HHS Logo: bird/facesU.S. Department of Health and Human Services

Individuals Living in the Community with Chronic Conditions and Functional Limitations: A Closer Look

Lisa Alecxih, Sophie Shen, Iris Chan and Duke Taylor
The Lewin Group

John Drabek
Office of the Assistant Secretary for Planning and Evaluation

January 2010

PDF Version: http://aspe.hhs.gov/daltcp/reports/2010/closerlook.pdf (51 PDF pages)


This report was prepared under contract #HHS-100-03-0027 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Lewin Group. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, John Drabek, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. His e-mail address is: John.Drabek@hhs.gov.



TABLE OF CONTENTS

I. INTRODUCTION
Data & Definitions
II. ALL COMMUNITY RESIDENTS
Individuals and health spending by health/functional status
Average health spending by number of chronic conditions and functional limitations
Average health spending by health/functional status and health service type
Average health spending by health/functional status and source of financing
Overview of community residents with functional limitations and chronic conditions
Average health spending by primary source of insurance
Most common chronic conditions by health/functional status
Most common chronic conditions by age
Individuals and health spending by age and health/functional status
III. TOP 5% OF HEALTH CARE SPENDERS
Distribution of health spending by top 5% spenders versus those not in top 5% spenders
Relative risk of being in the top 5% of spenders by health/functional status
Individuals and health spending by health/functional status among the top 5% spenders
Most common chronic conditions by age among the top 5% spenders
Average health spending by health service type and health/functional status among the top 5% spenders
Average health spending by primary source of insurance among the top 5% spenders
Average health spending by health service type and primary source of insurance among the top 5% spenders
IV. DUAL ELIGIBLES
Overview of dual eligibles
Average health spending by type of service and health/functional status among dual eligibles
V. CONCLUSION
APPENDIX
NOTES
LIST OF EXHIBITS
EXHIBIT 1: Distribution of Community Residents and Health Care Spending by Select Groups, 2006
EXHIBIT 2: Averge People with Chronic Conditions, Functional Limitations Are Associated with Increased Average Health Spending, Regardless of the Number of Chronic Conditions
EXHIBIT 3: Average Spending by Type of Service for Select Groups, 2006
EXHIBIT 4: Health Spending by Source of Financing for Select Groups, 2006
EXHIBIT 5: Overview of Community Residents with Functional Limitations and Chronic Conditions by Age Groups, 2006
EXHIBIT 6: Health Spending by Primary Source of Insurance and Payment Source, 2006
EXHIBIT 7: Most Common Conditions by Selected Groups, 2006
EXHIBIT 8: Most Common Conditions Among Community Residents Under Age 65, 2006
EXHIBIT 9: Most Common Conditions Among Community Residents Age 65 and Over, 2006
EXHIBIT 10: Distribution of Community Residents Under Age 65 and Health Care Spending by Select Groups, 2006
EXHIBIT 11: Distribution of Community Residents Age 65 and Over and Health Care Spending by Select Groups, 2006
EXHIBIT 12: Distribution of Health Care Spending by Top 5% Spenders Versus Those Not in the Top 5% Spenders, 2006
EXHIBIT 13: Relative Risk of Being in the Top 5% of Health Care Spenders by Selected Groups, 2006
EXHIBIT 14: Distribution of Community Residents and Health Care Spending Among the Top 5% of Spenders by Select Groups, 2006
EXHIBIT 15: Most Common Chronic Conditions Among Top 5% of Spenders Under Age 65, 2006
EXHIBIT 16: Most Common Chronic Conditions Among Top 5% of Spenders Age 65 and Over, 2006
EXHIBIT 17: Health Care Spending by Type of Service Among the Top 5% of Spenders, 2006
EXHIBIT 18: Average Health Spending for Community Residents by Primary Source of Insurance and Payment Source Among the Top 5% of Spenders, 2006
EXHIBIT 19: Health Spending by Type of Service for the Top 5% by Primary Insurance, 2006
EXHIBIT 20: Overview of Dual Eligibles in the Community, 2006
EXHIBIT 21: Health Spending by Type of Service for Dual Eligibles in the Community by Selected Groups, 2006

EXHIBIT A-1: Distribution of Community Residents and Health Care Spending by Select Groups, 2006
EXHIBIT A-2: Average Annual Health Spending by Number of Chronic Conditions & Functional Limitations or ADLs/IADLs, 2006
EXHIBIT A-3: Average Spending by Type of Service for Select Groups, 2006
EXHIBIT A-4: Health Spending by Source of Financing for Select Group, 2006
EXHIBIT A-6: Health Spending by Primary Source of Insurance and Payment Source Among Community Residents with Chronic Conditions & Functional Limitations, 2006
EXHIBIT A-8: Most Common Conditions Among Community Residents Under Age 65 with At Least One Chronic Condition, 2006
EXHIBIT A-9: Most Common Conditions Among Community Residents Age 65 and Over, 2006
EXHIBIT A-10: Distribution of Community Residents Under Age 65 and Health Care Spending by Select Groups, 2006
EXHIBIT A-11: Distribution of Community Residents Age 65 and Over and Health Care Spending by Select Groups, 2006
EXHIBIT A-12: Distribution of Health Care Spending by Top 5% of Spenders Versus Those Not in the Top 5% Spenders, 2006
EXHIBIT A-13: Relative Risk of Being in the Top 5% of Health Care Spenders by Selected Groups, 2006
EXHIBIT A-14: Distribution of Community Residents and Health Care Spending Among the Top 5% of Spenders by Select Groups, 2006
EXHIBIT A-15: Most Common Chronic Diseases Among Top 5% of Spenders Under Age 65, 2006
EXHIBIT A-16: Most Common Conditions Among Top 5% of Spenders Age 65 and Over, 2006
EXHIBIT A-17: Health Care Spending by Type of Service Among the Top 5% of Spenders, 2006
EXHIBIT A-18: Average Health Spending for Community Residents with Chronic Conditions and Functional Limitations by Primary Source of Insurance and Payments Source Among the Top 5% of Spenders, 2006
EXHIBIT A-19: Health Spending by Type of Service for the Top 5% by Primary Insurance, 2006
EXHIBIT A-21: Health Spending by Type of Service for Dual Eligibles in the Community by Select Groups, 2006


I. INTRODUCTION

Introduction

Data and Definitions


II. ALL COMMUNITY RESIDENTS

People with Chronic Conditions and Functional Limitations Use More Health Care Services than Those with Chronic Conditions Only

See Table A-1 for data used to develop this Pie Chart. Out of the 299 million individuals in the U.S. in 2006, 143 million, or 48 percent, had no chronic condition and no functional limitation. 108 million, 36 percent, had only chronic conditions and 5.5 million or 2 percent had functional limitations only. 42 million, or 14 percent, had both a chronic condition and functional limitation. Out of those with both chronic conditions and functional limitations, 14 million or 5% of the U.S. population received help with an ADL or IADL, and 28 million or 9% had other functional limitations only. Out of the $1.03 trillion spent on healthcare in 2006, $146 billion, or 14% of total spending, was spent by those with no chronic conditions and no functional limitations. $395 billion or 38% was spent by those with only chronic conditions, and $18 billion or 2% was spent by those with only functional limitations. $473 billion or 46% was spent by those with both chronic conditions and functional limitations. Out of those with both chronic conditions and functional limitations, $236 billion or 23% of all U.S. spending was spent by those who received help with an ADL or IADL, an $238 billion or 23% of spending was spent by those with other functional limitations only.

