Dementia Neurology Deserts and Long-Term Care Insurance Claims Experience in the United States

The Neurocern team recently partnered with Milliman and the Society of Actuaries to use our proprietary Alzheimer’s Disease and Related Disorders Neurology Desert Index (ANDI) scores to explore the relationship between geographic distribution of neurology specialists and the incidence of long-term care insurance (LTCI) cognitive claims.

It is estimated by the World Alzheimer’s Report that there are 50 million patients around the world with Alzheimer’s disease and other types of dementia (ADRD). This number will double every 20 years. By 2030, research studies estimate dementia will become a (U.S.) 2 trillion–dollar disease. If the cost of dementia care were a country, it would represent the 18th largest economy. 

In long-term care insurance, cognitive claims represent a significant portion of claims incurred. Severe irreversible cognitive impairment from Alzheimer’s or other types of dementia are a category of symptoms and behaviors that negatively impact daily life and activities of daily living. Alzheimer’s disease and dementia are not the same. Alzheimer’s disease is one type of dementia among more than 15 different types. From a risk management perspective, each clinical subtype of dementia has been demonstrated to have its own morbidity, mortality and utilization profile. Understanding each of these specific subtypes also leads to a timely and accurate diagnosis, possible referral to clinical trials and identification of other possible causes of cognitive impairment that may be treatable. For example, 10 percent to 20 percent of all new cases of cognitive impairment can be due to delirium, undiagnosed sleep apnea, untreated depression or drug interactions.

A wide array of clinical practitioners provides health care delivery for cognitive impairment. Neurologists are physicians who commonly evaluate patients with cognitive impairment and are the most likely to diagnose patients with a specific type of dementia. In 2015, it was estimated that about one in three Medicare beneficiaries had at least one office visit for a neurological condition such as dementia, Parkinson’s disease and stroke.

The average wait time to see a general neurologist across the United States for a new patient visit was 30 days in 2012. Today, wait times to see a geriatric neurologist are six to nine months across major academic medical centers. By 2025, there will likely be a large number of ADRD patients facing a shortage of neurologists, and the wait times for new and follow-up neurologist appointments are projected to grow significantly.

See more about what this means for the LTCI industry at the Society of Actuaries website or read the full report here.