Medicare program shows improvements in health outcomes & costs since 1999

An analysis of Medicare fee-for-service beneficiaries found all-cause mortality rates, hospitalization rates and expenditures per beneficiary decreased from 1999 to 2013. During that same time period, patients who were hospitalized also experienced better survival rates in later years and total hospitalizations and inpatient costs declined in the last six months of their lives, according to findings published online July 28 in JAMA.

Lead researcher Harlan Krumholz, MD, and colleagues analyzed data from more than 60,000 patients who enrolled in Medicare for at least one month from January 1999 through December 2013.

“We tend to focus a lot of studies on problems in health care, in part to identify where we can do better,” Krumholz, a cardiologist at Yale University, wrote in an email to Cardiovascular Business. “In this study we hoped to find that all the efforts over the last decade or so were paying off – but we did not anticipate such an amazing result." 

"For example," continued Krumholz, "our study indicates that there may have been as many as 3.5 million hospitalizations averted in 2013 compared with what would have happened had the rate from 1999 remain unchanged. We also saw fewer deaths each year, consistent with a growing life expectancy.”

From 1999 to 2013, the total number of hospitalizations decreased from 35,274 to 26,930 per 100,000 person-years, and the mean inflation-adjusted inpatient expenditures decreased from $3,290 to $2,801. The number of Medicare beneficiaries increased from 33,540,416 in 1999 to 42,474,269 in 2013.

In the last six months of their lives, the number of hospitalizations declined from 131.1 to 102.9 per 100 deaths, the percentage of beneficiaries with at least one hospitalization decreased from 70.5 to 56.8 per 100 deaths and the inflation-adjusted inpatient expenditures decreased from $15,312 to $13,388.

Although the researchers could not identify the reasons for the improved outcomes and reduced costs, Krumholz said they hoped to study the data further and identify explanations.

“It is hard to know what exactly caused these findings – and there are most likely the result of many efforts across the country,” Krumholz wrote. “This period was marked by a deep investment in improving the safety and quality of health care. There were parallel efforts seeking to promote population health and health behaviors. And technology also advances, with new drugs and devices. All these, and more, likely contributed.”