STATISTICAL BRIEF #545:
Expenditures for Commonly Treated Conditions Among Older Adults: Estimates From the Medical Expenditure Panel Survey, 2019

Introduction

About 88 percent of civilian noninstitutionalized adults 65 and older in the United States had at least one of 10 selected diagnosed chronic conditions in 2018 (1). In addition, just over three-fourths of Americans 80 years and older had at least one of four chronic diseases (cardiovascular disease, cancer, diabetes, and chronic lung disease) between 1998 and 2014 (2). Since 1996, the Medical Expenditure Panel Survey Household Component (MEPS-HC) has collected a wide range of healthcare data annually for the U.S. civilian noninstitutionalized population.

This statistical brief presents data from the 2019 MEPS-HC on condition-specificⁱ total annual expenditures and the share of those expenses associated with different medical servicesⁱⁱ and sources of payments for nine commonly treated conditions (those with an estimated treated disease prevalence of about 20 percent or higher) among adults 65 and olderⁱⁱⁱ. These conditions include: (a) hypertension, (b) hyperlipidemia, (c) arthritis and other joint disorders (including joint pain and back pain), (d) nervous system disorders, (e) heart disease, (f) diabetes, (g) cancer, (h) mental disorders, and (i) chronic obstructive pulmonary disease (COPD), asthma, and other respiratory conditions. All estimates are weighted to represent older adults in the U.S. civilian noninstitutionalized population, and standard errors are adjusted to account for the MEPS complex survey design. Most figures in this brief present estimates with a 95-percent confidence interval.

Findings

Percentage distribution of the number of treated conditions among older adults

Table 1 shows the percentage of older adults according to the number of conditions for which they received treatment. About one-half of older persons (47.0 percent) reported receiving treatment for three to nine of the conditions examined here, 18.2 percent for one condition, and 22.3 percent for two conditions^iv in 2019. Conversely, 5.8 percent received treatment for other conditions (but none of the nine commonly treated conditions), while 6.7 percent of older adults reported none (i.e., neither any of the nine commonly treated conditions nor any other condition). Thus, in 2019, 87.5 percent of older adults reported receiving treatment for at least one of these nine conditions, and 69.3 percent reported receiving treatment for more than one of them.

Prevalence of commonly treated conditions

As shown in Figure 1, in 2019 hypertension was the top commonly treated condition among older adults, with 56.2 percent of the population (31 million older adults) receiving treatment. This was followed by hyperlipidemia (44.4 percent; 24 million older adults), arthritis/other joint disorders (36.1 percent; 20 million older adults), nervous system disorders (27.2 percent; 15 million older adults), heart disease (25.6 percent; 14 million older adults), and diabetes (22.1 percent; 12 million older adults). The treated prevalence estimates for the remaining three conditions were each about 20 percent (19.9 percent for cancer, 19.8 percent for mental disorders, and 19.4 percent for COPD/asthma/other respiratory conditions; about 11 million older adults for each condition).

Mean annual expenditures per person and median expenditures by condition

As shown in Figure 2, mean annual expenditures per person among older adults with expenses^v for these nine conditions were highest for cancer ($5,681), heart disease ($5,397), and diabetes ($4,766), and lowest for hyperlipidemia ($622) and hypertension ($885) in 2019. Median expenditures followed a similar pattern, with the highest amount paid for treatment of diabetes ($1,390) and heart disease ($849) and the lowest for hypertension ($207) and hyperlipidemia ($151).

Total expenditures by condition

Figure 3 shows total annual expenditures for these nine commonly treated conditions among older adults. In 2019, among older adults, annual healthcare expenditures totaled $75.6 billion for heart disease, $61.7 billion for cancer, $58.6 billion for arthritis/other joint disorders, $57.5 billion for diabetes, $35.1 billion for nervous system disorders, and $34.7 billion for COPD/asthma/other respiratory condition. Despite the higher treated prevalence of hypertension and hyperlipidemia, estimates of total annual expenses for treating these conditions were relatively low ($27.2 billion, and $15.0 billion, respectively) due to low average expenses per person. In addition, the total annual spending for treating mental disorders, one of the less prevalent conditions among the nine, was also low ($18.1 billion).

Treatment expenditures by type of medical service (condition-specific)

Figure 4 presents the distribution of annual healthcare expenditures^vi by type of medical service for each of the nine treated conditions. Compared across these service categories, the proportion of yearly medical expenses associated with prescription drugs was largest for diabetes and hyperlipidemia (65.9 percent and 45.7 percent, respectively) in 2019. Ambulatory care accounted for the largest share of spending for arthritis/other joint disorders and cancer (50.2 percent and 45.7 percent, respectively). Inpatient care accounted for the largest share of spending for heart disease (45.9 percent). Finally, home healthcare accounted for the largest share of spending on treatment for mental disorders (48.9 percent).

Condition-specific treatment expenditures by source of payment

Figure 5 shows the share of the total healthcare spending for older adults on these nine treated conditions by source of payment. Overall, Medicare paid the largest share of healthcare expenses for treating these nine conditions in 2019. The share of expenditures paid by Medicare ranged from 55.5 percent for nervous system disorders to 68.9 percent for heart disease. In comparison, the private insurance share ranged from 8.3 percent for mental disorders to 21.5 percent for cancer treatment. Medicaid paid a smaller proportion, ranging from 1.8 percent for cancer treatment to 11.1 percent for hypertension and 11.7 percent for hyperlipidemia. Out-of-pocket payments were highest for mental disorders (19.1 percent), followed by nervous system disorders (15.3 percent) among these nine commonly treated conditions. In general, however, overall out-of-pocket expenses accounted for a relatively small proportion of annual expenditures for treatment of most conditions, accounting for less than 10 percent of expenditures for seven of the nine conditions examined.

