Chronic Disease
Gerard AndersonProfessor
Johns Hopkins University
“The lives of far too many people in the world are being blighted and cut short by non-
communicable chronic diseases such as heart disease, stroke, cancer, chronic respiratory disease and diabetes. This is no longer only
happening in high income countries... Globally, of the 58 million deaths in 2005,
approximately 35 million will be as a result of non-communicable chronic diseases. They are
currently the major cause of death among adults in almost all countries.”-Former Director General of WHO,
Lee Jong-wook
118
125
133
141
149
157
164
171
100
110
120
130
140
150
160
170
180
1995 2000 2005 2010 2015 2020 2025 2030
Year
Num
ber o
f Peo
ple
With
C
hron
ic C
ondi
tions
(mill
ions
)
• In 2000, 125 million Americans had one or more chronic conditions.
• Between 2000 and 2030, the number of Americans with chronic conditions will increase by 46 million people.
The Number Of People In US With Chronic Conditions Is Increasing Rapidly
Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.
23%
12%
6%
4% 4%
0%
5%
10%
15%
20%
25%
30%
1 2 3 4 5+
Number of Chronic Conditions
Perc
ent o
f All
Am
eric
ans
One In Four Americans Has Multiple Chronic Conditions
69%
75%
65%
64%
17%
17%
26%
27%
25%
13%
7%
9%
9%
8%67%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Children with LowerRespiratory Disease
Children with Disordersof Teeth and Jaw
Children with EyeDisorders
Children with Asthma
Children with UpperRespiratory Disease
Condition Alone Condition+1 Condition+2
Source: Medical Expenditure Panel Survey, 2004.
Children with Chronic Conditions Generally Have a Single Condition
17%
37%
15%
33%
23%
25%
29%
26%
28%
28%
18%
14%
24%
16%
21%
15%
10%
15%
10%
14%
25%
11%
20%
13%
15%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Adults with Arthritis
Adults with ChronicRespiratory Infection
Adults with Disorders oflipid metabolism
Adults with UpperRespiratory Disease
Adults with Hypertension
Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+
Source: Medical Expenditure Panel Survey, 2004.
Most Adults With A Chronic Condition Have More Than One Condition
12%
16%
13%
17%
20%
21%
20%
21%
21%
25%
19%
22%
21%
21%
38%
36%
38%
35%
26%11%
7%
6%
9%
4%
21%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Seniors with DiabetesMellitus
Seniors with EyeDisorders
Seniors with HeartDisease
Seniors with Arthritis
Seniors with Hypertension
Condition Alone Condition+1 Condition+2 Condition+3 Condition+4+
Source: Medical Expenditure Panel Survey, 2004.
Seniors With A Chronic Condition Rarely Have A Single Condition
Health Care Spending for People without Chronic Conditions
Health Care Spending for People with Chronic Conditions
Source: Medical Expenditure Panel Survey, 2004.
People With Chronic Conditions Accounted For 85 Percent Of All Health
Care Spending In 2004
85%
15%
Percent of Health Care Total Spending by Number of Chronic Conditions
2 Chronic
Conditions 18%
3 Chronic
Conditions 14%
4 Chronic
Conditions 12%
1 Chronic Condition
20%
0 Chronic
Conditions 15%5+ Chronic
Conditions 21%
Source: Medical Expenditure Panel Survey, 2004.
Sixty-Five Percent Of Health Care Spending Is On People With Multiple
Chronic Conditions
Source: Medicare Standard Analytic File, 2004.
1 Chronic Condition3%
4 Chronic Conditions12%
3 Chronic Conditions10%
2 Chronic Conditions6%
0 Chronic Conditions1%
5+ Chronic Conditions68%
Percent of Medicare Expenditures
Two-Thirds Of Medicare Spending Is For Beneficiaries With Five Or More
Chronic Conditions
$994
$2,753
$5,062
$7,381
$10,091
$16,819
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
0 1 2 3 4 5+
Number of Chronic Conditions
Ave
rage
Per
Cap
ita H
ealth
Car
e Sp
endi
ng
Source: Medical Expenditure Panel Survey, 2004.
Health Care Spending Increases With The Number Of Chronic Conditions
Source: Medicare Standard Analytic File, 2001.
1 8 1938
71
123
191
269
359
455
697
0
100
200
300
400
500
600
700
800
0 1 2 3 4 5 6 7 8 9 10+
Number of Chronic Conditions
Hos
pita
lizai
tons
for A
mbu
lato
ry C
are
Sens
itive
Con
ditio
ns P
er
1000
Med
icar
e B
enef
icia
ries
Age
s 65
+
Poor Care Coordination Leads To Unnecessary Hospitalizations
• Ambulatory care sensitive conditions (ACSCs) are conditions for which timely and effective outpatient primary care may help to reduce the risk of hospitalization.
24%
34%
34%
36%
44%
49%
54%
0% 10% 20% 30% 40% 50% 60%
Unnecessary nursing home placement
Experience of unnecessary pain
Patients not functioning to potential
Unnecessary hospitalization
Adverse Drug Interactions
Emotional problems unattended
Receipt of contradictory information
Adv
erse
Out
com
es
Percent of Physicians Who Believe that Adverse Outcomes Result from Poor Care Coordination
Physicians Believe That Poor Care Coordination Produces Bad Outcomes
46%43%
59%
71%
57%
46%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Total White Non-White Hispanic Uninsured Insured
Perc
ent o
f Peo
ple
with
Ser
ious
Chr
onic
Con
ditio
ns
Rep
ortin
g Th
at T
hey
Did
Not
Rec
eive
Nee
ded
Car
e
Source: Serious Chronic Illness Survey, conducted by the Gallup Organization, 2002.
People With Serious Chronic Conditions Believe
They Do Not Receive Needed Treatment
Problems To Overcome
Clinical research – complicated patients excluded form clinical trials Medical education – specialty not coordinated care is focus of medical school curriculumPayment and delivery systems- acute not chronic care orientationQuality measurement- care coordination and multiple chronic problems