Nearly all the growth in Medicare spending from 1987 to 2002 can be attributed to the 20% increase in patients being treated for five or more conditions, according to the results of a new study published in Health Affairs. In 1987, 31% of Medicare beneficiaries were treated for five or more conditions, which accounted for half of total Medicare spending. Fifteen years later, more than half of Medicare beneficiaries had five or more conditions, accounting for three-fourths of total spending. The authors of the report point to the rise in obesity as a major contributor to increased Medicare spending. While obesity has doubled in the Medicare population since 1987, medical spending to treat obese beneficiaries has nearly tripled, from 9.4% to almost 25%. An 11% increase in spending for mental disorders can also be linked in part to obesity, say the authors, because patients with diabetes and obesity have a high incidence of depression. In addition, physicians are more aggressively treating patients with five or more conditions. In 1987, 33% of the chronically ill said they were in good or excellent health compared with 60% in 2002. For Medicare to control spending for chronic illnesses, however, it must adopt strategies for lifestyle modification and care coordination, necessitating an overhaul of its fee-for-service payment model, say the authors.