Among People with Chronic Conditions, Functional Limitations Are Associated with Increased Average Health Spending, Regardless of the Number of Chronic Conditions

See Table A-2 for data used to develop this Bar Chart. Among those with no chronic conditions, average health spending for those with no functional limitation was $1,022; average health spending for those with other functional limitation only was $2,672; and average health spending for those who received help for ADLs/IADLs was $5,287. Among those with 1 chronic condition, average health spending for those with no functional limitation was $2,380; average health spending for those with other functional limitation only was $4,974; and average health spending for those who received help for ADLs/IADLs was $8,942. Among those with 2 chronic conditions, average health spending for those with no functional limitation was $3,817; average health spending for those with other functional limitation only was $6,383; and average health spending for those who received help for ADLs/IADLs was $12,233. Among those with 3 chronic conditions, average health spending for those with no functional limitation was $4,976; average health spending for those with other functional limitation only was $8,612; and average health spending for those who received help for ADLs/IADLs was $14,296. Among those with 4 chronic condition, average health spending for those with no functional limitation was $6,416; average health spending for those with other functional limitation only was $9,401; and average health spending for those who received help for ADLs/IADLs was $16,016. Among those with 5 or more chronic conditions, average health spending for those with no functional limitation was $9,723; average health spending for those with other functional limitation only was $12,749; and average health spending for those who received help for ADLs/IADLs was $22,380.

People with Functional Limitations and Chronic Conditions Spend More on All Types of Health Care Services

See Table A-3 for data used to develop this Bar Chart. On average, all U.S. community residents spent $3452 in 2006 on healthcare. Of those expenditures, $1117 was for outpatient spending, $1027 for inpatient, $125 for the emergency room, $746 for prescription drugs, and $113 for home health. On average, U.S. community residents with functional limitations spent $3278 in 2006 on healthcare. Of those expenditures, $1168 was for outpatient spending, $1298 for inpatient, $142 for the emergency room, $230 for prescription drugs, and $104 for home health. On average, U.S. community residents with chronic conditions spent $3641 in 2006 on healthcare. Of those expenditures, $1349 was for outpatient spending, $843 for inpatient, $128 for the emergency room, $893 for prescription drugs, and $22 for home health. On average, U.S. community residents with no functional limitation and no chronic condition spent $1022 in 2006 on healthcare. Of those expenditures, $365 was for outpatient spending, $288 for inpatient, $71 for the emergency room, $69 for prescription drugs, and $4 for home health. On average, U.S. community residents with both functional limitations and chronic conditions spent $11284 in 2006 on healthcare. Of those expenditures, $3079 was for outpatient spending, $3989 for inpatient, $304 for the emergency room, $2746 for prescription drugs, and $723 for home health. On average, U.S. community residents with functional limitations and chronic conditions who received help with ADLs and IADLs spent $16418 in 2006 on healthcare. Of those expenditures, $3464 was for outpatient spending, $6870 for inpatient, $436 for the emergency room, $3286 for prescription drugs, and $1909 for home health.

Medicare and Private Insurance Cover the Majority of Health Spending for People with Functional Limitations & Chronic Conditions

See Table A-4 for data used to develop this Bar Chart. On average, all U.S. community residents spent $3452 in 2006 on healthcare. Of those expenditures, $299 was from Medicaid, $812 from Medicare, $1408 from private insurance, $654 from out-of-pocket, and $278 was from other sources. On average, U.S. community residents with functional limitations only spent $3278 in 2006 on healthcare. Of those expenditures, $453 was from Medicaid, $581 from Medicare, $1323 from private insurance, $525 from out-of-pocket, and $396 was from other sources. On average, U.S. community residents with chronic conditions only spent $3641 in 2006 on healthcare. Of those expenditures, $200 was from Medicaid, $471 from Medicare, $1889 from private insurance, $860 from out-of-pocket, and $221 was from other sources. On average, U.S. community residents with no chronic conditions and no functional limitations spent $1002 in 2006 on healthcare. Of those expenditures, $132 was from Medicaid, $13 from Medicare, $564 from private insurance, $239 from out-of-pocket, and $74 was from other sources. On average, U.S. community residents with both chronic conditions and functional limitations spent $11284 in 2006 on healthcare. Of those expenditures, $1107 was from Medicaid, $4456 from Medicare, $3061 from private insurance, $1557 from out-of-pocket, and $1103 was from other sources. On average, U.S. community residents with both chronic conditions and functional limitations who received help with ADLs and IADLs spent $16418 in 2006 on healthcare. Of those expenditures, $2100 was from Medicaid, $7853 from Medicare, $3601 from private insurance, $1831 from out-of-pocket, and $1032 was from other sources.

People Under Age 65 Represent More than Half of the Population with Chronic Conditions and Functional Limitations

Exhibit 5: Overview of Community Residents with Functional Limitations and Chronic Conditions by Age Groups, 2006
  Number of
  Community  
Residents
(Millions)
  Percent of Age  
Group with
Chronic
Conditions &
Functional
Limitations
Total
Health Care
  Expenditures  
(Billions)
Average
Annual
Health Care
  Expenditures  
All Ages 42 14% $473 $11,283
     Age 65 & Older   18 48% $235 $12,880
     Under Age 65 24 9% $239 $10,068
SOURCE: The Lewin Group analysis of 2006 Medical Expenditures Panel Survey, 2009

Among the 42 Million People with Both Chronic Conditions and Functional Limitations, Private Insurance Plays a Greater Role for Individuals Under Age 65

See Table A-6 for data used to develop this Bar Chart. Among the 42 million people with both chronic conditions and functional limitations, 13 million were under the age of 65 and had any private insurance and spent on average $11473. $203 was from Medicaid, $929 was from Medicare, $7745 was from private insurance, $1747 was from out-of-pocket, and $849 was from other sources. 7 million were under the age of 65 with only public insurance and spent on average $10278 in 2006. $5112 was from Medicaid, $3311 was from Medicare, $971 was from out-of-pocket, and $884 was from other sources. 3 million were all ages and uninsured. They spent on average $3953 in 2006. $1643 was from out-of-pocket, and $2310 was from other sources. 10 million were over the age of 65 with Medicare and some private insurance and spent on average $13764 in 2006. $173 was from Medicaid, $8185 was from Medicare, $2578 was from private insurance, $1808 was from out-of-pocket, and $1020 was from other sources. 3 million were over the age of 65 with Medicare and Medicaid and spent on average $14172 in 2006. $2646 was from Medicaid, $10213 was from Medicare, $132 was from private insurance, $808 was from out-of-pocket, and $373 was from other sources. 6 million or 14% were over the age of 65 with Medicare and Medicaid and spent on average $11083 in 2006. $7637 was from Medicaid, $1755 was from out-of-pocket, and $1691 was from other sources.

