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NAACLS FORUM. Future of Health Care October 1, 2004 Thomas W. Elwood, Dr.P.H. FUTURE OF HEALTH CARE. Demography Epidemiology Technology Federal Government Role. DEMOGRAPHY. Aging of Society Related Aspects of Aging Ethnic Composition. RELATED ASPECTS OF AGING. Airplane Delays

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naacls forum

NAACLS FORUM

Future of Health Care

October 1, 2004

Thomas W. Elwood, Dr.P.H.

future of health care
FUTURE OF HEALTH CARE
  • Demography
  • Epidemiology
  • Technology
  • Federal Government Role
demography
DEMOGRAPHY
  • Aging of Society
  • Related Aspects of Aging
  • Ethnic Composition
related aspects of aging
RELATED ASPECTS OF AGING
  • Airplane Delays
  • Automobile Accidents
  • Voting Problems
ethnicity factors
ETHNICITY FACTORS
  • Hispanic/Asian Populations To Triple in Next 50 Years
  • Non-Hispanic Whites 50% of Population by 2050
  • Hispanic Is Largest Minority Group
    • 39,000,000 (3% growth rate)
  • Not Monolithic
  • Health Care Disparities (Pap,BSE,BP/Cholesterol,ER,Meds)
gender factors
GENDER FACTORS
  • 16,400,000 More Women over Age 65 in Next 25 Years
  • Increased Demand for Cardiovascular and Pulmonary Services
  • Cardiovascular Services Will Outstrip Obstetrical Services
epidemiology
EPIDEMIOLOGY
  • Causes of Death
  • Aging and Chronic Disease
  • Cultural Aspects of Health Care
  • Literacy and Compliance Issues
  • Obesity
  • Complementary & Alternative Medicine
  • Infectious Diseases
cultural aspects of health care
CULTURAL ASPECTS OF HEALTH CARE
  • Reluctance to Seek Care
  • Origin and Treatment of Disease
    • African-American VHA Patients
    • Tuskegee Syphilis Study
health literacy
HEALTH LITERACY
  • 46 million+ Do Not Speak English As Primary Language
  • One-Half of Adults Have Trouble Interpreting Medical Information
  • Providers Tend Not to Offer Interpreter Services
  • Linked to Higher Rates Hospitalizations/ER Visits
  • Affects Compliance/Self-Management of Chronic Disease
compliance discharge
COMPLIANCE/DISCHARGE
  • Non-Adherence Leads to Hospitalizations
  • Failure to Continue Taking Heart Medications
  • 33% Leave Hospital without ACE Inhibitors (One-Third Stop Using Within One Year)
  • 72% CHD Patients Don’t Receive Discharge Instructions
obesity rates
OBESITY RATES
  • More than 65% US Adults Obese or Overweight
    • BMI of 20-22 Ideal
    • BMI of 25 or Higher Overweight
    • BMI of 30 or Higher Obese
    • BMI of 40 or Higher Severely Obese
  • 31% Adults Meet Obesity Criteria
  • 4.7% Adults Severely Obese
    • Highest Growth Rate Category
slide23

Percentage of children ages 6 to 18 who are overweight by gender, race, and Hispanic origin, 1976-1980, 1988-1994, and 1999-2002

causes of obesity
CAUSES OF OBESITY
  • Eating Outside Home
    • Explosive Growth in Restaurants
    • Parent(s) Employed Full-Time
  • Decline in Smoking
  • Decline in Physical Activity
consequences of obesity
CONSEQUENCES OF OBESITY
  • Added Hospital Costs
    • Beds, Doorways, Toilets, HBP Cuffs, MRI
  • Shorter Life Spans
    • 2-5 Years Less for Moderately Obese
    • 5-20 Years Less for Severely Obese
  • Emotional Well Being
  • Lost Wages Due to Illness
complementary and alternative medicine
COMPLEMENTARY AND ALTERNATIVE MEDICINE
  • Frequency of CAM Usage
    • 36% of Adults Use Some Form
    • 62% if Prayer Included
  • CAM Practices (herbs, diet therapy, chiropractic)
  • Relates to Self-Control/Self-Reliance Image
    • 28% Lack Belief in Conventional Medicine
  • Dietary Supplements
    • Deregulated Industry in 1994
    • Everything Allowed Except for Blatant Lies and Claims of Curing Disease
slide27
“Man’s only competitors for the dominion of the planet are the viruses – and the ultimate outcome is not foreordained.”

