The Role of Chronic Disease and Multiple Chronic Conditions on the Level and Change in Per Capita Health Care Spending, 2010-2021

Objective: To estimate the key factors accounting for the level and change in inflation-adjusted per capita spending among all adults, privately insured adults aged 18-64 and Medicare beneficiaries. In addition to examining demographic factors, we focus on the role of patients with multiple chronic conditions and in the most recent years the impact that COVID-19 had on per capita spending. Methods: We used generalized linear regression models (GLM) with log-link given the skewness of the data. Our analysis focuses on 2010 to 2021. We report results for 2010, 2016 and 2021. The regressions models control for patient demographics, income, race/ethnicity, region of the country, the number of diagnosed chronic conditions and whether the adult was treated for COVID-19. Results: The number of chronic conditions treated were the strongest predictor of per capita health care spending. Moreover, in each of the populations examined, the impact of patients with 5 or more chronic on per capita spending increased dramatically. Patients diagnosed and treated, even controlling for comorbid chronic conditions, had a significant impact on increasing per capita spending. Conclusions: Adults with multiple chronic conditions are the key drivers of the level and growth in spending. During 2021, the COVID-19 pandemic also independently increased spending. With the prevalence of COVID-19 waning, this trend should take some pressure off the growth in spending. New more effective team-based care coordination models are needed to prevent and manage complex patients with multiple chronic conditions. The system need to continue to integrate the various silos of care into a more comprehensive patient centered focus.