People with Chronic Conditions Only and Those with Both Chronic Conditions and Functional Limitations Have Similar Chronic Conditions

Exhibit 7: Most Common Conditions by Select Groups, 2006
People with
Chronic
Conditions
Only
People with
Functional
Limitations
Only
People with
Chronic
Conditions &
Functional
Limitations
People with
Chronic
Conditions &
Received
ADL/IADL Help
Chronic Conditions Conditions Not Classified as
Chronic by AHRQ
Chronic Conditions Chronic Conditions
Essential Hypertension Back Disorder Nec & Nos Essential Hypertension Essential Hypertension
Allergic Rhinitis Injury Nec/Nos Dis of Lipoid Metabolism Diabetes Mellitus
Dis of Lipoid Metabolism Joint Disorder Nec & Nos Arthropathies Nec/Nos Dis of Lipoid Metabolism
Chronic Sinusitis General Symptoms Depressive Disorder Nec Depressive Disorder Nec
Depressive Disorder Nec Acute Nasopharyngitis Diabetes Mellitus Arthropathies Nec/Nox
Asthma Other Intestinal Infection Neurotic Disorders Neurotic Disorders
Neurotic Disorders Other Soft Tissue Dis Allergic Rhinitis Allergic Rhinitis
Diabetes Mellitus Normal Pregnancy Intervertebral Disc Dis Ill-Defined Heart Disorder
Arthropathies Nec/Nos Periph Enthesopathies Asthma Asthma
Migraine Skin/Other Integument Symp Ill-Defined Heart Disorder Intervertebral Disc Dis
Acquired Hypothyroidism Influenza Chronic Sinusitis Cataract
Hyperkinetic Syndrome Sprain of Ankle & Foot Cataract Cardiac Dysrhythmias
Intervertebral Disc Disorder Diseases of Esophagus Cardiac Dysrhythmias Acquired Hypothyroidism
Cataract Sprain Of Knee & Leg Acquired Hypothyroidism Chronic Sinusitis
Ill-Defined Heart Disorder Other Urinary Tract Disorder Glaucoma Heart Failure
SOURCE: The Lewin Group analysis of 2006 Medical Expenditures Panel Survey, 2009
Dis: disorder; Nec: not elsewhere classified; Nos: not otherwise specified

High Blood Pressure and Allergies Represent the Most Common Chronic Conditions Among People Under Age 65

See Table A-8 for data used to develop this Bar Chart. Among the 116 million community residents under the age of 65 with at least one chronic condition, 2% had a disorder of menstruation, 2% had menopausal disorders, 4% had acquired hypothyroidism, 4% had hyperkinetic syndrome, 5% had intervertebral disc disorder, 6% had migraine, 8% had arthropathies, 10% had diabetes mellitus, 12% had neurotic disorders, 13% had asthma, 13% had chronic sinusitis, 16% had disorder of lipoid metabolism, 17% had depressive disorder, 21% had allergic rhinitis, and  24% had essential hypertension.
Nec: not elsewhere classified; Nos: not otherwise specified

High Blood Pressure and High Cholesterol Represent the Most Common Chronic Conditions Among People Age 65 and Over

See Table A-9 for data used to develop this Bar Chart. Among the 34 million community residents over the age of 65 with at least one chronic condition, 5% had chronic sinusitis, 5% had hearing loss, 6% had asthma, 7% had acquired hypothyroidism, 7% had glaucoma, 9% had cardiac dysrhythmias, 9% had neurotic disorders, 11% had allergic rhinitis, 11% had ill-defined heart disease, 12% had cataracts, 12% had depressive disorder, 23% had diabetes mellitus, 25% had arthropathies, 41% had disorder of lipoid metabolism, and 61% had essential hypertension.
Nec: not elsewhere classified; Nos: not otherwise specified

People with Functional Limitations and Chronic Conditions Represent Nine Percent of Adults Under Age 65, but Account for One-Third of the Group's Health Care Expenditures

See Table A-10 for data used to develop this Pie Chart. Out of the 261 million individuals under the age of 65 in the U.S. in 2006, 140 million, or 54 percent, had no chronic condition and no functional limitation. 92 million, 35 percent, had only a chronic condition and 5 million or 2 percent only had a functional limitation. 24 million, or 9 percent, had both a chronic condition and functional limitation. Out of those with both chronic conditions and functional limitations, 7 million or 3% of the U.S. population under 65 received help with an ADL or IADL, and 17 million or 7% had other functional limitations only. Out of the $700 billion spent on healthcare by individuals under the age of 65 in 2006, $143 billion, or 20% of the groupís total spending, was spent by those with no chronic conditions and no functional limitations. $304 billion or 43% was spent by those with only chronic conditions, and $14 billion or 2% was spent by those with only functional limitations. $239 billion or 35% was spent by those with both chronic conditions and functional limitations. Out of those with both chronic conditions and functional limitations, $102 billion or 15% of all U.S. spending by those under 65 was spent by those who received help with an ADL or IADL, an $137 billion or 20% of spending was spent by those with other functional limitations only.

Almost Half of Older Adults Have Functional Limitations and Chronic Conditions, and Account for Over Two-Thirds of All Health Spending for that Age Group

See Table A-11 for data used to develop this Pie Chart. Out of the 38 million individuals over the age of 65 in the U.S. in 2006, 3 million, or 8 percent, had no chronic condition and no functional limitation. 16 million, 42 percent, had only chronic conditions and 1 million or 2 percent only had functional limitations. 18 million, or 48 percent, had both chronic conditions and functional limitations. Out of those with both chronic conditions and functional limitations, 8 million or 20% of the U.S. population over 65 received help with an ADL or IADL, and 10 million or 28% had other functional limitations only. Out of the $333 billion spent on healthcare by individuals over the age of 65 in 2006, $4 billion, or 1% of the groupís total spending, was spent by those with no chronic conditions and no functional limitations. $91 billion or 27% was spent by those with only chronic conditions, and $101 billion or 30% was spent by those with only functional limitations. $235 billion or 70% was spent by those with both chronic conditions and functional limitations. Out of those with both chronic conditions and functional limitations, $134 billion or 40% of all U.S. spending by those over the age of 65 was spent by those who received help with an ADL or IADL, and $101 billion or 30% of spending was spent by those with other functional limitations only.


III. TOP 5% OF HEALTH CARE SPENDERS

The Top 5% of Health Care Spenders in the Community Spend Half of Total Health Care Resources

See Table A-12 for data used to develop this Pie Chart. Among the 299 million individuals in 2006, 15 million people constituted the top 5% of spenders. Among the $1.03 trillion in health care expenditures, the top 5% accounted for $493, or 48%.

Among People with Chronic Conditions, Having a Functional Limitation Significantly Increases the Likelihood of Being in the Top 5% of Health Care Spenders

See Table A-13 for data used to develop this Bar Chart. Relative probability compared to the general population for being in the top 5% of spenders for people with no functional limitation and no chronic condition is .2. Relative probability for being in the top 5% of spenders for chronic conditions only is .8; Relative probability for being in the top 5% of spenders for functional limitation is .8; Relative probability for being in the top 5% of spenders for people with at least one chronic condition is 1.8; Relative probability for being in the top 5% of spenders for people with two or more chronic conditions is 2.7; Relative probability for being in the top 5% of spenders for people with 3 or more chronic conditions is 3.6; Relative probability for being in the top 5% of spenders for people with chronic conditions and functional limitations is 4.3; Relative probability for being in the top 5% of spenders for those who received help with an ADL or IADL is 6.1; Relative probability for being in the top 5% of spenders for people with one or more chronic conditions and who received help with an ADL or IADL is 6.6; Relative probability for being in the top 5% of spenders for people with two or more chronic conditions and who received help with an ADL or IADL is 7.1; and Relative probability for being in the top 5% of spenders for with three or more chronic conditions and who received help with an ADL or IADL is 7.7.

