic medical conditions, far more than 15 years ago, and these patients accounted for more than three-quarters of Medicare spending, according to a new analysis.
The study, published online this week by the journal Health Affairs, examines trends in annual Medicare spending and caseloads between 1987 and 2002.
Kenneth Thorpe, chairman of health-policy management at Emory University's School of Public Health, and David Howard, an assistant professor in the department, found that in 1987, 31 percent of Medicare patients were receiving treatment for five or more conditions; by 2002, that share had risen to 50.2 percent.
Better diagnostic tools and more options for treating chronic diseases of aging appear to be part of a trend toward doctors' aggressively treating the elderly.
Obesity also appears to be a major factor behind the spending increases. The study found that though obesity rates among Medicare patients doubled during the 15-year period, spending on obese patients tripled, to account for 25 percent of the total.
The share of normal-weight patients being treated for five or more conditions also grew, and their share of spending increased by 20 percent.
What's behind this
Thorpe and Howard say one explanation for the spending increases is that "physicians are more aggressively targeting healthier beneficiaries over time."
In 2002, nearly 60 percent of the Medicare patients being treated for five or more conditions reported being in "good" or "excellent" health, compared to just 33 percent in 1987.
The researchers focused on metabolic syndrome, a cluster of cardiovascular-related risk factors that affect nearly half of Medicare patients, as a case study of how treatment is becoming more aggressive.
During the first half of the study period, 57 percent of beneficiaries with metabolic syndrome were also treated for diabetes, high blood pressure or low levels of high-density lipoprotein (good cholesterol). These are all conditions associated with the metabolic disorders. By the final four years of the review, 68 percent of the patients were treated for at least one of the related conditions.