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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. 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

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  1. NAACLS FORUM Future of Health Care October 1, 2004 Thomas W. Elwood, Dr.P.H.

  2. FUTURE OF HEALTH CARE • Demography • Epidemiology • Technology • Federal Government Role

  3. DEMOGRAPHY • Aging of Society • Related Aspects of Aging • Ethnic Composition

  4. RELATED ASPECTS OF AGING • Airplane Delays • Automobile Accidents • Voting Problems

  5. 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)

  6. 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

  7. EPIDEMIOLOGY • Causes of Death • Aging and Chronic Disease • Cultural Aspects of Health Care • Literacy and Compliance Issues • Obesity • Complementary & Alternative Medicine • Infectious Diseases

  8. LEADING CAUSES OF DEATH

  9. ACTUAL CAUSES OF DEATH

  10. CULTURAL ASPECTS OF HEALTH CARE • Reluctance to Seek Care • Origin and Treatment of Disease • African-American VHA Patients • Tuskegee Syphilis Study

  11. 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

  12. 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

  13. 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

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

  15. CAUSES OF OBESITY • Eating Outside Home • Explosive Growth in Restaurants • Parent(s) Employed Full-Time • Decline in Smoking • Decline in Physical Activity

  16. 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

  17. 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

  18. “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

  19. CAVALCADE OF DISEASE • 1940s • 1950s • 1960s

  20. “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

  21. FACTORS LEADING TO COMPLACENCY (1950s-1970s) • Vaccines • Antibiotics • Better Nutrition • Improved Housing • Sanitation • Medical Schools Closed Microbiology Departments/Ended Infectious Training Programs

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. TECHNOLOGY • Genomics • Embryonic Stem Cells • Nanotechnology • Health Information Technology • Adoption of Innovations

  28. HUMAN FEMALE

  29. 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

  30. NANOTECHNOLOGY • Investment • $1Billion by Federal Government • Current Products (Sunscreens, Clothing, Computer Chips, Cosmetics) • Future Products (Body Armor, Prosthetics, CA Diagnosis/Treatment) • Bulk Particles - Nanoparticles

  31. 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

  32. HEALTH INFORMATION TECHNOLOGY • Other Industries • Costs • Legal Barriers • Translational Issues • 17 years Evidence to Clinical Practice

  33. 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)

  34. DIFFUSION OF TECHNOLOGY INNOVATIONS • Rapid Adoption • Coronary Artery Calcium Screening • Cost Effectiveness • Differential Access to Innovations • Cascade Effects of Medical Technology • AMHT

  35. FEDERAL GOVERNMENT’S ROLE • Economic Considerations • Structure of Government • Congress

  36. 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

  37. 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

  38. 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)

  39. 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

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