SOURCES: Harlan Krumholz, M.D., professor, medicine, Yale University School of Medicine, New Haven, Conn.; Louise Sheiner, Ph.D., senior fellow, economic studies, Brookings Institution, Washington, D.C.; Bowen Garrett, Ph.D., senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; July 28, 2015, Journal of the American Medical Association
TUESDAY, July 28, 2015 (HealthDay News) -- In a rare piece of good news about the U.S. health care system, a new study finds that deaths, hospital stays and spending are all falling among older Americans.
Between 1999 and 2013, yearly rates of death and hospitalization steadily declined among Americans in the traditional fee-for-service Medicare program. Meanwhile, spending on inpatient care showed the same pattern.
Researchers called the findings striking.
"The declines were steady throughout the study period," said lead researcher Dr. Harlan Krumholz, a professor of medicine at Yale University School of Medicine. "The trends are actually pretty jaw-dropping."
For a public used to hearing how broken the U.S. health care system is, the findings might come as a surprise, Krumholz acknowledged.
"As researchers," he said, "we often focus on finding deficiencies in health care, so we can work on them. And that can lead to a perception that we've got a terrible system."
In this case, Krumholz said, his team wanted to see whether national efforts to improve health care quality -- and public health -- have been paying off.
They focused on the traditional Medicare fee-for-service program, because it has the most data available. In this plan, hospitals and doctors bill Medicare for each individual service -- from a doctor's visit to providing a pain reliever in the hospital, according to the U.S. Government Accountability Office. In 2013, about 71 percent of Medicare beneficiaries were in the traditional fee-for-service program, the study 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 death rates among Americans in Medicare Advantage plans. The researchers found a similar decline.
The study can only show what is happening, and not why. "But," Krumholz said, "we have our suspicions."
For one, management of chronic health conditions such as high blood pressure, diabetes and heart disease has improved. Plus, Krumholz said, many Americans have made lifestyle changes for the better: Even though obesity is on the rise, smoking rates are down, and more people are exercising regularly.
The last 15 years have also seen a "big push" to improve health care quality nationally, Krumholz said. That has included measures to cut medical errors and boost hospital safety; public reporting on hospitals' performance, and efforts to improve patients' continuity of care among different providers.
Overall, U.S. spending on health care rose during the study period. But it's not clear if that's why Medicare patients' rates of death and hospitalization have fallen, according to Louise Sheiner, a senior fellow in economic studies at the Brookings Institution, a Washington, D.C.-based think tank.
"We don't know if we would've seen the same changes if we'd spent less on health care," said Sheiner, who was not involved in the study.
But she agreed that the trends, whatever the reasons, are encouraging. "The public is used to hearing that everything is terrible, and we waste too much money," Sheiner said. "But the system is at least increasing people's life expectancy."
In 1999, Medicare beneficiaries' rate of death from any cause was 5.3 percent; by 2013, that figure had declined to 4.5 percent. Death rates dipped both in and out of hospitals.
Meanwhile, hospitalizations fell from more than 35,000 per 100,000 annually, to just under 27,000 per 100,000. Inpatient spending dropped from an average of $3,300 per person in 1999, to $2,800 (adjusted for inflation).
Results of the study were published July 28 in the Journal of the American Medical Association.
"While the study can't pinpoint the reasons for the declines, they are welcome news," said Bowen Garrett, a senior fellow at the Urban Institute's Health Policy Center in Washington, D.C.
"It is good to see signs of improved outcomes during a period in which health care costs increased overall," Garrett said.
Progress is being made, at least for Medicare beneficiaries, Krumholz said. "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 death 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.
What's not clear from the study is whether those changes improved people's lives, or were cost-effective, Sheiner said.
As for the positive trends in deaths and hospitalizations, Sheiner said further studies are needed to weed out the specific reasons.
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