Joshua Lederberg

1958 Nobel Prize

cavalcade of disease
CAVALCADE OF DISEASE
  • 1940s
  • 1950s
  • 1960s
slide29
“One can think of the middle of the 20th century as the end of one of the most important social revolutions in history, the virtual elimination of the infectious diseases as a significant factor in social life.”

Sir Macfarlane Burnet

Nobel Prize 1960

factors leading to complacency 1950s 1970s
FACTORS LEADING TO COMPLACENCY (1950s-1970s)
  • Vaccines
  • Antibiotics
  • Better Nutrition
  • Improved Housing
  • Sanitation
  • Medical Schools Closed Microbiology Departments/Ended Infectious Training Programs
infectious diseases
INFECTIOUS DISEASES
  • AIDS (1981)
    • 4th Leading Cause of Death in World
    • 2nd Leading Cause for African-Americans
    • No Vaccine
    • No Curative Medication
  • Polio and TB
influenza
INFLUENZA
  • 36,000 Deaths in U.S. Each Year
  • 114,000-200,000 Hospitalizations
  • H5N1 Strain of Great Concern
    • High Case Fatality Rate
    • Cross-Animal Species Transmission
    • Danger of Evolving/Recombining to Produce a Virus Humans Can Transmit
    • Form Deadly Hybrid with Regular Flu Virus
factors affecting infectious diseases
FACTORS AFFECTING INFECTIOUS DISEASES
  • Human/Farm Animal Populations Increasing
  • Imported Foods
  • Global Urban Growth
  • Humans Moving to Wild Areas
  • Air Travel/Cargo Ship Traffic
  • Hospital Growth in Endemic Areas
  • Terrorism
spread of infectious diseases
SPREAD OF INFECTIOUS DISEASES
  • Growth in Urban Populations
    • Population of Cities
      • 1950 – Two with More Than 7,500,000
      • 2000 – 30 with More Than 7,500,000

