HealthDay News — Between 1999 and 2013, yearly mortality and hospitalization rates steadily declined among Americans in the traditional fee-for-service Medicare program. Meanwhile, spending on inpatient care showed the same pattern. The findings were published in the July 28 issue of the Journal of the American Medical Association.
Harlan Krumholz, MD, a professor of medicine at the Yale University School of Medicine in New Haven, Conn., and colleagues focused on the traditional Medicare fee-for-service program, because it has the most data available. In 2013, about 71% of Medicare beneficiaries were in the traditional fee-for-service program, the authors reported. The rest were enrolled in newer, Medicare Advantage plans, where private insurers approved by Medicare provide coverage. Krumholz’s team was also able to analyze mortality rates among Americans in Medicare Advantage plans.
In 1999, Medicare beneficiaries’ all-cause mortality rate was 5.3%; by 2013, that figure had declined to 4.5%. Mortality rates dropped both in and out of hospitals. Meanwhile, hospitalizations fell from 35,274 per 100,000 annually to 26,930 per 100,000. Inpatient spending dropped from $3,290 per person in 1999, to $2,801 in 2013 (adjusted for inflation).
Progress is being made, at least for Medicare beneficiaries, Krumholz told HealthDay. “That should give the public some confidence that we’re going in the right direction,” he added. “But we shouldn’t become complacent, either.” And while some trends are “unequivocally good” — such as the declining mortality rate — some others are tougher to interpret, Krumholz said. His team looked at what happened to beneficiaries after they were discharged from the hospital, and found changing patterns over time. By 2013, more people were discharged to skilled nursing facilities, long-term care, hospice, or home health services. Fewer were sent home without health services. Louise Sheiner, PhD, a senior fellow in economic studies at the Brookings Institution, a Washington, D.C.-based think tank, told HealthDay that what’s not clear from the study is whether those changes improved people’s lives, or were cost-effective.
One author disclosed financial ties to Medtronic, Johnson & Johnson, and UnitedHealth.