Washington Health Policy Week in Review

Washington Health Policy Week in Review is a weekly newsletter that offers selected stories from the daily newsletter CQ HealthBeat.

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Graying of America Means More Doctor Visits

By John Reichard, CQ HealthBeat Editor

August 6, 2008 -- Government statistics released Wednesday on how Americans use health care services show that Americans averaged nearly four visits apiece in 2006 to doctors' offices, hospital outpatient departments, and hospital emergency departments.

The number of those visits was 26 percent higher than in 1996, a rate of growth that far exceeded that of the U.S. population, which was 11 percent. "The rise in visits can be linked to both the aging of the population, as older persons have higher visit rates than younger persons in general, and an increase in utilization by older persons," the Centers for Disease Control and Prevention (CDC) said in releasing the data.

The percentage of patients admitted to the hospital who are elderly also has climbed steadily upward. People 65 or older made up 20 percent of all hospital inpatients in 1970, a figure that increased to 38 percent in 2006. Over the same period, the percentage who were 75 or older grew from 9 percent to 24 percent.

The data also showed heavy reliance by Medicaid patients on the emergency department for care. For every 100 persons on Medicaid in 2006, 82 made use of the emergency department, compared with 21 of every 100 who had private insurance.

In the case of African Americans, 38 percent of medical visits were to the emergency room or hospital outpatient department as opposed to physician offices, while in the case of whites the figure was 17 percent.

The most frequent specific reason for visiting the emergency room given by patients above the age of 14 was chest pain, followed by abdominal pain, back pain, headache, and shortness of breath. Doctors ordered imaging tests in 44 percent of the visits. Conventional X-rays were ordered in 35 percent of visits, CT scans in 11.6 percent, ultrasound imaging in 3.1 percent, and MRI scans in 0.5 percent.

The average time spent waiting to see a doctor during an emergency room visit was 56 minutes.

Medical visits in 2006 resulted in a large number of prescriptions. Seven of every 10 visits resulted in "at least one medication provided, prescribed or continued," for a total of 2.6 billion drugs overall, the CDC analysis found. Pain relievers were the common type of drug prescribed.

One-half of visits to the doctor were made by patients with at least one chronic condition. "Hypertension was the most frequent condition, followed by arthritis, high cholesterol, diabetes, and depression. Since 1996, visits by adults with diabetes, hypertension and depression have all significantly increased," the analysis said.

Visits to hospital outpatient departments by patients 18 or older
with chronic diabetes increased 43 percent between 1996 and 2006, while those for chronic hypertension increased 51 percent.

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