Chronic Disease  /  Economic Burden

While medical innovations and public health gains in the past century have been measurable in leaps and bounds, significant progress against acute disease has revealed an equally enormous challenge—chronic disease on an unprecedented scale. Close to half of Americans have chronic conditions and 1 in 4 have more than one. They cause 7 out of every 10 deaths and cost our country 75 cents of every health care dollar. With chronic disease prevalence growing at a faster rate than the population as a whole, the forecast is daunting.

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    • Lost wages for family caregivers
      The total impact of caregiving on lost wages for family caregivers age 50 and older is $283,716 for men, and $323,880 for men.  
    • Unpaid care from family caregivers
      Each week, family caregivers provide an average of 20.4 hours of unpaid care.  
    • Impact of family caregiving on work
      Seven out of 10 family caregivers have to cut back on work hours, change jobs, or stop working in order to care for their loved one.  
    • Out-of-pocket costs to family caregivers
      Being a family caregiver costs $5,531 in out-of-pocket direct costs each year.  
    • Economic contributions of family caregivers
      Family caregivers contribute an estimated $450 billion each year in economic value.  
    • Out-of-pocket health care for seniors in 2010
      In 2010, older Americans spent over a third of their Social Security checks on out-of-pocket health care expenses.  
    • In 2010, national health spending was estimated at $2.6 trillion.  
    • In 2011, the median annual rate for a private nursing home was $77,745—compared to $60,225 in 2005.  
    • The national median rate for a private nursing home room in 2011 was $213/day.  
    • The national median rate of licensed home health aide services in 2011 was $19/hour.  
    • The national median rate of adult day health care in 2011 was $60/day.  
    • The national median rate for homemaker (or personal care assistant) services in 2011 was $18/hour.  
    • The national median rate for assisted living facilities in 2011 was $3,261/month.  
    • The national median rate for a semi-private nursing home room in 2011 was $193/day.  
    • Two-thirds of people over the age of 65 will need long-term care in their lifetimes.  
    • The annual rate for a private nursing home room in 2010 was $75,190, compared to $60,225 in 2005 (a growth of $14,965).  
    • The national median rate for a semi-private nursing home room in 2010 was $185/day.  
    • The national median rate for a private nursing home room was $206/day.  
    • The national median rate for an assisted living facility (one bedroom/single occupancy with non-constant “hands-on” personal and medical care) in 2010 was $3,185/month.  
    • The national median rate for adult day health care (support services in a community-based, protective setting during any part of a day, but less than 24-hour care) in 2010 was…  
    • The national median rate for non-medicare certified, licensed home health aide services (non-medical “hands-on” care such as activities such as bathing, dressing and transferring) in 2010 was $19/hour.  
    • The national median rate for non-medicare certified, licensed homemaker services (“hands-off” care such as helping with cooking and running errands) in 2010 was $18/hour.  
    • In 2007, two-thirds of individuals age 65 and older who had limitation in instrumental activities of daily living received personal assistance.    
    • In 2006, health care costs for Medicare enrollees age 65 and older were: 25% for inpatient hospital care 16% for prescription drugs 35% for physician/outpatient services 13% for long-term care facilities  
    • In 2007, the number of home health care visits was 3,409 per 1,000 Medicare enrollees.  
    • In 2005, the number of physician visits was 13,914 per 1,000 Medicare enrollees.  
    • Between 1992 and 2007 skilled nursing facility stays increased from 28 to 81 stays per 1,000 Medicare enrollees.  
    • The hospitalization rate in 2007 was 336 stays per 1,000 Medicare enrollees.  
    • The average lenth of a hospital stay in 2007 was 5.6 days.  
    • In 2004, Americans aged 65 and older with five or more chronic conditions incurred $3,862 on average, while those with no chronic conditions incurred prescription drug costs at an average…  
    • In 2004, approximately 8% of those 65 and older incurred no prescription drug costs, but close to 24% incurred $2,500 or more that year.  
