All-cause mortality among Medicare beneficiaries fell from 5.3% in 1999 to 4.5% in 2013.
The study, published in JAMA, investigates health outcome trends in the Medicare fee-for-service population, utilizing data from over 68 million Medicare beneficiaries across the US.
"Even though it is difficult to disentangle the specific reasons for improvement, it is clear that over the past 15 years there have been marked reductions in mortality, hospitalization, and adverse hospital outcomes among the Medicare population aged 65 years or older," the authors write.
Dr. Harlan M. Kromholz, of Yale University School of Medicine in New Haven, CN, and colleagues felt that changes made to health care in terms of both technology and delivery warranted investigation to find out whether they had provided benefit or caused harm to the general population.
They considered the Medicare population to be ideally positioned as a source of data that could reveal the outcomes of the changes made within health care from 1999 to 2013.
A total of 68,374,904 Medicare beneficiaries - including 60,056,069 fee-for-service beneficiaries - made up the sample analyzed in the study.
The researchers noted that across the Medicare population, the annual rate of all-cause mortality fell from 5.3% at the start of the study period to 4.5% in 2013.
A wide variety of improvements was observed among fee-for-service beneficiaries. The total number of hospitalizations fell, as did the average length of hospital stays along with the number of hospitalizations that involved major surgery.
Inpatients expenditures also fell for this group of patients over the duration of the study. After adjusting for inflation, inpatient expenditures fell from $3,290 in 1999 to $2,801 by 2013.
Substantial improvements in health outcomes over past 2 decades
The researchers also assessed how standards of treatment and outcomes had changed for patients during the last 6 months of life, and again, improvements were observed among fee-for-service beneficiaries.
Hospitalizations fell from 131 to 103 per 100 deaths. By 2013, the percentage of beneficiaries who had one or more hospitalizations had fallen from 70.5% to 57% per 100 deaths. Although inpatient expenditure initially rose from $15,312 in 1999 to $17,423 in 2009, by 2013 it had decreased to $13,388.
These improvements were consistent among different demographic and geographic groups, and many of the worst performing regions in 2013 were found to be performing at a higher level than the best performing regions in 1999.
The researchers state that there are several possible explanations for the reductions in all-cause mortality and hospitalizations. National efforts to improve patient care have stepped up and technological advances have improved the type of care that can be offered, as well as how it is delivered.
Not only this, but healthier behaviors became more prevalent during the study period. "Although the prevalence of obesity was increasing," the authors write, "this period was marked by increases in rates of exercise and decreases in rates of smoking."
The authors state that there is now a need for further study of all expenditures in order to reveal how reductions in inpatient expenditures are related to those in other areas.
"Health outcomes related to hospitalizations appear to have improved substantially in the last 2 decades," they conclude.
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