A national study of medical care expenditures for musculoskeletal conditions - The impact of health insurance and managed care

Objective. To provide estimates of all medical care expenditures on behalf of persons with musculoskeletal conditions in the United States in 1996, to estimate the increment in expenditures attributable to the musculoskeletal conditions among such persons, and to ascertain the impact of the presence or absence of health insurance and/or managed care on such expenditures. Methods. The estimates were derived from the Medical Expenditure Panel Surv ey (MEPS), a national probability sample of 9,488 households, which include s responses from 21,571 persons. In the MEPS, respondents are surveyed ever y 6 months to report on medical care utilization and health care expenditur es. Of the 21,571 persons surveyed, 4,161 reported having 1 or more musculo skeletal conditions. After weighting the data, these 4,161 individuals were inferred to represent 53.935 million persons in the nation as a whole. We tabulated all medical care expenditures of these individuals, stratified by comorbidity status, and then compared their expenditures with those among persons with chronic conditions other than musculoskeletal disease or with no chronic conditions. We then used regression techniques to estimate the i ncrement of health care expenditures attributable to the musculoskeletal co nditions. Finally, we used regression to estimate the impact of health insu rance status and managed care status on the health care expenditures of the persons with musculoskeletal conditions. Results. Per capita medical care expenditures in 1996 averaged $3,578 among persons with musculoskeletal conditions, for a national total of $193 bill ion, the equivalent of 2.5% of the Gross Domestic Product in that year. The largest components were hospital admissions (37%), physician visits (23%), and prescriptions (16%). Estimates of the per capita increment in total me dical care expenditures attributable to musculoskeletal conditions ranged f rom a high of $723 when controlling for the other medical conditions presen t, to $364 when controlling for these variables and demographics. Persons w ith musculoskeletal conditions ages 16-64 who lacked health insurance repor ted total expenditures of $793, versus $3,249 among those with insurance (P < 0.0001). Among such persons with insurance, expenditures did not differ significantly between those in fee-for-service plans and those in managed c are health plans. Conclusion. Persons with musculoskeletal conditions and health insurance ex perienced high total expenditures for medical care and high expenditures at tributable to the musculoskeletal conditions. Insurance coverage under a ma naged care plan had no effect on the magnitude of these total expenditures, but lack of insurance coverage did have a significant effect among persons with musculoskeletal conditions.