The coming crisis: obtaining care for the growing burden of neurodegenerative conditions

Abstract

As the U.S. population ages, the burden of neurodegenerative disorders, including Alzheimer disease and Parkinson disease, will increase substantially. However, many of these patients and their families currently do not receive neurologic care. For example, a recent study found that over 40% of Medicare beneficiaries with an incident Parkinson disease diagnosis did not receive neurologist care early after diagnosis and those who did not were more likely to fracture a hip, be placed in a nursing home, and die. While geography, age, race, and sex likely contribute to these observed disparities in care and outcomes, a large barrier may be Medicare's reimbursement policies, which value procedures over care. With further reductions in Medicare reimbursement constantly on the horizon, the devaluing of clinical care will likely continue. Rather than guaranteeing access to care, Medicare's reimbursement policies may increasingly be an impediment to care.

Figure 1. Projected number of Medicare beneficiaries with Parkinson disease and Alzheimer disease in millions (2010–2030)

(A) Parkinson disease. (B) Alzheimer disease. Data adapted from Dorsey et al., 2007, and Hebert et al., 2003.

Figure 2. Proportion of Medicare beneficiaries (2002–2005) with an incident diagnosis of Parkinson disease who do not receive care from a neurologist within the first 4 years of diagnosis

Figure 3. Supply and demand curve demonstrates how a price set below market equilibrium price can result in a shortage^a

^a Market equilibrium price is where the quantity of care demanded equals the quantity supplied. If Medicare's price (reimbursement) is less than the equilibrium price, the quantity of medical care demanded will be greater than the quantity of care supplied, resulting in a shortage. The magnitude of the shortage is the difference between the quantity demanded at the Medicare price and the quantity supplied at the Medicare price.^e17

Figure 4. Neurologist workforce density in various nations (2009)

Inclusion of neurology subspecialties within these figures may vary by country; therefore, the number of neurologists per 100,000 inhabitants may not be perfectly comparable across countries. ^a Neurologists per 100,000 inhabitants from DataMarket.com (Cambridge, MA).^{e18 b} Rates are calculated using physician counts and population estimates from the Australian Institute for Health and Welfare Medical Labour Force Survey, 2009.^{e19 c} Rates are calculated using physician counts from the Canadian Institute for Health Information and population estimates reported by the Organization for Economic and Co-operation Development in 2009.^{e20,e21 d} Data adapted from Adornato et al., 2011.