Chronic disease and costly testing are two big contributors to health care costs in the United States, with many diseases being preventable and many medical tests being unnecessarily performed. Addressing both issues could produce much-needed savings, say health care professionals. These issues were addressed Tuesday in Washington, D.C., at a discussion organized by the nonprofit, nonpartisan Alliance for Health Reform.
Chronically ill patients account for around three-quarters of the spending on health care in the United States, around $1.6 trillion a year, says Dr. Kenneth Thorpe, professor and chair of the department of Health Policy & Management at Emory University. He said that is it not only the biggest source of spending, but it is also the fastest growing. A number of chronic illnesses, like kidney disease, diabetes, and cardiovascular diseases, have risen over the last decade, he said.
According to the Kaiser Family Foundation, one of the sponsors of the D.C. forum, health care costs are also expected to grow faster than national income in the future. The foundation also notes that while Medicare covers the elderly and people with disabilities, and Medicaid provides coverage to low-income families, enrollment has grown in both—with aging baby boomers entering Medicare and the recession driving the needy to Medicaid. “In total, health spending accounted for 17.9 percent of the nation’s gross domestic product (GDP) in 2010,” the Kaiser Family Foundation says on its website.
Chronic illnesses are not only a burden to the health care system, they also impact the economy directly through loss of productivity. Dr. Thorpe estimates that for every $1 spent on health care, $4 are lost in productivity as a result of chronic illnesses. He is most concerned about obesity. Directly linked to the rise in diabetes, obesity has doubled in the last decade, now affecting over 30 percent of the population.
In total, health spending accounted for 17.9 percent of the nation’s gross domestic product in 2010.
—Kaiser Family Foundation
When comparing adults who are obese with those of average weight, the obese adults will spend 20 to 40 percent more on health care over the course of a lifetime, he said. Many chronic diseases like obesity are a result of lifestyle choices and are largely preventable under the right interventions, says Dr. Thorpe, but Medicare does not address those initiatives.
“We need to find ways to change the incoming health profile of people coming into the program [Medicare] because the benefits of interventions in a program like Medicare are enormous,” he said. According to Dr. Thorpe, the United States will spend $500 billion to $600 billion over the next decade on “readmission for things that we can potentially prevent.”
High-tech medical equipment testing is also adding to the cost of health care. While Joseph Antos, health care expert with the American Enterprise Institute, defends those technological advances saying in many ways they have proved effective, he adds that it is in the routine procedures that he sees the waste. Costly and sometimes intrusive testing, like blood tests, X-rays, and scans, are done with constant regularity and with what seems to be disregard as to whether they are necessary.
“That is where the money is for the very sick people and obviously that is where the money is for the not very sick people,” he said at the Alliance for Health Reform discussion. “It is not in the major surgery … it is in the seemingly ordinary interventions that we are used to. That is where all the money is.”
Shannon Brownlee, a health policy specialist at the New America Foundation, says many people, and particularly the elderly, are subject to all sorts of testing without anyone assessing whether it is actually leading to better outcomes.
“Mindless testing that tends to happen without really thinking: What will the clinician do with the information? Will it change the course of treatment? Is it what the patient wants?” she told The Epoch Times.Author of the book “Overtreated,” Ms. Brownlee believes the U.S. health system is not in touch with the real needs of patients. Like Dr. Thorpe, she would like to see more education, more engagement between patient and doctor, and more programs to encourage healthy lifestyles.
“What is sometimes missed is the thing that has the greatest influence on us, that has nothing to do with hospitals,” she said, referring to good diets and exercise. “They have everything to do with whether or not we teach kids and adults about what to eat and how to eat, and why they need to get exercise, and how hard it is to get exercise.”
“In so many places, and we have made great strides in smoking, but obesity is going to swamp us,” she said.
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