According to Chapel et al.(2017) the prevalence of chronic diseases has been high in the U.S. in recent decades. In 2012, half of all U.S. adults had at least one chronic condition, and at least one in four had two or more. The high prevalence of chronic diseases is a key driver of total U.S. healthcare costs. In 2010, 86% of healthcare spending was for patients with at least one chronic condition, and 71% of spending was for patients with multiple conditions.
Medicaid is the second largest source of health insurance in the U.S. In 2012, average monthly enrollment in Medicaid was 57.5 million, and total Medicaid program expenditures for that year were $428.5 billion. Historically, Medicaid has primarily covered low-income children and parents, pregnant women, and the disabled. This population is vulnerable to higher rates of chronic diseases than are seen in the U.S. as a whole or even in the low-income population overall.
Wehby et al.(2018) agree that older adults have two or more chronic diseases and must cope with the illness burdens through their remaining life. Understanding the relationships between the underlying mechanisms for these conditions and long-term wellbeing including genetic links may offer insights into strategies for promoting successful and healthy aging. The study show that genetic predispositions to major chronic health conditions are strongly and consistently related to several aspects of functional health and socioeconomics among older adults.
The most significant source of medical waste is overuse, defined as care that is provided without supporting evidence or when the risk for harm exceeds the potential benefit. Providers who commit fraud and abuse target vulnerable patient groups such as those with chronic diseases and the elderlies. They engaged in egregious activities, including reselling Medicare-reimbursed prescription drugs, performing unnecessary procedures, and using untrained personnel. In one study, the patients most likely to be treated by such providers were significantly more likely to be non-White, and those eligible for Medicare and Medicaid( Hughes & Meadows, 2020)
How DNP can Apply into Practice
DNP prepared nurses can respond to the growing number of patients with chronic illness and designed and test new ways of providing care. Care that will result in the improvement of health and patient outcomes. Also care should focus on lowering healthcare costs and enhance patient satisfaction. Now, the medical profession including the DNP prepared nurse and its leadership are confronted by the responsibility to build a practice of medicine and a health care system that better meet the needs of patients with chronic illness and reduces the health care crisis (Holman, 2020). It is increasingly important to understand the major health burdens this population faces and the associated medical costs, which is important for informing future program design and developing health promotion programs to contain or reduce the public health burden and healthcare costs( Hughes & Meadows, 2020) .
References
Chapel, J. M., Ritchey, M. D., Zhang, D., & Wang, G. (2017). Prevalence and Medical Costs of Chronic Diseases Among Adult Medicaid Beneficiaries. American Journal of Preventive Medicine, 53(6), S143–S154. https://doi.org/10.1016/j.amepre.2017.07.019
Holman, H. R. (2020). The Relation of the Chronic Disease Epidemic to the Health Care Crisis. ACR Open Rheumatology, 2(3), 167–173. https://doi.org/10.1002/acr2.11114
Hughes, D. L., & Meadows, P. D. (2020). Reducing Medical Waste to Improve Equity in Care. American Journal of Public Health, 110(12), 1749–1750. https://doi.org/10.2105/ajph.2020.305962
Wehby, G. L., Domingue, B. W., & Wolinsky, F. D. (2018). Genetic Risks for Chronic Conditions: Implications for Long-term Wellbeing. The Journals of Gerontology: Series A, 73(4), 477–483. https://doi.org/10.1093/gerona/glx154
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