MEDICAL TREATMENT 5 conditions cause a third of rise in health-care costs



The cost of treating each heart patient showed dramatic increase.
SCRIPPS HOWARD
WASHINGTON -- Five of the most expensive medical conditions accounted for nearly one-third of the $200 billion increase in health care spending between 1987 and 2000, according to a new online study by the journal Health Affairs.
Emory University economist Kenneth Thorpe and colleagues calculate that five conditions -- heart disease, mental disorders, lung disorders, cancer and trauma -- were responsible for about 31 percent of the overall change in spending.
Thorpe and his team used data from national medical spending surveys to come up with their estimates, and the reasons behind them, for the 15 most costly medical conditions.
Though some of the increases in spending for each condition are a result of the country's having a bigger population, most of the growth is because more people are being treated for each condition and costs have risen for each individual treated.
"If we really want to get a handle on rising health costs, we need to analyze what it is we're spending money on instead of where we're spending the money," Thorpe said.
He noted that much of the spending has focused on the health industry sectors -- pharmaceuticals, hospitals, physicians -- and the share they get of an estimated $1.7 trillion a year in health expenditures.
Discovery
In eight of the top 15 conditions, researchers found most of the increased spending was due to a rise in the cost per patient.
For instance, there was little change in the number of people treated for heart disease during the 13 years. But the cost of treating each patient accounted for about 70 percent of the increase in spending for the disease, which rose from $30 billion in 1987 to more than $56 billion in 2000.
Thorpe noted that the increased spending led to better treatments with new drugs and procedures such as diagnostic cardiac catheterization.
"While spending per person with heart disease is going up, death rates associated with this condition continue to go down," he said.
Likewise, the higher costs of treating each patient for hypertension accounted for 60 percent of the overall growth in spending for that condition. While treatments for trauma declined by more than 4 percent during the 13 years, the cost for each case rose 169 percent.
On the other hand, increases in the number of people being treated accounted for 60 percent of the higher costs for vascular diseases in the brain, such as stroke; 59 percent of the increase in costs for mental disorders; and 41 percent of the cost increase for lung disorders.
Causes
These changes were due largely to increased awareness and the availability of treatments. While the overall prevalence of mental illness in the population did not change, the number of people being treated for mental disorders nearly doubled.
This comes from both increasing recognition of the disorders, particularly depression, and a rapid expansion of the availability of psychiatric drugs, Thorpe said.
"Given the historical underdiagnosis and treatment of disorders such as depression, this wider use of treatments and the associated increase in health care spending is likely to represent benefits that outweigh the cost," the researchers wrote in the study released today.
The researchers said more study is needed to determine whether increases in spending really do reap increased medical benefits for large groups of people, or whether similar improvements could be purchased at a lower cost.

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