    • In 2004, average annual prescription drug costs for noninstitutionalized Medicare enrollees over 65 was $2,107 per person.  
    • Annual health care costs for Medicare enrollees age 65 and over with no chronic disease was, on average, $5,186.  This number rises to $25,132 for those whith five of more…  
    • Average annual prescription drug costs for noninstitutionalized Medicare enrollees age 65 and over, by sources of payment, 1992-2004  
    • Average annual health care costs for Medicare enrollees age 65 and over, by age group, 1992-2006  
    • Medicare-covered physician and home health care visits per 1,000 Medicare enrollees age 65 and over in fee-for-service, 1992-2007  
    • Major components of health care costs among Medicare enrollees age 65 and over, 1992-2006  
    • Medicare-covered hospital and skilled nursing facility stays per 1,000 Medicare enrollees age 65 and over in fee-for-service, 1992-2007  
    • Costs for hospital stays with the six most expensive principal procedures: United States, 1999-2006  
    • Contribution of Key Medical Conditions to Inflation-Adjusted Health Care Spending Growth Among Medicare Beneficiaries, 1987-1997, 1997-2006, and 1987-2006  
    • Total Medicare spending reached $469.2 billion in 2008.  
    • Nursing home spending reached $138.4 billion in 2008.  
    • Spending on physician and clinical services reached $496.2 billion in 2008.  
    • Hospital spending by Medicare increased 7.7% in 2008–from 4.7% in 2007.  
    • In 2008, overall spending on hospital services reached $718.4 billion.  
    • National health spending in 2008 reached $2.3 trillion, or $7,681 per person.  This was a 4/4% increase from 2007.  
    • The health care portion of the gross domestic product (GDP) grew from 15.9% in 2007 to 16.2% in 2008.  
    • In 2001, 5% of Medicare beneficiaries accounted for 43% of Medicare spending. For these beneficiaries, health care spending averaged around $63,000 per year. The bottom 50% of beneficiaries…  
    • Percentage of Medicare dollars Spent on Chronic Illness, 1987, 1997, and 2002  
    • In 2007, the Medicare program had about 44 million enrollees and expenditures of $432 billion, up from $408 billion the previous year. Expenditures for the new Medicare drug program (Part…  
    • Out-of-pocket spending grew 5.3% in 2007, compared to 3.3% in 2006. This acceleration was mostly due to increased payments for prescription drugs, nursing home services, and nondurable medical supplies.  
    • Medicaid spending grew 6.4% in 2007 to $329.4 billion.  
    • In 2007, Medicare spending grew 7.2% to $431.2 billion.  
    • Nursing home spending increased 4.8% in 2007 to reach $131.3 billion.  
    • Home health spending increased 11.3% (to $59 billion) in 2007.  
    • Hospital spending growth increased 7.3% to $696.5 billion in 2007, compared to 6.9% in 2006.  
    • Home health care spending is projected to reach $64.4 billion in 2008.  
    • Hospital spending is projected to reach $746.5 billion in 2008.  
    • Spending on physician and clinical services is expected to reach $508.5 billion in 2008.  
    • Spending on prescription drugs is projected to grow 3.5% in 2008–a slowdown of 1.4% from 2007–and reach $235.4 billion. Drug spending growth is expected to rebound to 4.5% in…  
    • National health spending numbers are projected to reach $2.4 trillion for 2008.  
    • Of the total health care spending in Medicare households, 62.9% is spent on health insurance premiums, 18.1% is spent on prescription drugs, 15.3% is spent on medical services, and 3.8%…  
    • Average health care spending made up 14.1% of all spending in Medicare households.  
    • In the United States, chronic disease accounts for 75% of the more than $2 trillion spent on health care per year.  
    • In 2005, a person with 3 or more chronic conditions who was 65 and older and insured through Medicare paid, on average, $2,588 in out-of-pocket medical expenses.  
