People with chronic health problems are heaviest users of medical care, but system not organized to meet their needs

from chronic health conditions, such as diabetes, heart disease, depression, and arthritis. They are also responsible for 75 percent of all medical care spending. Approximately 39 million Americans suffer from disabilities, which include physical impairments, as well as mental illness and drug addiction. Nearly 12 million suffer from functional limitations. People with functional limitations require special medical or supportive services, which can include home nursing or program like Meals-On-Wheels, to carry out daily activities.

Many people have more than one condition or overlapping conditions. More than 9.5 million Americans have all three conditions and have medical costs that are 16 times greater than people without any chronic conditions. They are also 10 times more likely to be hospitalized and 5 times more likely to see a doctor or need prescription drugs.

"Many people with chronic health problems will see as many as eight different doctors in a year, but most health care information systems do not allow doctors to know what care others are providing for their patients. Some care is deemed a "medical expense" while other services, like home nursing care, may be considered a "social expense" and may not be covered or will be covered under a different program with different rules. In other cases with an injury, long-term care may only offered for a limited time, even when some individuals may need longer treatment," explains Dr. Anderson.

Dr. Anderson adds that long-term care coverage is often based on financial needs. Ironically, the most complete long-term care and services are often available only to the poorest people. According to the study, this disparity can severely limit the treatment options available to physicians and create large out-of-pocket expenses for patients.

Dr. Anderson also says changes are needed in the clinical culture and in medical school curriculums to make coordination of care more feasible. Curre

Contact: Tim Parsons or Ming Tai
Johns Hopkins University Bloomberg School of Public Health

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