Among the Top 5% of Spenders, a Majority Have Chronic Conditions and Functional Limitations

See Table A-14 for data used to develop this Pie Chart. Out of the 15 million individuals in the top 5% of healthcare spenders in 2006, 1.1 million, or 7 percent, had no chronic condition and no functional limitation. 4.6 million, 31 percent, had only a chronic condition and .2 million or 1 percent only had a functional limitation. 9 million, or 61 percent, had both a chronic condition and functional limitation. Out of those with both chronic conditions and functional limitations, 4.7 million or 32% of the top 5% of spenders received help with an ADL or IADL, and 4.3 million or 29% had other functional limitations only. Out of the $493 billion spent on healthcare by individuals in the top 5% of spending 2006, $30 billion, or 6% of the groupís total spending, was spent by those with no chronic conditions and no functional limitations. $138 billion or 28% was spent by those with only chronic conditions, and $9 billion or 2% was spent by those with only functional limitations. $316 billion or 64% was spent by those with both chronic conditions and functional limitations. Out of those with both chronic conditions and functional limitations, $182 billion or 37% of all spending by those in the top 5% of spenders was spent by those who received help with an ADL or IADL, and $134 billion or 27% of spending was spent by those with other functional limitations only.

High Blood Pressure and Mood Disorders Represent the Most Common Chronic Conditions Among the Top 5% of Spenders Under Age 65

See Table A-15 for data used to develop this Bar Chart. Among the 7.7 million top 5% of spenders under the age of 65 with at least one chronic condition, 5% had malignant neoplasm of the female breast, 6% had cardiac dysrhythmias, 6% had ill-defined heart disease, 7% had acquired hypothyroidism, 7% had migraine, 11% had intervertabral disc disorder, 12% had asthma, 12% had chronic sinusitis, 17% had arthropathies, 17% had neurotic disorders, 20% had allergic rhinitis, 25% had diabetes mellitus, 27% had depressive disorder, 29% had disorder of lipoid metabolism, and 42% had essential hypertension.
Nec: not elsewhere classified; Nos: not otherwise specified

High Blood Pressure and High Cholesterol Also Represent the Most Common Chronic Conditions Among the Top 5% of Spenders Age 65 and Over

See Table A-16 for data used to develop this Bar Chart. Among the 6 million top 5% of spenders over the age of 65 with at least one chronic condition, 7% had arterial embolism, 8% had cerebral vascular accident (stroke), 8% had glaucoma, 10% had asthma, 11% had heart failure, 13% had allergic rhinitis, 13% had cataract, 14% had cardiac dysrhythmias, 15% had neurotic disorders, 17% had depressive disorder, 20% had ill-defined heart disease, 30% had arthropathies, 37% had diabetes mellitus, 45% had disorder of lipoid metabolism, and 66% had essential hypertension.
Nec: not elsewhere classified; Nos: not otherwise specified

Among the Top 5% of Spenders, People with Chronic Conditions and Functional Limitations Spend More on Prescription Drugs and Home Health Care

See Table A-17 for data used to develop this Bar Chart. On average, all top 5% spenders spent $32942 in 2006 on healthcare. Of those expenditures, $8363 was for outpatient spending, $16628 for inpatient, $767 for the emergency room, $4630 for prescription drugs, and $1750 for home health. On average, top 5% spenders with only functional limitations spent $38768 in 2006 on healthcare. Of those expenditures, $8562 was for outpatient spending, $25629 for inpatient, $376 for the emergency room, $1892 for prescription drugs, and $1375 for home health. On average, top 5% spenders with only chronic conditions spent $30076 in 2006 on healthcare. Of those expenditures, $9324 was for outpatient spending, $15602 for inpatient, $704 for the emergency room, $3101 for prescription drugs, and $394 for home health. On average, top 5% spenders with no functional limitations and no chronic conditions spent $26419 in 2006 on healthcare. Of those expenditures, $6555 was for outpatient spending, $16694 for inpatient, $899 for the emergency room, $1132 for prescription drugs, and $288 for home health. On average, top 5% spenders with both functional limitations and chronic conditions spent $35087 in 2006 on healthcare. Of those expenditures, $8100 was for outpatient spending, $16919 for inpatient, $792 for the emergency room, $5920 for prescription drugs, and $2636 for home health. On average, top 5% spenders with functional limitations and chronic conditions who received help with ADL/IADLs spent $38518 in 2006 on healthcare. Of those expenditures, $7305 was for outpatient spending, $19462 for inpatient, $885 for the emergency room, $5608 for prescription drugs, and $4611 for home health.

Among Top 5% Spenders with Both Chronic Conditions and Functional Limitations, Private Insurance Plays a Greater Role for Individuals Under Age 65

See Table A-18 for data used to develop this Bar Chart. Among the 9 million top 5% spenders with both chronic conditions and functional limitations, 2.7 million were under the age of 65 and had any private insurance and spent on average $38462 in 2006. $736 was from Medicaid, $3808 was from Medicare, $27185 was from private insurance, $4007 was from out-of-pocket, and $2726 was from other sources. 1.5 million top 5% spenders with both chronic conditions and functional limitations were under the age of 65 and only had public insurance. They spent on average $30661 in 2006. $15065 was from Medicaid, $10963 was from Medicare, $2111 was from out-of-pocket, and $2552 was from other sources. .2 million top 5% spenders with both chronic conditions and functional limitations were all ages and were uninsured. They spent on average $23897 in 2006. $4489 was from out-of-pocket, and $19408 was from other sources. 2.7 million top 5% spenders with both chronic conditions and functional limitations were over the age of 65 and had Medicare and private insurance. They spent on average $36082 in 2006. $616 was from Medicaid, $23447 was from Medicare, $6307 was from private insurance, $2918 was from out-of-pocket, and $2794 was from other sources. .7 million top 5% spenders with both chronic conditions and functional limitations were over the age of 65 with Medicare and Medicaid. They spent on average $37659 in 2006. $7192 was from Medicaid, $27921 was from Medicare, $373 was from private insurance, $1302 was from out-of-pocket, and $871 was from other sources. 1.3 million top 5% spenders with both chronic conditions and functional limitations were over the age of 65 and had Medicare only. They spent on average $32849 in 2006. $24196 was from Medicare, $3145 was from out-of-pocket, and $5508 was from other sources.

