The New Health Dialogue

You hear a lot of talk in policy circles about disease management of chronic conditions, and we're all for new models of effective, coordinated care. But even if we figured out the perfect way to treat chronic diseases, it won't do much for uninsured people who can't get this wonderful new care. As a new study by the Kaiser Family Foundation shows, there are a lot of people who fall into that category. The number of working age adults with major chronic conditions grew by 25 percent during the ten years from 1997 through 2006.

The study by Catherine Hoffman and Karyn Schwartz, on the Health Affairs website, found that this group experienced access problems both based on their insurance status, and because of cost.

Nearly 58 million working age adults had at least one of seven major chronic conditions—heart disease, hypertension, stroke, diabetes, asthma, emphysema, and cancer. People with chronic conditions account for three-quarters of all personal medical spending in the United States. They documented that uninsured people had less access to care in 1997, and that the gap had grown much larger by 2006. The uninsured were less likely to have a usual source of care, less likely to have seen any health provider at all for a year, and by 2006, less likely to have seen a specialist. In contrast, for the insured, access improved over the decade, and for those on Medicaid it was unchanged.

But even for the insured, the rising costs of health care—particularly for medications which are so crucial to controlling chronic disease—took their toll. The authors found that the uninsured, the insured and the Medicaid population all reported unmet needs for prescription drugs because of cost in 2006 compared to 1997. For the insured, this problem doubled from 5 to 9.5 percent during the decade. For the uninsured 25 percent grew to 33 percent; for the Medicaid group: 5 percent growing to 8 percent by 2006.

Hoffman and Schwartz conclude, "Controlling health system costs overall will require effective and efficient care for people with chronic conditions, because they use the majority of health care services in this country. These high costs put people with chronic conditions on the front lines to test major and even minor reforms of our health insurance system."