Study of Medicare Patients Finds "Remarkable Improvement" in Health, Healthcare

All-cause mortality and hospitalization rates and inpatient expenditures among Medicare fee-for-service beneficiaries decreased from 1999 to 2013, according to a study published in JAMA.

According to lead author Harlan M. Krumholz, MD, MS, professor of cardiology at the Yale School of Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, the study’s findings suggest a “remarkable improvement in health and healthcare” in the United States. He attributed this improvement to changes in healthcare technology, delivery, and behaviors.

“The improvements that we observed were extraordinarily broad based,” he explained in an interview with JAMA. “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.”

Dr Krumholz and colleagues examined a sample of 68,374,904 adults age 65 years or older and in Medicare fee-for-service or Medicare Advantage determined all-cause mortality among this population declined from 5.3% in 1999 to 4.5% in 2013. Inpatient expenditures declined from $3290 to $2801 per Medicare fee-for-service beneficiary.

Care for fee-for-service beneficiaries in the last 6 months of life also improved with hospitalizations down from 131 to 103 per 100 deaths and inpatient expenditures decreased from $17,423 in 2009 to $13,388 in 2013.

During the time studied, more patients were being discharged to rehabilitation and nursing facilities or with home healthcare and the proportion of patients discharged to home without care steadily declined.

“Even though it is difficult to disentangle the specific reasons for improvement, it is clear that over the past 15 years there have been marked reductions in mortality, hospitalization, and adverse hospital outcomes among the Medicare population aged 65 years or older,” the authors wrote.