Older Adults with Medicaid and Medicare (Dual Eligibles) in the Top 5% of Spenders with Chronic Conditions and Functional Limitations Have High Home Health Expenditures

See Table A-19 for data used to develop this Bar Chart. People under the age of 65 with any private insurance spent on average $38461 on healthcare in 2006. $11602 was for outpatient, $15587 was for inpatient, $937 was for emergency room, $8489 was for prescription drugs, and $1040 was for home health. People under the age of 65 with only public insurance spent on average $30660 on healthcare in 2006. $6930 was for outpatient, $12333 was for inpatient, $837 was for emergency room, $6666 was for prescription drugs, and $3502 was for home health. People of all ages who were uninsured spent on average $23898 on healthcare in 2006. $5230 was for outpatient, $13252 was for inpatient, $855 was for emergency room, $4094 was for prescription drugs, and $94 was for home health. People over the age of 65 with Medicare and private insurance spent on average $35816 on healthcare in 2006. $7245 was for outpatient, $19266 was for inpatient, $725 was for emergency room, $4545 was for prescription drugs, and $3146 was for home health. People over the age of 65 who were dual eligibles spent on average $37659 on healthcare in 2006. $5085 was for outpatient, $18025 was for inpatient, $1071 was for emergency room, $4535 was for prescription drugs, and $8516 was for home health. People over the age of 65 with Medicare only spent on average $32849 on healthcare in 2006. $6039 was for outpatient, $19114 was for inpatient, $653 was for emergency room, $3729 was for prescription drugs, and $2518 was for home health.


IV. DUAL ELIGIBLES

Dual Eligibles Are a Group with Chronic Conditions, Functional Limitations, and Significant Expenditures

Exhibit 20: Overview of Dual Eligibles in the Community, 2006
  Number of
Dual Eligibles
  in Community  
(Millions)
Percent of
Total
  Community  
Population
Total
Health Care
  Expenditures  
(Billions)
Percent of
Total
Health Care
  Expenditures  
Average
Annual
Health Care
  Expenditures  
All Dual Eligibles 7.0 2.3% $70 7% $10,133
Dual Eligibles with Chronic Conditions and Functional Limitations   4.4 1.5% $60 6% $13,821
     Age 65 & Older 2.6 0.6% $37 4% $14,173
     Under Age 65 1.7 0.9% $23 2% $13,288
SOURCE: The Lewin Group analysis of 2006 Medical Expenditures Panel Survey, 2009

Most Dual Eligibles Have Chronic Conditions and Functional Limitations, and Correspondingly Higher Expenditures

See Table A-21 for data used to develop this Bar Chart. On average, all dual eligibles spent $10133 on healthcare in 2006. $1841 was for outpatient, $3480 for inpatient, $290 for emergency room, $2543 for prescription drugs, and $1700 for home health. On average, dual eligibles with chronic conditions and functional limitations spent $13821 on healthcare in 2006. $2540 was for outpatient, $4459 was for inpatient, $403 was for emergency room, $3451 was for prescription drugs, and $2589 was for home health. On average, dual eligibles under the age of 65 spent $9146 on healthcare in 2006. $1992 was for outpatient, $2355 for inpatient, $282 for emergency room, $2831 for prescription drugs, and $1395 for home health. On average, dual eligibles under the age of 65 with chronic conditions and functional limitations spent $13288 on healthcare in 2006. $2846 was for outpatient, $3206 was for inpatient, $379 was for emergency room, $4218 was for prescription drugs, and $2240 was for home health. On average, dual eligibles 65 and over spent $10814 on healthcare in 2006. $1736 was for outpatient, $4256 for inpatient, $296 for emergency room, $2344 for prescription drugs, and $1910 for home health. On average, dual eligibles 65 and over with chronic conditions and functional limitations spent $14173 on healthcare in 2006. $2338 was for outpatient, $5288 was for inpatient, $420 was for emergency room, $2944 was for prescription drugs, and $2820 was for home health.


V. CONCLUSION

Conclusion


APPENDIX

Appendix Each table in this Appendix provides data used in developing the corresponding figure or chart in the report. For example, Exhibit A-3 provides the amounts paid for each type of service listed in the bar chart Exhibit 3.

Exhibit A-1: Distribution of Community Residents and Health Care Spending by Select Groups, 2006
Health Status Community Residents
(Millions)
Percent of Total People
No Chronic, No Limitation 143.3 48%
Chronic Only 108.5 36%
Functional Limitation Only 5.5 2%
Chronic and Functional Limitation 42 14%
Among Chronic Condition and Functional Limitation Community Residents
(Millions)
Percent of Total People
     Received ADL-IADL Help 14.3 5%
     Had Other Functional Limitations Only 27.6 9%
Total 299.3 100%
Expenditures Total Spending
(Billions)
Percent of Total Spending
No Chronic, No Limitation $ 146.4 14%
Chronic Only $ 395.1 38%
Functional Limitation Only $ 18.1 2%
Chronic and Functional Limitation $ 473.4 46%
Among Chronic Conditions and Functional Limitation Total Spending
(Billions)
Percent of Total Spending
     Received ADL-IADL Help $ 235.7 23%
     Had Other Functional Limitations Only $ 237.8 23%
Total $ 1,033 100%


  Exhibit A-2: Average Annual Health Spending by Number of Chronic Conditions & Functional Limitations or ADLs/IADLs, 2006  
Number of Chronic Conditions No Functional
Limitation
Had Other
Functional
Limitation Only
Received Help
with an ADL/IADL
No Chronic Condition $ 1,022 $ 2,672 $ 5,287
1 Chronic Condition $ 2,380 $ 4,974 $ 8,942
2 Chronic Conditions $ 3,817 $ 6,383 $ 12,233
3 Chronic Conditions $ 4,976 $ 8,612 $ 14,296
4 Chronic Conditions $ 6,416 $ 9,401 $ 16,016
5+ Chronic Conditions $ 9,723 $ 12,749 $22,380


Exhibit A-3: Average Spending by Type of Service for Select Groups, 2006
Health
Services
  Everyone     Functional  
Limitation
Only
Chronic
  Condition  
Only
No
Functional
Limitatoin,
  No Chronic  
Condition
All
  Functional  
Limitation
& Chronic
Condition
Subset of
Functional
Limitation
& Chronic
--People
who
Received
  ADL/IADL  
Help
Outpatient $ 1,117 $ 1,168 $ 1,349 $ 365 $ 3,079 $ 3,464
Inpatient $ 1,027 $ 1,298 $ 843 $ 288 $3,989 $ 6,870
Emergency Room $ 125 $ 142 $ 128 $ 71 $ 304 $ 436
Prescription Drugs $ 746 $ 230 $ 893 $ 69 $ 2,746 $ 3,286
Home Health $ 113 $ 104 $ 22 $ 4 $ 723 $ 1,909
Average Total Expenditures $ 3,452 $ 3,278 $ 3,641 $ 1,022 $ 11,284 $ 16,418
Health
Services
Millions of
Community
Residents,
Everyone
Millions of
Community
Residents,
Functional
Limitation
Only
Millions of
Community
Residents,
Chronic
Condition
Only
Millions of
Community
Residents,
No
Functional
Limitatoin,
No Chronic
Condition
Millions of
Community
Residents,
All
Functional
Limitation
& Chronic
Condition
Millions of
Community
Residents,
Subset of
Functional
Limitation
& Chronic
--People
who
Received
ADL/IADL
Help
Community Residents (Millions) 299.3 5.5 108.5 143.3 42.0 14.3
  Percent of
Total
Spending,
Everyone
Percent of
Total
Spending,
Functional
Limitation
Only
Percent of
Total
Spending,
Chronic
Condition
Only
Percent of
Total
Spending,
No
Functional
Limitatoin,
No Chronic
Condition
Percent of
Total
Spending,
All
Functional
Limitation
& Chronic
Condition
Percent of
Total
Spending,
Subset of
Functional
Limitation
& Chronic
--People
who
Received
ADL/IADL
Help
Percent of Total Spending 100% 2% 38% 14% 46% 23%


