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Medicare outcomes have improved markedly over past two decades, study indicates

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4124 (Published 29 July 2015) Cite this as: BMJ 2015;351:h4124
  1. Michael McCarthy
  1. 1Seattle

Over the past two decades mortality and admissions to hospital have fallen markedly among Medicare patients, while health outcomes have improved, a new study has reported.1 The study appears in this week’s issue of the Journal of the American Medical Association (JAMA), which features articles marking Medicare’s 50th anniversary.

In an audio summary accompanying the paper, the lead author, Harlan M Krumholz, of Yale University School of Medicine in New Haven, Connecticut, said that the report “suggests we are in the midst of a remarkable improvement in health and healthcare.”

“The improvements we observed were extraordinarily broad based,” Krumholz added. “We looked at various different subgroups: we looked by age, we looked by sex, we looked by race, and there was evidence of these improvements everywhere. There still remains some disparities between blacks and whites, but both groups experienced this dramatic improvement.”

In the study researchers identified 68 374 904 Medicare beneficiaries aged 65 years or older who had participated in the program for at least one month from 1999 to 2013. The researchers assessed trends for overall mortality among all beneficiaries, including those in the fee for service program and in the Medicare Advantage program, the managed care component of Medicare. Because the records of the fee for service program contained information on healthcare usage, their records were used to determine rates of admission to hospital, healthcare outcomes, and expenditures.

They found that among all Medicare beneficiaries mortality from all causes fell from 5.30% in 1999 to 4.45% in 2013 (difference 0.85 percentage points (95% confidence interval 0.83 to 0.87)). Among the 60 056 069 fee for service beneficiaries, the total number of admissions to hospital per 100 000 person years fell from 35 274 to 26 930 (difference 8344 (8315 to 8374)), and the mean inflation adjusted inpatient expenditures per fee for service beneficiary fell from $3290 (£2120; €2990) to $2801 (difference $489 ($487 to $490)).

The researchers also found that, among the fee for service beneficiaries, in-hospital mortality fell from 1.30% to 0.71% (difference 0.59 percentage points (0.59 to 0.60)), 30 day mortality fell from 2.16% to 1.65% (difference 0.51 percentage points (0.50 to 0.51)), and one year mortality fell from 4.49% to 3.48% (difference 1.01 percentage points (0.99 to 1.01)). “These findings did not change substantially after accounting for beneficiary age, sex, and race and geographic location,” they wrote.

Among the fee for service beneficiaries who died, use of inpatient care in the last six months of life also declined: the total number of hospital admissions fell from 131.1 to 102.9 per 100 deaths (difference 28.2 (27.9 to 28.4)), and the average number of days spent as an inpatient fell from 17 to 14. The researchers wrote, “The decreased hospitalization rates may reflect an increasing recognition of the importance of person-centered care at the end of life and a focus on decreasing the burden of multiple care transitions and hospitalizations on patients and their families.”

The researchers said that, although it was difficult “to disentangle the specific reasons for improvement,” it was likely that a combination of factors had a role, including improvements in the quality of healthcare delivery; improvements in the overall health of the Medicare population, because of such factors as reduction in tobacco use and better risk modification; and technological advances, such as advances in lipid lowering statins, coronary revascularization, and targeted anticancer treatments.

Notes

Cite this as: BMJ 2015;351:h4124

Footnotes

  • thebmj.com Observations: US Medicare, Medicaid, and nurse practitioners all turn 50 (BMJ 2015;351:h3863, doi:10.1136/bmj.h3863)

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