Cost Sharing, Caps on Benefits, and the Chronically Ill — A Policy Mismatch

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Abstract
Crafting effective policy solutions to the high and rising costs of health care requires a clear understanding of the underlying problem. First, more than 75 percent of health care spending is traced back to patients with a chronic illness.1 Patients who are chronically ill have long-lasting conditions that, in general, require predictable medical interventions. Although these medical interventions are well established, chronically ill patients receive only 56 percent of the recommended care each year.2 Second, most of the increase in health care spending is associated with a rise in the prevalence of treated disease, much of which is in turn associated with the rise in obesity and changes in clinical thresholds for treating cardiovascular disease in asymptomatic patients.3

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