As insurers, employers and average Americans grapple with skyrocketing health care bills, a study being published today has found that a small number of illnesses -- many of them preventable -- account for most of the spending increase over the past two decades.
In the first comprehensive examination of which illnesses are driving an unprecedented rise in medical expenditures, Emory University health economist Kenneth E. Thorpe tracked 370 conditions and found that 15 accounted for 56 percent of the $200 billion rise in health spending between 1987 and 2000.
Five conditions accounted for one-third of the increase, with heart disease at the top of the list, followed by pulmonary conditions, mental disorders, cancer and hypertension.
Thorpe's study, published in the journal Health Affairs, found that chronic conditions such as heart disease, hypertension, diabetes and mental disorders are costing Americans billions more than they did 20 years ago.
By documenting the most costly conditions, Thorpe's findings offer the beginnings of a road map for controlling health costs. At the same time, they suggest that in some cases, the increased spending has resulted not only in better health but also in long-term savings.
"Higher spending on treating heart attacks, low-birthweight babies, cataracts and depression has benefits that outweigh the increased costs," Thorpe wrote in Health Affairs. "Inasmuch as treatments for these conditions are cost-effective, their more widespread use is likely to represent an appropriate if costly expenditure by society."
Americans spent about $1.6 trillion on health care last year, or about 15 percent of the gross domestic product, compared with 11 percent of GDP 15 years ago. In the past three years, health insurance costs have increased an average of 12.5 percent annually, and that increase is the most commonly cited reason for why nearly 44 million people do not have insurance.
Thorpe found that medical spending has risen for three main reasons: More people are suffering from disorders such as asthma and diabetes; some conditions, such as heart disease, have become more expensive to treat; and the number of people diagnosed with some illnesses, such as mental disorders, has climbed.
"We've known health care spending is concentrated on certain individuals, but I don't think we knew how concentrated it is by medical condition," said Len Nichols, vice president of the Center for Studying Health System Change. "This points us in the direction of investigating value for dollars."
Although Americans spend more per capita on health care than citizens of any other industrialized nation, numerous studies have suggested the investments have not resulted in a healthier population.
The irony illuminated by the Health Affairs article is that there are "truly massive opportunities to improve the effectiveness and value and cost of health care, which are just not being pursued in public policy," said Henry E. Simmons, president of the National Coalition on Health Care, a nonpartisan group that promotes high-quality, universal care. "That's a very sad statement."
Simmons and others pointed to diabetes as the most obvious example of where the United States could drastically reduce costs and improve patients' health by following well-established treatment guidelines on diet, exercise and preventive measures, such as eye and foot exams.
Thorpe agreed that a stronger emphasis on prevention and following "best practices" guidelines would likely slow the growth rate in health spending and improve overall health.
"This is very much of a reactive system; we wait for somebody to get sick and show up" at a doctor's office, he said. "What's needed is a much more proactive approach."
Many of the 15 costliest maladies could be prevented or managed with simple, affordable steps.
However, the data also suggest that some medical procedures and prescription drugs have been worth the increased expense, Thorpe said.
Although the prevalence of heart disease has remained constant, 70 percent of the rise in cost per treated case was attributed to more expensive prescription drugs and procedures such as angioplasty and cardiac catheterization. At the same time, death rates associated with heart disease continue to go down, the article noted.
In many other areas, though, Thorpe found that "we do a substandard job of providing care" or identifying why certain maladies are on the rise. Two of the biggest mysteries, he said, were the "explosion" in patients reporting back pain and pulmonary cases, such as asthma and allergies.