    • The annual out-of-pocket medical costs for chronic disease rose from and average of $427 per American in 1996 to $741 in 2005.  
    • National Health Expenditures and Their Share of Gross Domestic Product, 1960-2006  
    • In 2005, national health care expenditures in the U.S. totaled $2 trillion–a 6.9% increase from 2004. The rate of increase slowed for the third consecutive year, though it was still…  
    • Presenteeism is Responsible for the Largest Share of Lost Economic Output Associated with Chronic Health Problems  
    • Health Care Spending Related to Chronic Diseases is Dwarfed by the Indirect Costs of These Health Problems  
    • Increases in Prevalence and Treatment Intensity of Chronic Disease are Responsible for About Two-Thirds of the Increase in Health Care Costs Over the Past Two Decades  
    • Average annual prescription drug costs and sources of payment among noninstitutionalized Medicare enrollees age 65 and over, 1992-2004  
    • Major components of health care costs among Medicare enrollees age 65 and over, 1992 and 2004  
    • Average annual health care costs for Medicare enrollees age 65 and over, in 2004 dollars, by age group, 1992-2004  
    • In 2004, older Americans with no chronic conditions spent an average of $800 on prescription drugs. Those with 5 or more chronic conditions spent on average $3,862.  
    • In 2004, around 8% of older Americans incurred $2,500 or more in prescription drug costs.  
    • The average prescription drug costs for older Americans in 2004 were $2,107 per person.  
    • In 2004, Americans with no chronic conditions incurred about $4,700 on average in health care costs. Those with 5 or more chronic conditions incurred $20,300.  
    • Around 13% of all household expenditures in households headed by people age 65 and older were on healthcare expenses, compared to 7% in households headed by people age 55-64.  
    • Private health expenditures is expected to grow to 6.3% in 2007–increasing from 5.4% in 2006.  
    • The health share of the GDP is expected to increase to 16.3% in 2007.  
    • Total U.S. health expenditures reached $2.1 trillion in 2006, which translates to $7,026 per person or 16% of the nation’s GDP.  
    • In 2005, national health expenditures were projected to surpass $2 trillion.  
    • In 2005, health costs incurred on average by older consumers consisted of $2,617 (60%) for insurance, $887 (20%) for drugs, $663 (15.3%) for medical services, and $164 (4%) for medical…  
    • Older Americans spent 12.4% of their total expenditures on health, more than twice the proportion spent by all consumers (5.7%).  
    • In 2005 older Americans averaged $4,331 in out-of-pocket health care expenditures, an increase of 57% since 1995. In contrast, the total population spent considerably less, averaging $2,766 in out-of-pocket…  
    • Prescription drug spending growth accelerated in 2006 to 8.5%, partly as a result of Medicare Part D’s impact.  
    • The health care portion of the GDP was 16.0% in 2006, slightly higher than in 2005.  
    • The U.S. health care spending increased 6.7% to $2.1 trillion, or $7,026 per person in 2006.  
    • Two-Thirds of Medicare Spending is For Beneficiaries with Five or More Chronic Conditions  
    • Percentage of Health Care Spending for Individuals with Chronic Conditions Varies by Type of Health Insurance  
    • People with Chronic Conditions are the Heaviest Users of Health Care Services  
    • People with Chronic Conditions Accounted for 85 Percent of All Health Care Spending in 2004  
    • In 1998, the care given to people with chronic conditions accounted for 78% of health care spending–Now they account for 85%.  
    • The U.S. spent 85% of our health care dollars on people with chronic conditions in 2004.  
    • Lost Productivity by Source, 2003  
    • Lost Productivity by Chronic Disease, 2003  
    • Economic Impact of Chronic Disease, 2003  
    • The costs of productivity loss because of a chronic disease were 4 times as great as the direct medical costs of a chronic condition.  
    • Lost workdays and lower employee productivity because of hypertension cost $279.5 billion– the highest amount among chronic diseases.  