Exhibit A-4: Health Spending by Source of Financing for Select Groups, 2006
Payment Source   Everyone     Functional  
Limitation
Only
Chronic
  Condition  
Only
No
Functional
Limitatoin,
  No Chronic  
Condition
All
  Functional  
Limitation
& Chronic
Condition
Subset of
Functional
Limitation
& Chronic
--People
who
Received
  ADL/IADL  
Help
Medicaid Expenditures $ 299 $ 453 $ 200 $ 132 $ 1,107 $ 2,100
Medicare Expenditures $ 812 $ 581 $ 471 $ 13 $ 4,456 $ 7,853
Private Insurance Expenditures $ 1,408 $ 1,323 $ 1,889 $ 564 $ 3,061 $ 3,601
Out-of-Pocket Expenditures $ 654 $ 525 $ 860 $ 239 $ 1,557 $ 1,831
Other Payment $ 278 $ 396 $ 221 $ 74 $ 1,103 $ 1,032
Average Total Expenditures $ 3,452 $ 3,278 $ 3,641 $ 1,022 $ 11,284 $ 16,418
Payment Sources Millions of
Community
Residents,
Everyone
Millions of
Community
Residents,
Functional
Limitation
Only
Millions of
Community
Residents,
Chronic
Condition
Only
Millions of
Community
Residents,
No
Functional
Limitatoin,
No Chronic
Condition
Millions of
Community
Residents,
All
Functional
Limitation
& Chronic
Condition
Millions of
Community
Residents,
Subset of
Functional
Limitation
& Chronic
--People
who
Received
ADL/IADL
Help
Community Residents (Millions) 299.3 5.5 108.5 143.3 42.0 14.3
  Percent of
Total
Spending,
Everyone
Percent of
Total
Spending,
Functional
Limitation
Only
Percent of
Total
Spending,
Chronic
Condition
Only
Percent of
Total
Spending,
No
Functional
Limitatoin,
No Chronic
Condition
Percent of
Total
Spending,
All
Functional
Limitation
& Chronic
Condition
Percent of
Total
Spending,
Subset of
Functional
Limitation
& Chronic
--People
who
Received
ADL/IADL
Help
Percent of Total Spending 100% 2% 38% 14% 46% 23%


Exhibit A-6: Health Spending by Primary Source of Insurance and Payment Source Among Community Residents with Chronic Conditions & Functional Limitations, 2006
Payment
Source
Under Age
65, Any
Private
Under Age
65, Public
Only
All Age,
Uninsured
Age 65+,
Medicare &
Privatea
Age 65+,
Medicare &
Medicaid
Age 65+,
Medicare
Only
Medicaid $ 203 $ 5,112 --- $ 173 $ 2,646 ---
Medicare $ 929 $ 3,311 --- $ 8,185 $ 10,213 $ 7,637
Private $ 7,746 --- --- $ 2,578 $ 132 ---
Out-of-Pocket $ 1,747 $ 971 $ 1,643 $ 1,808 $ 808 $ 1,755
Other $ 849 $ 884 $ 2,310 $ 1,020 $ 373 $ 1,691
Average Total Expenditures $ 11,474 $ 10,278 $ 3,953 $ 13,764 $ 14,172 $ 11,083
  Millions of
Community
Residents,
Under Age
65, Any
Private
Millions of
Community
Residents,
Under Age
65, Public
Only
Millions of
Community
Residents,
All Age,
Uninsured
Millions of
Community
Residents,
Age 65+,
Medicare &
Private
Millions of
Community
Residents,
Age 65+,
Medicare &
Medicaid
Millions of
Community
Residents,
Age 65+,
Medicare
Only
Community Residents (Millions) 13 7 3 10 3 6
  Percent of
Total
Spending,
Under Age
65, Any
Private
Percent of
Total
Spending,
Under Age
65, Public
Only
Percent of
Total
Spending,
All Age,
Uninsured
Percent of
Total
Spending,
Age 65+,
Medicare &
Private
Percent of
Total
Spending,
Age 65+,
Medicare &
Medicaid
Percent of
Total
Spending,
Age 65+,
Medicare
Only
Percent of Total Spending For those With Chronic Conditions and Functional Limitations 31% 17% 7% 24% 7% 14%
  1. This column represents people with Medicare and private insurance, but no Medicaid coverage. However, about 6% of this group that did not report Medicaid coverage had expenditures reported as paid by Medicaid.


Exhibit A-8: Most Common Conditions Among Community Residents Under Age 65 with At Least One Chronic Condition, 2006
Under Age 65 Percent of People with Condition, Out
of 116 Million Community Residents
with Some Chronic Condition
Disorder of Menstruation 2%
Menopausal Disorders 2%
Acquired Hypothyroidism 4%
Hyperkinetic Syndrome 4%
Intervertebral Disc Disorder 5%
Migraine 6%
Arthropathies Nec/Nos 8%
Diabetes Mellitus 10%
Neurotic Disorders 12%
Asthma 13%
Chronic Sinusitis 13%
Disorder of Lipoid Metabolism 16%
Mood Disorder 19%
Allergic Rhinitis 21%
Essential Hypertension 24%
Mood Disorders is comprised of people with Depressive Disorders Nec and Affective Psychoses.
Total number of community residents under age 65 is 261 M.


  Exhibit A-9: Most Common Conditions Among Community Residents Age 65 and Over, 2006  
Age 65 & Over Percent of People with Condition, Out
of 34 Million Community Residents with
Some Chronic Condition
Chronic Sinusitis 5%
Hearing Loss 5%
Asthma 6%
Acquired Hypothyroidism 7%
Glaucoma 7%
Cardiac Dysrhythmias 9%
Neurotic Disorders 9%
Allergic Rhinitis 11%
Ill-Defined Heart Disorder 11%
Cataract 12%
Mood Disorders 13%
Diabetes Mellitus 23%
Arthropathies Nec/Nos 25%
Disorder of Lipoid Metabolism 41%
Essential Hypertension 61%
Mood Disorders is comprised of people with Depressive Disorders Nec and Affective Psychoses.
Total number of community residents age 65 and over is 38 M.


