Over the 13 3-year average periods, 1996 to 1998 to 2009 to 2011, for which the MEPS data is analyzed, prescription medications and ambulatory nonphysician care visits increased more than other categories of health care percentage-wise. The former showed an average annual increase of more than 8%, while the latter showed an increase of 6.6%. Of note, however, the increases for all services were much slower in the most recent three-year period, at 1.4% across the board. (Reference Table 10.3 PDF [1] CSV [2])
Persons with musculoskeletal diseases account for a large and growing share of health care utilization. In any given year, about 85% of persons with musculoskeletal diseases have at least one ambulatory care visit to a physician’s office, averaging just under six such visits per year. Between 1996 to 1998 and 2009 to 2011, ambulatory physician visits for these individuals increased from 425.5 million to 574.0 million. Growth in the number of persons with musculoskeletal diseases, rather than an increase in the number of visits by individuals, is primarily responsible for this increase. (Reference Table 10.2 PDF [3] CSV [4])
In contrast to the relatively stable number of physician office visits, there was an increase in the proportion of the US population with visits to ambulatory providers other than medical physicians; the average number of visits to nonphysician providers by persons with musculoskeletal diseases also increased. Nonphysician ambulatory health care providers include physical therapists, occupational therapists, chiropractors, social workers, physician assistants, nurse practitioners, and other related health care workers. In 1996 to 1998, approximately 40% of persons with musculoskeletal diseases visited a nonphysician health care provider at least once; by 2009 to 2011 the proportion had jumped to nearly 52%. At the same time, the average number of such visits increased from 2.6 per person to 3.7. The result was a 92% increase, from 197.5 million to 379.3 million, in total nonphysician ambulatory care visits between 1996 to 1998 and 2009 to 2011. (Reference Table 10.2 PDF [3] CSV [4])
The aggregate total for all ambulatory care visits, including those to physicians and nonphysicians, thus increased over the 13-year period by 53%, from 623.0 million visits to 953.3 million visits.
During this same time frame of 1996 to 2011, the use of prescription medications among persons with musculoskeletal diseases rose substantially. While the proportion of persons with a musculoskeletal disease who filled at least one prescription changed only slightly, from 81.3% to 83.7%, the mean number of prescriptions filled per person increased from 13.1 to 20.8. The result was a 142% increase, from 995.3 million in 1996 to 1998 to more than 2.1 billion in 2009 to -2011, in the number of prescription medications filled by persons with a musculoskeletal disease. (Reference Table 10.2 PDF [3] CSV [4])
Despite widespread concerns that an aging population would use an increasing amount of home health care, there is no evidence that this is occurring. Both the proportion of persons with a musculoskeletal disease using home health care and the average number of home health care visits declined slightly in the past 13 years. Only 4.9% of persons reported any home health care visits in 2009 to 2011, with an average of 3.8 visits incurred. The total number of home health care visits to persons with a musculoskeletal disease rose from 296.3 million to 389.5 million, entirely due to population increase. (Reference Table 10.2 PDF [3] CSV [4])
An increase of 35%, from 15.2 to 20.5 million, in the number of hospital discharges for persons with a musculoskeletal disease occurred in the periods 1996 to 1998 to 2009 to 2011. This may be due to the aging population. The percentage of persons with a musculoskeletal disease who were hospitalized one or more times in a year was roughly stable, with 11.1% and 11.0% of persons in 1996 to 1998 and 2009 to 2011 hospitalized, respectively. The average number of hospitalizations per person, at 0.2, did not change. (Reference Table 10.2 PDF [3] CSV [4])
Using the more expansive definition [5] of musculoskeletal diseases, in 2009 to 2011 there were an estimated 767.3 million visits to physicians among persons with these diseases, as well as 469.8 million ambulatory visits to providers other than physicians, 2.8 billion prescriptions filled, 438.4 million home care visits, and 15.7 million hospital discharges. It should be noted that in this expansive definition, the number of ambulatory visits per person to providers other than physicians and the number of medications per person has risen dramatically. The number of hospital discharges per person and overall has declined, reflecting the increase in management of these conditions on an ambulatory basis.
Links:
[1] https://bmus.latticegroup.com/docs/T10004.3.pdf
[2] https://bmus.latticegroup.com/docs/T10004.3.csv
[3] https://bmus.latticegroup.com/docs/T10003.2.pdf
[4] https://bmus.latticegroup.com/docs/T10003.2.csv
[5] https://bmus.latticegroup.com/2014-report/xl0/economic-cost-icd-9-cm-codes