The pace of medical spending for older adults is slowing, and one highly-respected health economist gives much of the credit to the increased use of medications that reduce the risk of heart disease. That is good news, but it largely ignores the growing costs of long-term care and the increasing burden on family caregivers, whose assistance is not included in this analysis.
To put it simply: The increased use of drugs such as statins is improving heart health. Not only will that slow the growth of medical costs for seniors, it may help them live longer. However, it will not keep them healthy forever. They will, in effect, live long enough to suffer from frailty of old age. And that means they will need more personal care that most often is delivered by family members.
To oversimplify: Instead of dying of heart attacks at 60, more of us will live to 85, when we will get dementia. That’s why we need to shift resources from medical care to long-term supports and services.
Less heart disease
In the study published in the February edition of the journal Health Affairs, Harvard University health economist David Cutler and his co-authors calculated that the per beneficiary growth rate of Medicare spending slowed substantially from 1992-2012. Until 2004, program spending per enrollee rose by 3.8 percent annually. From 2005-2012, it grew by only 1.1 percent.
Overall Medicare spending grew much faster, largely because so many more people turned 65 and enrolled in the program. But spending for each beneficiary grew far more slowly than many predicted. By 2012, actual Medicare spending was about $3,000 less than forecast.
Cutler and his colleges dug into the data (and made some important adjustments to the available numbers) to try to understand why. This is what they found:
Half of the lower-the-expected spending was due to fewer acute cardiovascular-related medical events, such as strokes, heart attacks, or acute episodes of congestive heart failure. And they attributed half of that savings to greater use of medications that prevent or control conditions such as high blood pressure, high cholesterol, or diabetes.
More use of drugs
Few new drug therapies were developed for these diseases during this period. But consumers used existing drugs more frequently, in part to lower prices and creation of the Medicare Part D drug benefit.
Better heart health means less hospital care, fewer heart surgeries, and less need for post-acute care. Hospital admissions for heart disease are off by 56 percent since 1999, and admissions for strokes declined by 41 percent, the study reports.
And, the authors’ add, there is more opportunity to improve heart health and save money. Only 55-60 percent of American are controlling their risk factors for cardiovascular disease.
While the news on the health cost side is positive, there is another side to the story. Cutler and colleagues looked at a broad definition of medical spending that mimics the government’s National Health Expenditure Accounts. But personal health spending generally excludes long-term care services and supports. And it entirely ignores personal care provided by family members.
And that’s where matters get interesting. Widespread use of medications to prevent heart attacks or strokes keeps us healthier for longer. But it doesn’t make us immortal or immune from the frailty of old age.
A growing challenge
We will live longer in old age, and indeed life expectancy among older adults in the US continues to increase (though it has reversed a bit in the past few years for those under 65). Longer lives, however, make more of us susceptible to chronic conditions of very old age such as Alzheimer’s disease and some other dementias, pulmonary disease, and severe arthritis. It even is true with heart failure. Medications can reduce repeated hospitalizations for the disease but they won’t prevent it from slowly and inexorably sapping a senior’s strength.
We are left then, with a growing challenge. Medical costs for those with chronic conditions and functional or cognitive limitations are two- to three-times higher than for those with chronic conditions alone. Cutler and colleagues attempt to adjust their data for demographic changes but because they looked backward to 2012, they did not capture the coming explosion in the population of those 80 and older—when those limitations are most common.
We are left with a classic good news/bad news story. For example, some dementias, such as stroke-related or vascular dementia, may also become less common as medications prevent the underlying conditions. But Alzheimer’s may become more common as more of us live to a very old age.
While Cutler and his colleagues didn’t put it this way, their research strengthens the argument that the US needs to shift resources from medical care to long-term supports and services.
by Howard Gleckman