Tuesday, October 13, 2009

Medicated Nation: 12.6 Prescriptions Per Capita!

According to the Kaiser Family Foundation's study, "Prescription Drug Trends":

The average number of retail prescriptions per capita increased from 8.9 in 1997 to 12.6 in 2007 (see chart above). The percent of the population with a prescription drug expense in 2005 was 59% for those under age 65, and 91% for those 65 and older; the proportions of these populations with a drug expense has changed little since 1997, when they were 59% and 86%, respectively.

MP: I'm not sure what's going on here, but these statistics on prescription drug use were really surprising to me (maybe because I fall into the "0 retail prescriptions per capita" category almost every year). But here are a couple possible explanations on why the average per-capita prescription drug use is so high in the U.S. (it would be interesting to see an international comparison), and why it's increased between 1997 and 2007:

Increased advertising for prescription drugs, an aging population taking more drugs, greater availability of generic drugs, new and better drugs being introduced, and lower drug prices? Comments welcome.

27 Comments:

At 10/13/2009 9:06 AM, Blogger Nicolas Martin said...

Let us not leave out the medicalization of everyday life. Drug companies (and their physician collaborators-payees) have ferociously worked to convince Americans that formerly normative conditions and behaviors are syndromes, diseases, and disabilities.

 
At 10/13/2009 9:08 AM, Blogger Buce said...

I wonder how to factor in the level of control. In Italy, Japan, you can over the counter lots of stuff that is perscription here.

 
At 10/13/2009 9:17 AM, Blogger juandos said...

Hmmm, I see the problem right there on page one: "increased use of prescription drugs, attributed to the implementation of Medicare Part D"...

More government intervention is the supposedly free market place of American medical care...

Lovely!

 
At 10/13/2009 9:55 AM, Anonymous John said...

Most years I also fall into the zero prescriptions per year category. Same for my wife. And even my kids fall way below a dozen a year. Some people must really be popping some serious pills.

I agree with Nicolas. Many people (and doctors) have begun to treat behavioral problems as if they are medical problems. It's much easier (or at least it causes one to feel less guilty) if you call your problem (or your child's problem) a syndrom or a disease when the truth is that it's often a lack of self-control or in the case of your children a lack of responsible parenting.

 
At 10/13/2009 9:59 AM, Blogger Tom said...

The vast majority of medical care is via prescription. Drugs are usually cheap, and usually very effective. Generics are over 60% of prescriptions, and you can get most at WalMart, Target, etc. for $4/month or $10 for 90 days. Drugs are controlling disease cheaply and effectively. All to the good.

People don't LIKE to take drugs, they do so because drugs work well.

This trend will continue as drugs improve, and we age and develop more diseases of aging. A virtuous cycle. Life expectancy continues to rise because of effective drugs.

Developing better drugs requires healthy profits for drug companies, something liberals want to "cure" with a government takeover of medicine and "negotiation" of drug prices. The fatal conceit of liberals - that they alone can make everything better, if only the government can take over. Don't bet you life on that socialist fantasty.

 
At 10/13/2009 10:04 AM, Blogger Highgamma said...

The Employee Benefit Research Institute did an analysis of prescription drug expenditures using data from before the passage of the Medicare Part D benefit.

One of the big changes from the early 1990s to early 2000s was a shift from out-of-pocket expenditures for drugs to private health insurance coverage of expenditures. Clearly, this creates an incentive for overuse of drugs and is a great example of what happens when people do not pay for the full cost of their behavior.

"Furthermore, in 1994, 80.2 percent of all prescription drug expenditures were made with private funds, while 19.8 percent were made with public funds (Figure 7). These proportions have remained relatively constant; in 2001, 78 percent of prescription drug expenditures were made with private funds, and 21.9 percent were made with public funds. However, the proportions among the different private expenditure categories have shifted. In 1994, 60 percent of private funds going toward prescription drugs were out-of-pocket expenditures, and 40 percent of private expenditures on prescription drugs were from private health insurance. In contrast, in 2001, 39.3 percent of private prescription drug expenditures were out-of-pocket, while 60.7 percent were from private health insurance."

The full report is here:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=498985

Figure 2 provides an extensive demographic breakdown of drug expenditures.

 
At 10/13/2009 10:33 AM, Blogger QT said...

Agree that a drug benefit creates an incentive for use, however, increasing life expectancy, an aging demographic and changes in treatment would seem to be very strong forces contributing to an increase in the use of prescription drugs. Just consider the treatment of coronary heart disease for example:

Use of cardio-vascular drugs triples. The standard treatment for high chlosterol is a statin drug which costs an estimated $150,000 for each year of life saved.

Patients receiving stents now routinely receive Plavix to prevent scarring for 2 years after the procedure along with other medications like aspirin, a statin drug, blood pressure medication, beta blockers. The procedure of stenting occlusions is a great advance allowing surgeons to treat more patients with a safer, minimally invasive procedure.

As Red Green would say "You're not getting older, you're just getting better medication".

