The economic impact of stroke.

Estimates of the total cost of stroke in the United States vary widely, ranging from annual health care expenses of $15 billion to $30 billion when the patients' lost wages are included. As a result of increasingly shorter acute hospitalizations under the DRG-based Prospective Payment System, medical costs paid by Medicare have stabilized. Data from Medicare show that people over age 64 years account for 87% of all deaths and 74% of all hospitalizations for cerebrovascular disease. Data through 1986 indicate that cost-containment measures did not appear to affect outcomes negatively or lead to more complications that would likely add to the cost of hospital care. Shorter inpatient rehabilitation stays are also a product of Medicare reimbursements and of capitated care. The mean cost across regions of the United States for inpatient rehabilitation is three to four times that of an acute hospital stay; however, only a minority of stroke survivors receive this level of care. The greater availability of nursing homes and a decline in age-adjusted death rates that might leave more patients disabled could raise some costs, whereas more widespread management of risk factors might decrease stroke rates and the severity of disability.