Data Source

This statistical brief uses the 2019 MEPS public use files: (a) Medical Conditions File (H214), (b) Condition-Event Link File (H213IF1), (c) Office-Based Medical Provider Visits File (H213G), (d) Outpatient Visits File (H213F), (e) Emergency Room Visits File (H213E), (f) Prescribed Medicines File (H213A), (g) Hospital Inpatient Stays File (H13D), (h) Home Health File (H213H), and (i) Full-Year Consolidated Data File (H216). These data files are publicly available from this site: https://meps.ahrq.gov/data_stats/download_data_files.jsp. For the 2019 data year, the medical conditions files were merged into the different medical events files and the person-level full-year consolidated file.

Definitions

Individuals in this subpopulation are adults 65 and older. Data on age are based on the sample person's age at the end of the year. However, if the MEPS-HC did not collect the age data during a data collection round due to the sample person being out of scope (e.g., deceased or institutionalized), it then used the age data collected at the time of the previous round to determine the person's age.

The health conditions reported in this statistical brief were the most commonly treated conditions whose prevalence was about 20 percent or higher among older adults and were not mutually exclusive. Persons were classified as treated for a particular condition if they had one or more healthcare events (i.e., office-based, hospital outpatient or emergency room visits, hospital inpatient stays, prescribed medicine purchases, or home healthcare) where the condition was reported as leading to or having been discovered during the event. Conditions reported by the household were coded into International Classification of Diseases (ICD), 10th Revision codes, which were then collapsed to Clinical Classifications Software Refined (CCSR) codes. Similar CCSR codes were further grouped into broader condition categories. Table A.1 presents CCSR codes corresponding to nine treated conditions based on the array of three CCSR categories (i.e., CCSR1X, CCSR2X, and CCSR3X).

Additionally, this statistical brief uses a five-category condition variable: (a) none (i.e., neither any of the nine commonly treated conditions nor any other condition); (b) one commonly treated condition (with or without other conditions); (c) two commonly treated conditions (with or without other conditions); (d) three to nine commonly treated conditions (with or without other conditions); and (e) other conditions (but none of the nine commonly treated conditions).

For each of the nine commonly treated conditions, expenditures on treatment comprise payments from all sources (defined below) for prescribed medicines and for services provided in medical providers' offices, and hospital outpatient departments combined, emergency departments, inpatient hospitals, and patients' homes (home health). Total expenditures for each condition include expenses for any event linked to that condition. Consequently, expenditures may be counted more than once if an event is reported associated with multiple conditions. Finally, the report sums the treatment costs across service categories for each medical condition to create a person-level total.

• Ambulatory: Expenses for this event type include those for office-based provider visits (physician and non-physician medical providers seen in office settings) and hospital outpatient visits. These expenses include payments for services provided by the facility and by physicians who bill separately from the facility.
• Hospital inpatient stays: Expenses for this medical service category include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician services, and emergency room expenses for patients who were admitted as an inpatient from the same hospital's emergency department.
• Hospital inpatient stays: Expenses for this medical service category include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician services, and emergency room expenses for patients who were admitted as an inpatient from the same hospital's emergency department.
• Emergency room: Expenses include payments for services covered under the basic facility charge and those for separately billed physician services, excluding expenses for emergency room services included in an inpatient hospital bill.
• Prescribed medicines: Expenses in this medical service category are for all prescribed medications initially purchased or refilled during the year and expenses for diabetic supplies.
• Home health: Expenses for this category are for home healthcare services provided by agencies and paid independent providers.

Sources of direct payment for various types of medical service associated with each treated condition for the sample person are classified into five categories: (a) private insurance (including Tricare for military services), (b) Medicare, (c) Medicaid, (d) out of pocket (by patient or patient's family), and (e) other. The "other" category includes other federal government sources (e.g., Indian Health Service); (b) state/local government sources (other than Medicaid); workers' compensation; and Veterans Administration/Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).

About MEPS

References

For a detailed description of the MEPS-HC survey design, sample design, and methods used to minimize sources of nonsampling error, see the following publications:

1. Chowdhury, SR, Machlin, SR, and Gwet KL. Sample designs of the Medical Expenditure Panel Survey Household Component, 1996-2006 and 2007-2016. Methodology Report #33. Rockville, MD: Agency for Healthcare Research and Quality; January 2019. https://meps.ahrq.gov/data_files/publications/mr33/mr33.shtml
2. Cohen, J. Design and methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, MD: Agency for Health Care Policy and Research; 1997. https://meps.ahrq.gov/data_files/publications/mr1/mr1.shtml
3. Boersma P, Black LI, Ward BW. Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis 2020;17:200130. DOI: U.S. Department of Health and Human Services, CDC. http://dx.doi.org/10.5888/pcd17.200130
4. Fong, J.H. Disability incidence and functional decline among older adults with major chronic diseases. BMC Geriatr 19, 323 (2019). https://doi.org/10.1186/s12877-019-1348-z
5. Centers for Disease Control and Prevention (CDC)/National Center of Health Statistics (NCHS). Percent of U.S. Adults 55 and Over with Chronic Conditions. Hyattsville, MD; September 2009. https://www.cdc.gov/nchs/data/health_policy/adult_chronic_conditions.pdf

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