 
At 10/13/2009 10:51 AM, Anonymous Anonymous said...

I am not surprised at all--that's only one monthly prescription per year. While I am two of my children take no meds on a regular basis, my husband (crohn's dz) takes multiple monthly meds, and my oldest son does as well(bi-polar). Unless I am not understanding how they are using the terminology, in which case totally diregard my comment. :)

 
At 10/13/2009 12:07 PM, Blogger Richard Rider, Chair, San Diego Tax Fighters said...

Yes, I agree with above comment. Our use of prescription drugs is not nearly as high as it looks in this report, though usage may well be increasing from times past. I've got a kid who uses Adderal, and the doc will give only a monthly perscription. Part of the physician's motivation is that they get to collect on more no brainer patient office visits, which GREATLY increases the cost of the perscription -- plus is inconvenient, increases road traffic etc.

Prescriptions for many drugs should be for longer periods. Let the patient decide.

Then if the patient decides wrongly -- or any conceivable unwanted side effect results -- another destitute ambulance chaser will be set for life!

'Vat a country.

 
At 10/13/2009 1:31 PM, Blogger OA said...

In addition to things like drugs being increasingly used for chronic conditions like obesity related or behavioral, the funding is probably a big reason.

Look at the change in the portion of funding by payer. In 1990, 56% was consumer out-of-pocket. By 2006 it was 22%. Public funding went from 18% to 34% of total spending. Private insurers made up the rest of the consumer decrease.

With that shift in the payment burden, what is the expected outcome other than an increase in usage?

 
At 10/13/2009 1:51 PM, Blogger juandos said...

"Look at the change in the portion of funding by payer. In 1990, 56% was consumer out-of-pocket. By 2006 it was 22%. Public funding went from 18% to 34% of total spending. Private insurers made up the rest of the consumer decrease"...

Good observations OA and I can't help but wonder just how skewed these %s will be after ObamaCare makes an appearance....

From the Cato blog: Three Irrefutable Facts About the Baucus Bill

 
At 10/13/2009 1:59 PM, Blogger Jason Woertink said...

I would also suggest that there are for more drugs in any given class of drugs. So a person might try half a dozen drugs over a year until they find the one that works best for them. As opposed to the past when there might have been only one drug to take and no others.

 
At 10/13/2009 2:46 PM, Anonymous Anonymous said...

People live longer, need more drugs.

More diseases are treated with drugs rather than surgery such as depression, inflammatory disease, cardiac, high blood pressure, obesity, cancer,......

 
At 10/13/2009 2:58 PM, Blogger juandos said...

Hey QT, this comment by you is most disheartening considering the news today: "The standard treatment for high chlosterol is a statin drug which costs an estimated $150,000 for each year of life saved"...

That cost is just mind numbing and thanks for that link BTW....

Michael Tanner over at the Cato Institute has the following: Despite New Deficit-Cutting Claim, Baucus Bill Is Just Tax-and-Spend

Cost wise this is a very ugly bill and NOT just with regards to the national debt either...

 
At 10/13/2009 3:45 PM, Anonymous Anonymous said...

For some perspective, ObamaCare didn't introduce the Medicare Prescription Drug Benefit. That was the previous administration.


Medicare Drug Benefit May Cost $1.2 Trillion

 
At 10/13/2009 5:19 PM, Blogger juandos said...

"For some perspective, ObamaCare didn't introduce the Medicare Prescription Drug Benefit"...

I know and if you're refering to me I didn't mean to infer that it was part of ObamaCare anon...

Thanks for the WaPo link BTW...

The Heritage Foundation in Nov. of '03 warned the Bush administration and Congress that Taxpayers would see a $41 billion tax increase in 2001 dollars if Congress passes the proposed Medicare prescription drug legislation and raises taxes to pay for this massive new program...

The Cato Institute in June of '03 warned the Bush Administration and Congress: Even without a prescription drug benefit, the cost of Medicare will double as a percentage of GDP by 2040...

 
At 10/13/2009 6:03 PM, Blogger QT said...

Juandos,

Have to agree that this bill looks like it will be disasterous. Charles Krauthammer on rhetoric & reality.

How much do you bet that prescriptions for blood pressure medication will rise over the next 4 years?

 
At 10/13/2009 6:21 PM, Anonymous Non Vou said...

I have chronic back pain caused by herniated disks. The alternative to drugs is risky and expensive diskectomy and fusion. So as an alternative to surgery, drugs are a huge bargain.

I take one pain killer and one muscle relaxant at bedtime. I take two prevacid for GERD and a low dose aspirin as a precaution for heart disease. So that's 5 per day.

I could easily cut out the pain killer and muscle relaxant and be over withdrawal in two nights, but then lying in bed is painful. The doctor said my dose is so low, I'm at now risk of permanently taking them, but the marginal benefit of restful sleep and pain relief is worth a lot. The GERD doesn't go away on its own and not taking the medicine could lead to severe esophogeal damage.