    • Chronic disease cost $42 trillion in treatment costs and economic output.  
    • The combined cost of treatment expenditures and lost economic output for seven common chronic diseases (cancer, diabetes, heart disease, hypertension, stroke, mental disorders, and pulmonary conditions) totaled $1.3 trillion in…  
    • Lost workdays and lower employee productivity as a result of chronic disease cost the United States over $1 trillion in 2003.  
    • Medicare income in 2006 was $437 billion, and expenditures were $408 billion.  
    • 40% of American adults reported that they went without care in 2004 because of costs during the year. This rate is 4 times higher than in the U.K., the benchmark…  
    • Health Care Costs: 1965-2004  
    • Out-of-Pocket Spending on Prescription Drugs by Medicare beneficiaries, by Presence of Prescription Drug Coverage, 2003  
    • Average Out-of-Pocket Spending on Health Care by Medicare Beneficiaries, by Type of Supplemental Coverage, 2003  
    • Average Out-of-Pocket Spending on Health Care by Medicare Beneficiaries, by Income as a Percent of Federal Poverty Level, 2003  
    • Out-of-Pocket Spending on Health Care by Medicare Beneficiaries, by Type of Expenditure, 2003  
    • Out-of-pocket spending on health care tends to rise with income. Medicare beneficiaries with incomes above 400% of poverty spent an average of $3,785, which is the highest among the income…  
    • In 2003, Medicare beneficiaries with excellent health spent $2,845 (16% of their income) on health care.  
    • In 2003, Medicare beneficiaries in fair or poor health had the highest average out-of-pocket health care costs of the health status groups, both in dollars and % of income ($4,000…  
    • In 2003, Medicare beneficiaries age 65-74 had the lowest out-of-pocket expenses as a percent of income (18%), while beneficiaries age 85 and older had the highest (30%).  
    • Average out-of-pocket health care spending tends to increase with age. Medicare beneficiaries age 65-74 spent $2,920 out-of-pocket in 2003, while beneficiaries age 85 and older spent $4,615.  
    • Spending on prescription drugs by non-institutionalized Medicare beneficiaries age 65 and older averaged $830 (24% of out-of-pocket spending) in 2003.  
    • In 2003, 45% of beneficiaries’ total out-of-pocket health care expenses were for premiums for Medicare Part B, private Medicare plans (primarily HMOs) and private supplemental insurace.  
    • Non-institutionalized Medicare beneficiaries age 65 and older spent an average of $3,455 (22% of their income) on healthcare in 2003.  
    • Spending for two Medicaid services is expected to accelerate in 2006: home health care (from 14% in 2005 to 19.8% in 2006), and other personal health care (from 8.1% in…  
    • In 2007, growth in national health spending is projected to decelerate slightly to 6.6%, while spending growth among private payers and Medicaid accelerates.  
    • This year’s national health spending projection anticipates an average annual growth of 6.9% from 2006 to 2016.  
    • Even though the proportion of Americans using prescription drugs remained constant between 1996 and 2003, spending per person more than doubled from $424 to $950.  
    • The national average annual cost for a private one-bedroom unit in an assisted living facility is $32,294.40 ($88.48/day). This is a 6.7% increase over 2005 rates. Note–these rates exclude one-time…  
    • In 2004, national health expenditures were approximately $1.88 trillion.  
    • 2/3 of Medicare expenditures are for the 9.5 million beneficiaries who have 5 or more chronic conditions.  
    • 99% of Medicare spending is on behalf of beneficiaries with at least 1 chronic condition. 96% of Medicare spending is on behalf of beneficiaries with multiple chronic conditions.  
    • Compared to individuals with no chronic conditions, the average per capita spending for someone with 1 chronic condition is more than 2.5 times greater; with 3 chronic conditions is more…  
    • Health care spending accounts for 16% of the GDP, with total spending estimated to reach $2.2 trillion in 2006.  