Seven with More Than 15,000,000

aum shinrikyo cult
AUM SHINRIKYO CULT
  • Released Sarin Gas in Tokyo Subway (1995)
    • Cult Previously Unknown to Intelligence
    • Thousands of Members, Well-Funded
    • Tried to Aerosolize Anthrax and Botulinum Toxin throughout Tokyo at Least Eight Times (1990-95)
    • Organized Team to Zaire to Obtain Ebola Virus (1993)
  • Threat – Unknown, Non-State Sponsored Organization, Acting without Concern for Moral Deterrents
technology
TECHNOLOGY
  • Genomics
  • Embryonic Stem Cells
  • Nanotechnology
  • Health Information Technology
  • Adoption of Innovations
stem cell research
Stem Cell Research
  • Bush Administration Policy
    • Funding for Limited Set of 22 Lines Dating from 2001
  • Potential Treatments and Cures
    • Alzheimer’s Disease
    • Retinal Disease
nanotechnology
NANOTECHNOLOGY
  • Investment
    • $1Billion by Federal Government
  • Current Products (Sunscreens, Clothing, Computer Chips, Cosmetics)
  • Future Products (Body Armor, Prosthetics, CA Diagnosis/Treatment)
  • Bulk Particles - Nanoparticles
health concerns
HEALTH CONCERNS
  • Workplace Dangers
  • Waste Streams from Industry/Labs
  • Surface Contact with Cosmetics
  • Ingestion of Food/Beverages Containing Nanoparticles
  • Injection of Medicinal Products
  • Excretion of Medical Particles That Are Not Biodegraded
  • Lack of Coordinated Federal Monitoring
health information technology
HEALTH INFORMATION TECHNOLOGY
  • Other Industries
  • Costs
  • Legal Barriers
  • Translational Issues
    • 17 years Evidence to Clinical Practice
slow adoption of information technology
SLOW ADOPTION OF INFORMATION TECHNOLOGY
  • Lack of Access to Capital/Data Standards
  • MD Usage with Patients (8%)
  • Handwritten Information/Scattered Records
  • Legal Barriers (Anti-Kickback, Tax Status, UBIC, Liability/Malpractice, Licensing)
diffusion of technology innovations
DIFFUSION OF TECHNOLOGY INNOVATIONS
  • Rapid Adoption
    • Coronary Artery Calcium Screening
  • Cost Effectiveness
  • Differential Access to Innovations
  • Cascade Effects of Medical Technology
    • AMHT
federal government s role
FEDERAL GOVERNMENT’S ROLE
  • Economic Considerations
  • Structure of Government
  • Congress
health insurance
HEALTH INSURANCE
  • Need Broad Payment Reforms
  • Private Premiums Up 11.2% in 2004
  • Higher Tax Obligations for Workers
  • Small Firms Dropping Coverage
    • 68% in 2001
    • 63% in 2004
  • 17% Increase in Part B Premium
  • Health Costs Projected 18.4% of GDP by 2013
program costs
PROGRAM COSTS
  • Medicare Cost $281 B in 2003
  • Drug Costs to Be Added in 2006
  • 85% Beneficiaries 65 and Older
  • Medicaid Cost $270 B in 2003
    • Aged Are 10% Beneficiaries
    • Consume 60% of Spending
    • Plus $39 B on Veterans Health Care
medicare
MEDICARE
  • Medicare Outlays Exceed SS by 2024
  • 80,000,000 Beneficiaries by 2030
  • Spending Will Be 7% of GDP
  • Cost Projections Usually Exceeded
    • In 1965, projected $9 Billion for Part A in 1990 (Actual Cost: $67 Billion)
    • In 1988, projected $4 Billion for Home Care in 1992 (Actual Cost: $10 billion)
social security
SOCIAL SECURITY
  • 1st Check Issued 1940
  • 42 Workers Per Retiree
  • Males Retired at Age 68
  • Males Retire at Age 62 Now
  • 4 Workers Per Retiree Today
  • 2 Workers Per Retiree by 2030
related considerations
RELATED CONSIDERATIONS
  • Fewer Non-Elderly Caregivers
    • Group in Bracket 20-54 Will Shrink As a Percentage
  • Labor Force Growth One-Third of Today’s Growth
    • Slower Government Revenue Growth
health workforce
HEALTH WORKFORCE
  • AHRA (S. 2491 and H.R. 4016)
  • Pipeline Problems
  • Faculty Shortages
  • Practitioner Shortages
    • Aging Factors Involved
congressional performance
CONGRESSIONAL PERFORMANCE
  • 108th Congress (2003-2004)
    • 2,810 Senate bills introduced
    • 82 Enacted (2.92%)
    • 13 Honorific
    • 69 Substantive (2.45%)
  • 157 Referred to HELP Committee
    • 9 Enacted (5.73%)
congressional performance1
CONGRESSIONAL PERFORMANCE
  • 108th Congress (2003-2004)
    • 5,103 House bills introduced
    • 150 Enacted (2.94%)
    • 53 Honorific
    • 97 Substantive (1.90%)
  • 590 Referred to E & C Subcommittee
    • 7 Enacted (1.90%)
capitol hill climate
CAPITOL HILL CLIMATE
  • More Fractious Atmosphere
  • Gerrymandering
    • Fewer Competitive Partisan House Races
    • Increased Polarization
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