  Exhibit A-10: Distribution of Community Residents Under Age 65 and Health Care Spending by Select Groups, 2006  
Health Status Community Residents
(Millions)
Percent of Total People
No Chronic, No Limitation 140.4 54%
Chronic Only 92.4 35%
Functional Limitation Only 4.7 2%
Chronic and Functional Limitation 23.7 9%
Among Chronic Condition and Functional Limitation Community Residents
(Millions)
Percent of Total People
     Received ADL-IADL Help 6.6 3%
     Had Other Functional Limitations Only 17.1 7%
Total 261.2 100%
Expenditures Total Spending
(Billions)
Percent of Total Spending
No Chronic, No Limitation $ 142.8 20%
Chronic Only $ 304.1 43%
Functional Limitation Only $ 14.1 2%
Chronic and Functional Limitation $ 238.7 35%
Among Chronic Conditions and Functional Limitation Total Spending
(Billions)
Percent of Total Spending
     Received ADL-IADL Help $ 101.8 15%
     Had Other Functional Limitations Only $ 136.9 20%
Total $ 699.7 100%


  Exhibit A-11: Distribution of Community Residents Age 65 and Over and Health Care Spending by Select Groups, 2006  
Health Status Community Residents
(Millions)
Percent of Total
People
No Chronic, No Limitation 2.9 8%
Chronic Only 16.1 42%
Functional Limitation Only 0.8 2%
Chronic and Functional Limitation 18.2 48%
Among Chronic Condition and Functional Limitation Community Residents
(Millions)
Percent of Total
People
     Received ADL-IADL Help 7.7 20%
     Had Other Functional Limitations Only 10.5 28%
Total 38.0 100%
Expenditures Total Spending
(Billions)
Percent of Total
Spending
No Chronic, No Limitation $ 3.6 1%
Chronic Only $ 91.0 27%
Functional Limitation Only $ 4.0 1%
Chronic and Functional Limitation $ 234.7 70%
Among Chronic Conditions and Functional Limitation Total Spending
(Billions)
Percent of Total
Spending
     Received ADL-IADL Help $ 133.9 40%
     Had Other Functional Limitations Only $ 100.8 30%
Total $ 333.4 100%


  Exhibit A-12: Distribution of Health Care Spending by Top 5% of Spenders Versus Those Not in the Top 5% Spenders, 2006  
Spending Status Community Residents
(Millions)
Percent of Total
People
Not Top 5% 284.3 95%
Top 5% 15.0 5%
Total 299.3 100%
Expenditures Total Spending
(Billions)
Percent of Total
Spending
Not Top 5% $ 539.9 52%
Top 5% $ 493.2 48%
Total $ 1,033.1 100%


Exhibit A-13: Relative Risk of Being in the Top 5% of Health Care Spenders by Selected Groups, 2006
Group (By Chronic Condition,
Functional Limitation)
Community
Residents in the
Top 5% of
Spenders
(Millions)
Percent of Group
in Top 5% of
Spenders
Relative Probability
of Being in the
Top 5%
All Community Residents 15.0 5% 1.0
No Chronic Condition, No Functional Limitation 1.1 1% 0.2
Chronic Condition Only 4.6 4% 0.8
Functional Limitation Only 0.2 4% 0.8
1+ Chronic Conditions 13.6 9% 1.8
2+ Chronic Conditions 11.5 13% 2.7
3+ Chronic Conditions 9.3 18% 3.6
Chronic Conditions and Functional Limitation 9.0 21% 4.3
Help with an ADL/IADL 4.8 31% 6.1
Help with an ADL/IADL and 1+ Chronic Conditions 4.7 33% 6.6
Help with an ADL/IADL and 2+ Chronic Conditions 4.4 36% 7.1
Help with an ADL/IADL and 3+ Chronic Conditions 3.8 38% 7.7
NOTE: Relative risk for being in the top 5% of spenders is the probability that a specified group will be in the top 5%, compared to the overall probability of being in the top 5% of spenders.


  Exhibit A-14: Distribution of Community Residents and Health Care Spending Among the Top 5% of Spenders by Select Groups, 2006  
Health Status Community Residents
(Millions)
Percent of Total People
No Chronic Condition, No Functional Limitation 1.1 7%
Chronic Condition Only 4.6 31%
Functional Limitation Only 0.2 1%
Chronic Condition and Functional Limitation 9.0 61%
Among Chronic Condition and Functional Limitation Community Residents
(Millions)
Percent of Total People
     Received ADL-IADL Help 4.7 32%
     Had Other Functional Limitations Only 4.3 29%
Total 15 100%
Expenditures Total Spending
(Billions)
Percent of Total Spending
No Chronic Condition, No Functional Limitation $ 30.3 6%
Chronic Condition Only $ 137.9 28%
Functional Limitation Only $ 8.6 2%
Chronic Condition and Functional Limitation $ 316.3 64%
Among Chronic Conditions and Functional Limitation Total Spending
(Billions)
Percent of Total Spending
     Received ADL-IADL Help $ 181.8 37%
     Had Other Functional Limitations Only $ 134.5 27%
Total $ 493.2 100%


  Exhibit A-15: Most Common Chronic Diseases Among Top 5% of Spenders Under Age 65, 2006  
Community Residents Under Age 65 Percent of People with Condition, Out
of 7.7 Million Community Residents
with Some Chronic Condition
Malignant Neoplasm of Female Breast 5%
Cardiac Dysrhythmias 6%
Ill-Defined Heart Disease 6%
Acquired Hypothyroidism 7%
Migraine 7%
Intervertebral Disc Disorder 11%
Asthama 12%
Chronic Sinusitis 12%
Arthropathies Nec/Nos 17%
Neurotic Disorders 17%
Allergic Rhinitis 20%
Diabetes Mellitus 25%
Disorder of Lipoid Metabolism 29%
Mood Disorder 31%
Essential Hypertension 42%
Mood Disorders is comprised of people with Depressive Disorders Nec and Affective Psychoses.
Total number of community residents in the top 5% of spenders under age 65 is 9 M.


  Exhibit A-16: Most Common Conditions Among Top 5% of Spenders Age 65 and Over, 2006  
Community Residents Age 65 & Over Percent of People with Condition, Out
of 6 Million Community Residents with
Some Chronic Condition
Arterial Embolism 7%
Cerebral Vascular Accident 8%
Glaucoma 8%
Asthma 10%
Heart Failure 11%
Allergic Rhinitis 13%
Cataract 13%
Cardiac Dysrhythmias 14%
Neurotic Disorder 15%
Mood Disorders 19%
Ill-Defined Heart Disease 20%
Arthropathies Nec/Nos 30%
Diabetes Mellitus 37%
Disorder of Lipoid Metabolism 45%
Essential Hypertension 66%
Mood Disorders is comprised of people with Depressive Disorders Nec and Affective Psychoses.
Total number of community residents in the top 5% of spenders age 65 and over is 6 M.


