Principles and Applications

The Medicare program is the second largest social insurance program in the United States, behind Social Security, offering health insurance benefits to those eligible by virtue of their Social Security eligibility

Persons eligible for Medicare insurance include:

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Individuals aged 65 and over

The severely disabled

Those with end stage renal disease

While the Medicare insured make up just 17% of the U.S. population, they account for most of the U.S. health care costs

The rise in treatment prevalence (common chronic diseases) accounts for most of the spending growth in health care costs

The sickest 25% of the Medicare-insured spend 90% of the U.S. health care dollars with an average of:

At least one hospitalization yearly

$181,800 in health expenditures yearly

5 diagnosed medical conditions

10 prescriptions

12 physicians

 

The key to cutting costs lies with the physicians who treat these super-users:

At least two of their chronic medical conditions were preventable

Their care is not being coordinated by their multiple providers

They are being over-treated and mistreated (polypharmacy)

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