Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Am J Manag Care. 2011 Feb;17(2):118-22.
To determine the longitudinal effect on healthcare costs of multiple chronic conditions among adults aged 18 to 64 years.
Retrospective cohort assessment of working-age employees and their dependents with continuous coverage in a self-funded health plan from January 1, 2004, to December 31, 2007. Data were obtained from health benefit enrollment files and from medical and pharmacy claims.
Individuals were defined as having chronic conditions based on modification of a published method. The mean annual healthcare costs were estimated for individuals with 0, 1, 2, 3, 4, or 5 or more chronic conditions. The probability of persistence in high-cost categories across years was estimated for individuals in each group.
Overall, 75.3% of working-age adult enrollees had at least 1 chronic condition, 54.3% had multiple chronic conditions, and 16.5% had 5 or more chronic conditions. The cost of healthcare was higher among individuals with more chronic conditions for all ages. The mean medical cost per year for an individual with no chronic conditions was $2137, while that for an individual with 5 or more chronic conditions was $21,183. Enrollees with more chronic conditions had higher persistence in high-cost categories between years and persisted at these high costs for more years.
While multiple chronic conditions are common in the population 65 years and older, they are also of great concern for the working-age population. Understanding how to effectively manage individuals with multiple chronic conditions is an important challenge. Effective care management focused on managing the patient as opposed to a condition has the potential to significantly affect healthcare costs.
确定 18 至 64 岁成年人多种慢性病对医疗成本的纵向影响。
对 2004 年 1 月 1 日至 2007 年 12 月 31 日期间，连续参加自付费健康计划的在职员工及其家属的工作年龄员工进行回顾性队列评估。数据来自健康保险登记文件和医疗及药房理赔。
根据已发表方法的修改，根据个人患有慢性病的情况进行定义。根据个人患有 0、1、2、3、4 或 5 种或更多种慢性病的情况，估算个人的年度平均医疗成本。为每个群体中的个人估算了在高成本类别中持续存在的概率。
总体而言，75.3%的在职成年参保人至少有一种慢性病，54.3%的人患有多种慢性病，16.5%的人患有 5 种或更多种慢性病。对于所有年龄段的个人，患有更多慢性病的个人医疗成本更高。没有慢性病的个人每年的医疗费用平均为 2137 美元，而患有 5 种或更多种慢性病的个人则为 21183 美元。患有更多慢性病的参保人在高成本类别中跨年度的持续性更高，并且在这些高成本类别中持续的时间更长。
虽然 65 岁及以上人群中多种慢性病很常见，但对于工作年龄人群来说，这些疾病也令人非常担忧。了解如何有效管理患有多种慢性病的个人是一个重要的挑战。针对患者而非针对某种疾病的有效护理管理有潜力显著影响医疗成本。