Exhibit A-17: Health Care Spending by Type of Service Among the Top 5% of Spenders, 2006
    Top 5% of  
Spenders
  Functional  
Limitation
Only
Chronic
  Condition  
Only
No
Functional
Limitatoin,
  No Chronic  
Condition
  Functional  
Limitation
& Chronic
Condition
Subset of
Functional
Limitation
& Chronic
--People
who
Received
  ADL/IADL  
Help
Outpatient $ 8,363 $ 8,562 $ 9,324 $ 6,555 $ 8,100 $ 7,305
Inpatient $ 16,628 $ 25,629 $ 15,602 $ 16,694 $ 16,919 $ 19,462
Emergency Room $ 767 $ 376 $ 704 $ 899 $ 792 $ 885
Prescription Drugs $ 4,630 $ 1,892 $ 3,101 $ 1,132 $ 5,920 $ 5,608
Home Health $ 1,750 $ 1,375 $ 394 $ 288 $ 2,636 $ 4,611
Average Total Expenditures $ 32,942 $ 38,768 $ 30,076 $ 26,419 $ 35,087 $ 38,518
  Millions of
Community
Residents,
Top 5% of
Spenders
Community
Residents,
Top 5% of
Spenders,
Functional
Limitation
Only
Community
Residents,
Top 5% of
Spenders,
Chronic
Condition
Only
Community
Residents,
Top 5% of
Spenders,
No
Functional
Limitatoin,
No Chronic
Condition
Community
Residents,
Top 5% of
Spenders,
Functional
Limitation
& Chronic
Condition
Community
Residents,
Top 5% of
Spenders,
Subset of
Functional
Limitation
& Chronic
--People
who
Received
ADL/IADL
Help
Community Residents (Millions) 15.0 0.2 4.6 1.1 9.0 4.7
  Percent of
Total
Spending
for Top 5%
Percent of
Total
Spending
for Top 5%
Functional
Limitation
Only
Percent of
Total
Spending
for Top 5%
Chronic
Condition
Only
Percent of
Total
Spending
for Top 5%
No
Functional
Limitatoin,
No Chronic
Percent of
Total
Spending
for Top 5%
Functional
& Chronic
Percent of
Total
Spending
for Top 5%
Subset of
Functional
& Chronic

Received
ADL/IADL
Help
Percent of Total Spending 100% 2% 28% 6% 64% 37%


Exhibit A-18: Average Health Spending for Community Residents with Chronic Conditions and Functional Limitations by Primary Source of Insurance and Payments Source Among the Top 5% of Spenders, 2006
Insurance
Payment
Under Age
65 Any
Private
Under Age
65 Public
Only
All Ages
Uninsured
Age 65+
Medicare
& Private
Age 65+
Medicare
&
Medicaid
Age 65+
Medicare
Only
Medicaid $ 736 $ 15,065 $ 0 $ 616 $ 7,192 $ 0
Medicare $ 3,808 $ 10,963 $ 0 $ 23,447 $ 27,921 $ 24,196
Private $ 27,185 $ 0 $ 0 $ 6,307 $ 373 $ 0
Self $ 4,007 $ 2,111 $ 4,489 $ 2,918 $ 1,302 $ 3,145
Other $ 2,726 $ 2,522 $ 19,408 $ 2,794 $ 871 $ 5,508
Average Total Expenditures $ 38,461 $ 30,660 $ 23,898 $ 36,081 $ 37,659 $ 32,849
  Millions of
Community
Residents,
Under Age
65 Any
Private
Millions of
Community
Residents,
Under Age
65 Public
Only
Millions of
Community
Residents,
All Age
Uninsured
Millions of
Community
Residents,
Age 65+
Medicare &
Private
Millions of
Community
Residents,
Age 65+
Medicare &
Medicaid
Millions of
Community
Residents,
Age 65+
Medicare
Only
Community Residents (Millions) 2.7 1.5 0.2 2.7 0.7 1.3
  Percent of
Top 5%,
Under Age
65 Any
Private
Percent of
Top 5%,
Under Age
65 Public
Only
Percent of
Top 5%, All
Ages
Uninsured
Percent of
Top 5%,
Age 65+
Medicare &
Private
Percent of
Top 5%,
Age 65+
Medicare &
Medicaid
Percent of
Top 5%,
Age 65+
Medicare
Only
Percent of Top 5% with Chronic Conditions & Functional Limitations 30% 16% 2% 29% 8% 14%


Exhibit A-19: Health Spending by Type of Service for the Top 5% by Primary Insurance, 2006
Health Services
Settings
Under
  Age 65,  
Any
Private
Under
  Age 65,  
Public
Only
All Age,
  Uninsured  
Over Age
65,
  Medicare &  
Private
  Over Age  
65, Dual
Eligible
  Over Age  
65,
Medicare
Only
Outpatient $ 11,602 $ 6,930 $ 5,230 $ 7,245 $ 5,085 $ 6,039
Inpatient $ 15,587 $ 12,333 $ 13,252 $ 19,266 $ 18,025 $ 19,114
Emergency Room $ 937 $ 837 $ 855 $ 725 $ 1,071 $ 653
Prescription Drugs $ 8,489 $ 6,666 $ 4,094 $ 4,545 $ 4,535 $ 3,729
Home Health $ 1,040 $ 3,502 $ 94 $ 3,146 $ 8,516 $ 2,518
Average Total Expenditures $ 38,461 $ 30,660 $ 23,898 $ 35,816 $ 37,659 $ 32,849


Exhibit A-21: Health Spending by Type of Service for Dual Eligibles in the Community by Select Groups, 2006
Health Services
Settings
All Ages Under Age 65 Age 65 & Over
  All Groups   Chronic
Conditions
&
Functional
  Limitations  
  All Groups   Chronic
Conditions
&
Functional
  Limitations  
  All Groups   Chronic
Conditions
&
Functional
  Limitations  
Office/Outpatient ($) 1,841 2,540 1,992 2,846 1,736 2,338
Inpatient ($) 3,480 4,459 2,355 3,206 4,256 5,288
Emergency Room ($) 290 403 282 379 296 420
Prescription Drugs ($) 2,543 3,451 2,831 4,218 2,344 2,944
Home Health ($) 1,700 2,589 1,395 2,240 1,910 2,820
Average Total Expenditures ($) 10,133 13,821 9,146 13,288 10,814 14,173
  Millions of
Community
Residents,
All Ages &
Groups
Millions of
Community
Residents,
All Ages
with
Chronic &
Functional
Millions of
Community
Residents,
Under Age
65 & All
Groups
Millions of
Community
Residents,
Under Age
65 with
Chronic &
Functional
Millions of
Community
Residents,
Age 65 &
Over, All
Groups
Millions of
Community
Residents,
Age 65 &
Over with
Chronic &
Functional
Community Residents (Millions) 6.9 4.4 2.8 1.7 4.1 2.6
  Percent of
Total
Spending
for Dual
Eligibles,
All Ages &
Groups
Percent of
Total
Spending
for Dual
Eligibles,
All Ages
with
Chronic &
Functional
Percent of
Total
Spending
for Dual
Eligibles,
Under Age
65 & All
Groups
Percent of
Total
Spending
for Dual
Eligibles,
Under Age
65 with
Chronic &
Functional
Percent of
Total
Spending
for Dual
Eligibles,
Age 65 &
Over, All
Groups
Percent of
Total
Spending
for Dual
Eligibles,
Age 65 &
Over with
Chronic &
Functional
Percent of Total Spending for Dual Eligibles (%) 100 86 37 33 63 53


NOTES

  1. MEPS may miss some expenditures for high-cost cases while people are living in the community due to sample attrition. For further information see: Sing, Merrile, Jessica S. Banthin, Thomas M. Selden, Cathy A. Cowan and Sean P. Keehan, "Reconciling Medical Expenditure Estimates from the MEPS and NHEA, 2002," Health Care Financing Review 28, no. 1:25-40.

  2. Diagnosis classification can be defined by 3-digit International Classification of Diseases codes (ICD-9).

  3. URL: http://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp#files

  4. Hwang, W., Heller, W., Ireys, H., Anderson, G. 2001. "Out-Of-Pocket Medical Spending for Care of Chronic Conditions," Health Affairs 20, no. 6:267-278.


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