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Diagnoses for Chronic Illnesses Expected to Increase Under the ACA
A recent study published in Health Affairs found that chronic illness diagnoses are more likely to occur among insured individuals, suggesting that with more individuals covered under the Affordable Care Act (ACA), the number of chronic illness diagnoses will increase [2015;34:1554-1562]. This means that potentially 1.5 million more individuals could be diagnosed with at least 1 chronic illness.
Data from the 1999 to 2012 National Health and Nutrition Examination Surveys was analyzed to determine the relationship between health insurance and the 3 major chronic illnesses affecting the US population: (1) diabetes; (2) hypercholesterolemia; and (3) hypertension.
Study Findings
Improved diagnosis and control of the 3 chronic conditions was associated with having health insurance. Specifically, the probability of diagnosis for diabetes and hypercholesterolemia is 13.5 percentage points higher (95% confidence interval [CI]: 4.9, 22.2; 95% CI: 10.1,17, respectively), and the diagnosis of hypertension is 8.8 percentage points higher (95% CI: 5.7, 11.9).
Using the estimate provided by the Congressional Budget Office that states the ACA will cut the amount of nonelderly Americans without health insurance in half, the researchers determined that there would be 313,000 (95% CI: 108,000, 545,000) fewer cases of undiagnosed diabetes, and 162,000 (95% CI: -21,000, 374,000) fewer cases of uncontrolled diabetes among 659,000 individuals. Hypercholesterolemia would have 811,000 (95% CI: 565,000, 1,078,000) fewer undiagnosed cases, and 241,000 (95% CI: 25,000, 475,000) fewer uncontrolled cases among 659,000 individuals. Hypertension would have 485,000 (95% CI: 302,000, 681,000) fewer undiagnosed cases, and 271,000 (95% CI: 82,000, 476,000) fewer uncontrolled cases among 659,000 individuals.
Once patients were diagnosed with ≥1 of the 3 common chronic conditions, they were associated with improved control and management of the condition.
“In a hypothetical scenario in which all nonelderly Americans had health insurance, we estimate that there would be 3.1 million more people with a diagnosis of 1 of these chronic conditions and 1.3 million fewer with uncontrolled cases,” the researchers said.
While more chronic illness diagnoses will trigger an increase in health care costs initially, Wayne Riley, MD, MPH, president of the American College of Phy- sicians, pointed out in a Medscape Medical News article that economic models need to assess the cost over time, not just the initial cost of diagnosing and treatment. Dr Riley asked, “What is the putative cost if 25% of them don’t have a heart attack?” When a diagnosis occurs early, complications such as amputations in diabetes patients could be avoided.
Researchers stressed that improved management of the chronic conditions could lead to a decrease in health care spending in the long run, pointing out that less intervention would be necessary if a condition is better managed.
The Health Affairs study had the following 4 limitations:
1. Some estimated effects could be biased due to unobservable characteristics.
2. Classifications and definitions for insurance status and health outcomes caused some limitations.
3. Control of each chronic condition was defined as a single measurement at a single point in time so fluctuation may have occurred after the measurement took place.
4. Disease definitions were standardized and may not be exact to those used in clinical practice.
More studies should be done on the specific short-and long-term effects of an increase in diagnosed chronic illnesses and how it will affect health care services demand and spending. The researchers pointed out a potential issue caused by an increase in demand for health care services. “These people will need regular access to health care providers, and policy makers need to rethink their strategy for ensuring that newly insured patients can get the care they need.”—Melissa D. Cooper
