Kidney Patients Have Higher Costs than Others | Loyola Medicine
Tuesday, January 17, 2017

Kidney Disease Patients Have Higher Out-of-Pocket Costs than Stroke and Cancer Patients

Stethoscope on top of calculator

MAYWOOD, IL – Patients who have chronic kidney disease but are not on dialysis have higher out-of-pocket healthcare expenses than even stroke and cancer patients, according to a study by researchers at Loyola University Chicago and Loyola Medicine.

Chronic kidney disease patients paid a median $1,439 in annual out-of-pocket costs, compared with $770 for cancer patients and $748 for stroke patients. Patients who did not have chronic kidney disease, cancer or stroke spent $226 on out-of-pocket costs. The study was published in the journal BMC Nephrology.

Out-of-pocket spending includes coinsurance, deductibles and payments for services, supplies and other items not covered by insurance.

More than 20 million people – about 10 percent of U.S. adults – have non-dialysis dependent chronic kidney disease, and nearly one of every two adults aged 30 to 64 are expected to develop kidney disease during their lifetimes. Most people with kidney disease have other health problems, such as diabetes, high blood pressure and heart disease, and consequently see many doctors and take multiple medications.

While previous studies have examined the total healthcare costs of kidney disease, this Loyola study is unique in also examining out-of-pocket costs. Chronic kidney disease patients spent 7.2 percent of their personal income on out-of-pocket costs, compared with 5.8 percent for stroke patients, 5.1 percent for cancer patients and 1.9 percent for people who did not have stroke, cancer or kidney disease.

“Higher out-of-pocket cost burden can impede efforts to prevent disease progression,” corresponding author Talar Markossian, PhD, MPH, and colleagues wrote. “Previous research has shown that some patients opt to not fill prescriptions or take less than the prescribed amount due to out-of-pocket costs.” Markossian is an assistant professor in the Department of Public Health Sciences of Loyola University Chicago Stritch School of Medicine.

The study found that chronic kidney disease patients have a high prevalence of “comorbidities” (other chronic health problems): 87.8 percent also had high blood pressure, 85 percent had high cholesterol, 63.7 percent had arthritis and 49.6 percent had diabetes.

Previous studies found that kidney disease patients have an average of 10.8 physician visits per year and more than 60 percent of patients with stage 3 kidney disease take five or more medications per day.

“The high total number of physician visits and medications required for chronic kidney disease care drives up total direct healthcare expenditures and likely also increases out-of-pocket expenditures, creating a financial burden for patients,” researchers wrote.

Researchers examined surveys of 74,267 adults who participated in the Medical Expenditure Panel Survey (MEPS) from 2011 to 2013. MEPS is an annual household survey of the noninstitutionalized population.

The study looked at total and out-of-pocket healthcare expenditures for chronic kidney disease (excluding dialysis patients); cancer (colon, breast or lung); and stroke. Total healthcare expenditures were the amounts covered by insurance plus the patients’ out-of-pocket costs.

Chronic kidney disease patients had median total healthcare expenditures, including insurance payments, of $12,877, compared with $8,150 for stroke patients, $7,428 for cancer patients and $1,189 for patients who did not have kidney disease, stroke or cancer.

In addition to Markossian, other co-authors of the study are Loyola medical student Christina Small (first author), Holly J. Kramer, MD, MPH, Karen A. Griffin, MD, Kavitha Vellanki, MD, David J. Leehey, MD, and Vinold K. Bansal, MD.

The study is titled “Non-Dialysis Dependent Chronic Kidney Disease is Associated with High Total and Out-of-Pocket Healthcare Expenditures.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.