Four Ways Health Reform Can Improve Patient Medication Adherence

Janice Simmons, for HealthLeaders Media , August 13, 2009

Patients who do not take their medications as prescribed by their physicians are costing the American healthcare system as much as $290 billion annually in avoidable medical spending—or about 13% of total national healthcare expenditures, according to a new report from the nonprofit New England Healthcare Institute (NEHI) in Cambridge, MA.

Overall, an estimated one-third to one-half of all patients in the United States do not take their medications as prescribed by their physicians. These adherence problems are being generated in part by growing numbers of individuals with chronic disease: Adherence rates have been found to be lower among patients with chronic conditions than among those with acute conditions, according to the report, Thinking Outside the Pillbox: A System wide Approach to Improving Patient Medication Adherence for Chronic Disease.

"There are enormous costs to non-adherence," said Valerie Fleishman, NEHI's executive director. "First and foremost are the human costs of poorer health."

Among all patient groups, the risk of hospitalization due to poor health outcomes increases—resulting in higher excess costs. For example, among patients with diabetes, those with lower levels of adherence have nearly twice the total annual healthcare costs of those with high levels of adherence ($16,498 versus $8,886).

"In this era where we're looking both at improving patient outcomes and in reducing overall healthcare spending, improving adherence is really a significant link to [addressing] health reform," Fleishman said. "We believe that adherence needs to be woven into the fabric of the health reform debate in several different ways."

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