Study Documenting Rise in Hospitalization Costs for Elderly Spotlights Workforce Concerns

U.S. Census Bureau population growth projections confirm what many people consider common knowledge: that older adults -- defined as those who are age 65 or older -- are the fastest growing age group in the United States. What's not commonly known is that the cost of hospitalizing these individuals for infectious diseases, or IDs, is far outstripping the rate at which this patient population is increasing. That's among the findings of a study published recently in the Journal of the American Geriatrics Society.

The study examined hospitalization rates for IDs by age group and other factors from 1998 to 2004, as well as charges for those hospitalizations. It found that although the average annual rate of ID hospitalizations remained fairly stable at 503 per 10,000 older adults throughout the study period, "the total charges for ID hospitalizations and for all hospitalizations in older adults in the United States increased 45 percent and nearly 40 percent, respectively, during the seven-year study period, whereas the population of older adults grew by only 5 percent" in that time.

Moreover, the study found that "the average charge for an ID hospitalization increased 36 percent, from $18,396 in 1998 to $25,034 in 2004," among individuals age 65 or older during that same period.

"Sustained increases of such magnitude will have major implications for the U.S. health care system as it prepares for the more than doubling of the older U.S. adult population during the first 30 years of this century," study authors warned. Specifically, they said, the population of older adults is expected to double from 35 million to 72 million between 2000 and 2030, with older adults accounting for nearly 20 percent of the U.S. population in 2030, compared with 12 percent in 2000.

However, the study authors suggested, "Because many IDs are effectively treatable and frequently preventable, they may represent an area in which preventive measures could help offset some of the substantial health care costs associated with hospitalizations."

That's where family physicians can have a major impact, said Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, an AAFP liaison to the CDC's Advisory Committee on Immunization Practices. According to him, primary care physicians generally are the first to deal with infectious diseases circulating in communities and, thus, can take an active role in preventing these illnesses in older, high-risk patients.

"Prevention is the best way of handling the infectious disease problem, and for this, patients need a medical home," Campos-Outcalt said.

But some question whether a critical component of the patient-centered medical home -- and the comprehensive care it represents -- is being threatened by an ongoing drop in the number of medical students choosing careers in primary care.

"Based on current workforce estimates, there will likely be an insufficient number of primary care physicians to help care for (the elderly) population," FP Stanley Robinson, M.D., told AAFP News Now. Robinson is medical director of the Glendale Family Health Center in Glendale, Ariz.

For example, according to the National Resident Matching Program, the total number of medical students entering family medicine residencies dropped from 3,293 in 1998 to 2,711 in 2006, a decline that has been attributed to various factors, including students' perceptions about lifestyle differences and overall payment inequities between primary care and subspecialty physicians. A similar trend can be seen for general internal medicine programs.

In short, said Robinson, increasing numbers of medical students in recent years have focused on subspecialization in such fields as cardiology or anesthesiology, which they view as both more lucrative and prestigious.

"Specialties that have a technical or invasive nature are perceived as being more complex and challenging. This is reinforced in some medical school settings, where the generalist physician is looked down upon as having a less intellectually challenging job," Robinson said. "I worry that students today are making career decisions based on what I believe is a rapidly changing landscape that may not reliably produce the results they expect throughout their careers."

Whatever the cause of the declining numbers, a growing body of research shows that failure to boost the number of FPs and other primary care physicians stands to hinder not only the U.S. health system's ability to provide the essential acute care services needed by the burgeoning elderly population, but also the nation's capacity to avert future health crises through preventive care for all patient populations.