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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 Automobile Accidents Voting Problems 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 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 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 ACTUAL CAUSES OF DEATH CULTURAL ASPECTS OF HEALTH CARE Reluctance to Seek Care Origin and Treatment of Disease African-American VHA Patients Tuskegee Syphilis Study 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 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 More than 65% US Adults Obese or Overweight BMI BMI BMI BMI of of of of 20-22 Ideal 25 or Higher Overweight 30 or Higher Obese 40 or Higher Severely Obese 31% Adults Meet Obesity Criteria 4.7% Adults Severely Obese Highest Growth Rate Category 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 Eating Outside Home Explosive Growth in Restaurants Parent(s) Employed Full-Time Decline in Smoking Decline in Physical Activity CONSEQUENCES OF OBESITY Added Hospital Costs Shorter Life Spans Beds, Doorways, Toilets, HBP Cuffs, MRI 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 Frequency of CAM Usage CAM Practices (herbs, diet therapy, chiropractic) Relates to Self-Control/Self-Reliance Image 36% of Adults Use Some Form 62% if Prayer Included 28% Lack Belief in Conventional Medicine Dietary Supplements Deregulated Industry in 1994 Everything Allowed Except for Blatant Lies and Claims of Curing Disease “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 1940s 1950s 1960s “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) Vaccines Antibiotics Better Nutrition Improved Housing Sanitation Medical Schools Closed Microbiology Departments/Ended Infectious Training Programs 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 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 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 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 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 Genomics Embryonic Stem Cells Nanotechnology Health Information Technology Adoption of Innovations HUMAN FEMALE 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 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 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 Other Industries Costs Legal Barriers Translational Issues 17 years Evidence to Clinical Practice 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 Rapid Adoption Coronary Artery Calcium Screening Cost Effectiveness Differential Access to Innovations Cascade Effects of Medical Technology AMHT FEDERAL GOVERNMENT’S ROLE Economic Considerations Structure of Government Congress 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 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 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 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 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 AHRA (S. 2491 and H.R. 4016) Pipeline Problems Faculty Shortages Practitioner Shortages Aging Factors Involved 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 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 More Fractious Atmosphere Gerrymandering Fewer Competitive Partisan House Races Increased Polarization