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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


Leading causes of death

LEADING CAUSES OF DEATH


Actual causes of death

ACTUAL CAUSES OF DEATH


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


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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


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  • “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


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  • “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


Human female

HUMAN FEMALE


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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