Drugs which are preventive are as important as those which replace surgery. My case may not be typical. Some people may be over medicating, especially on other people's money. I got injured from my job, so I "earned" my free drugs. It wasn't from poor lifestyle, except perhaps the need for the aspirin which I could prevent. That's cheap though.

Every year I send a Christmas card to the drug manufacturers thanking them for a better life.

 
At 10/13/2009 7:11 PM, Anonymous Dr. T said...

The biggest change in that ten year period is the greater use of drugs that people take for the rest of their lives:

1. Cholesterol-lowering and triglyceride-lowering drugs.
2. Bone density maintenance drugs.
3. Anti-hypertensives
4. Drugs against auto-immune diseases.
5. Drugs for arthritis.
6. Anti-rejection drugs after organ or bone marrow transplants.
7. Anti-epileptic drugs.
8. Mood stabilizing drugs.
9. Reflux esophagitis drugs.
10. Various vitamins, minerals, and other supplements.
11. Replacement hormones (thyroid, estrogen, cortisol)
etc.

We have more drugs for more diseases and more drugs that are taken for years instead of days or weeks. The average 70-year-old who gets admitted to a hospital is on 10-15 prescription medications. I know of one VA patient who had 23.

Juandos mentioned Medicare Part D. Please note that the increase in prescription drugs began well before Part D, and that it affects people under 65.

 
At 10/13/2009 9:36 PM, Blogger QT said...

Dr. T,

Thanks for the very comprehensive list. It helps to put this discussion into perspective.

Non Vou,

Thanks for sharing your experiences as a patient. It is often difficult for people who do not suffer chronic pain to understand how debilitating chronic pain is. Like many people, I've been there. The two things that I learned as a patient were to keep looking for solutions and to listen to other patients. At the end of the day, the patient owns the problem and sometimes, finding solutions is a journey.

All too often, people suffering chronic pain give up. The quality of life that can be gained through finding the right medication and developing management strategies is phenominal. Surgery is not always the best answer.

Hang in there. You are not alone.

 
At 10/13/2009 9:48 PM, Anonymous Anonymous said...

If I didn't sit in front of a computer all day I wouldn't be overweight and have high blood pressure. It would probably help my colitis too.

 
At 10/13/2009 10:27 PM, Anonymous Maximum Liberty said...

I suspect that a small part of the increase is in antibiotic prescriptions. It seems like no one ever does lab tests to see if a routine infection is bacterial (except for strep tests). It makes sense from an economics perspective: the test costs more than the generic anti-biotic, so if you treat it and it goes away, it was bacterial; if it doesn't, then it wasn't. I think the cost of a lot of antibiotics -- to the consumer -- dropped below the cost of a lab test in the last 10 years as insurers introduced the generic tier into their formularies. Of course, this promotes anti-biotic resistant bacteria, but that's a different issue.

Max

 
At 10/13/2009 10:41 PM, Anonymous Steve said...

I agree with you that the number is incredible. I have 1 maybe 2 if my back goes out. That's it. 12.7 is crazy. Reselling is the only reason I can conclude.

 
At 10/14/2009 8:04 AM, Anonymous Anonymous said...

How about the drug companies want the solution to every health problem (real or not!) to be drugs, drugs and more drugs?

 
At 10/14/2009 9:43 AM, Anonymous Hillbilly MBA said...

How about the surgeons who want the solution to every problem (real or not) to be surgery.

When the only tool in your box is a hammer, the hwhole world looks like a nail.

I see the same crap from chiropracters, auto mechanics, plumbers, dentists, lawyers, teachers - they've all got the solution to whatever ails you, and it always involves giving money to them.

I'm not saying they're all crooks. I'm not even saying they don't BELIEVE you "need" it. There are a lot of low cost or no cost alternatives which should be attempted first, and they often don't think to recommend them. It's their bread and butter not to.

For example, diet and exercise could solve a good percentage of common ailments. People are lazy and gluttonous so they want a solution in pill form.

In true health care reform people would be charged premiums based on their lifestyle choices.

 
At 10/14/2009 5:09 PM, Blogger juandos said...

O.K. QT!

Krauthammer wrote: "So on to the next gambit: selling health-care reform as a cure for the deficit. When that was exploded by the Congressional Budget Office's demonstration of staggering Obamacare deficits, Obama tried a new tack: selling his plan as revenue-neutral insurance reform — until the revenue neutrality is exposed as phony future cuts and chimerical waste and fraud"...


Robert Samuelson (courtesy of IBD) writes Health Spending Condemns Youth To Future Of Downward Mobility

 
At 4/07/2010 10:34 AM, Anonymous Anonymous said...

Dr T makes an important point about introduction of medications that you take for the rest of your life like statins. These account for a good part of this increase because most people will refill their prescriptions monthly to quarterly so one medication x 1 year accounts for 4-12 prescriptions per year. (I checked the fine print on the Kaiser website - refills or new rxs counted equally)

 

Post a Comment

Links to this post:

Create a Link

<< Home