    • Freestanding home health care spending continued to grow in 2005, increasing 11.1%, which was the 3rd straight year of double-digit growth. Home health care spending was the fastest growing health…  
    • “Medicaid spending growth increased slightly in 2005 to 3.9%, while Medicare nursing home expenditures grew 12.0% following growth of 16.2% in 2004.”  
    • Hospital spending accounted for 31% of all money spent on health care in 2005, which was the largest share of overall health spending.  
    • Out-of-pocket spending for health care was $249.4 billion in 2005.  
    • In 2005, Medicare spending reached $342.0 billion which was a 9.3% increase. Medicare spending increased 10.3% in 2004.  
    • Public-sector spending on health care increased 7.7% in 2005, compared with 7.8% in 2004.  
    • In 2004 and 2005, hospital spending continued to grow quickly by 7.9% each year and accounted for the largest share of the overall spending increase in both years.  
    • The health care portion of the GDP was 16%, which was slightly higher than the 15.9% in 2004.  
    • U.S. health care spending increased 6.9% in 2005 to almost $2.0 trillion, or $6,697 a person.  
    • In 2004, hospital spending, which is 30% of national heath expenditures, increased by 8.6%.  
    • “Medicare spending has grown about nine-fold in the past two decades, from $37 billion in 1980 to $336 billion in 2005.”  
    • About 95% of health care spending for older Americans is for chronic diseases.  
    • Total health care spending in 2006 is projected to be $2.1 trillion.  
    • 95% of all nursing homes in the United States are Medicare certified.  
    • Certified home care providers charge the most of any home health aides, averaging $36.22 per hour (a 17% increase over 2005). Non-certified but licensed providers charge an average of $22.15…  
    • The average annual rate for home health aides is $25.32. This includes licensed and Medicare-certified home care providers, non-certified but licensed home care providers, and non-certified and non-licensed home care…  
    • The lowest annual cost for a one-bedroom in an assisted living facility is in North Dakota ($20,714 excluding community fees) and Arkansas ($20,937 excluding community fees).  
    • The highest annual costs for a one-bedroom in an assisted living facility are in the Bridgeport area in Connecticut ($57,566.52 excluding community fees) and New Jersey state, excluding the Newark…  
    • The national annual average cost for a one-bedroom in an assisted living facility increased $2,029 from 2005.  
    • On average, the cost of care for a private (single occupancy) room in a Medicare certified nursing home is 17% greater in America’s urban areas than non-urban areas. The greatest…  
    • The national average annual cost for a semi-private room (double occupancy) in a Medicare certified nursing home is $62,532 ($171.32/day). This is a 2.3% increase over 2005 rates.  
    • The lowest average annual cost for a private room (single occupancy) in a Medicare certified nursing facility is in Louisiana and Missouri (excluding St. Louis and Kansas City) at a…  
    • The highest average annual cost for a private room (single occupancy) in a Medicare certified nursing home is in Alaska at a cost of $191,140. The next highest cost is…  
    • The national average annual cost for a private room (single occupant) in a Medicare certificed nursing home increased $1,490 from 2005 rates.  
    • The national average annual cost for a private room (single occupant) in a Medicare certified nursing home is $70,912 ($194.28/day). This is a 2.2% increase from 2005 rates.  
    • In 2003, national health expenditures were 15.3% of the GDP, compared to 5.1% in 1960.  
    • In 2003, the U.S. spent $1.7 trillion on health, an average of $5,671 per person.  
    • In 2004, nursing home and home health care cost the nation $158.4 billion.  
    • More than Three-Fifths of Health Care Spending Is on Behalf of People with Multiple Chronic Conditions  
    • People with Chronic Conditions Account for 83 Percent of all Health Care Spending  
    • The United States spends more than $26 billion annually on additional health care costs for people over 65 who lose their ability to live independently over the course of a…  
    • In 2003, heart disease, stroke, cancer, diabetes, and Alzheimer’s disease cost an estimated $771 billion.