Health Affairs, 28, no. 1 (2009): 14 doi: 10.1377/hlthaff.28.1.14 © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Scope Of Problem

PROLOGUE

The Scope Of The Problem

Examining data from the Medical Expenditure Panel Survey, Kathryn Anne Paez and colleagues report sobering findings. U.S. adults in midlife and beyond are increasingly experiencing multiple chronic conditions—the patient with diabetes who also has hypertension, arthritis, and depression, for example. As a result, these patients are experiencing substantial out-of-pocket spending to boot. A kind of perfect storm is brewing, as chronic care access changes shape. Paez and colleagues’ findings reflect an increased reliance on using medications to manage disease.

Sandra Decker and colleagues examine data from the National Center for Health Statistics and report a shift in care from hospital inpatient departments to ambulatory settings. Although these latter changes are not inherently problematic, when coupled with rising uninsurance, underinsurance, and cost sharing for nonemergency expenses they can easily make out-of-pocket spending for chronic care so onerous that people reduce it or forgo it altogether.

Policymakers will thus have to strike a better balance between delivering better chronic care and constraining costs. Is it more important to save payers’ money by exposing patients to copays on drugs, or to increase adherence to costly drug regimens by waiving those copays for patients? And, in the long haul, the papers in this section make clear, the need to reduce both the incidence and the prevalence of chronic conditions is practically a national emergency.

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