Better, less-costly national health by fixing chronic disease

Submitted by Jerry Halberstadt on Thu, 06/18/2009 - 23:36

The misdirected debate on reforming health care gets bogged down on how much it will cost but overlooks the big picture. We should focus on the big pieces that waste the most--chronic diseases. This is where health reform can improve lives and save big money. Here's how.

A strategy that is focused on eliminating the big costs going into the wrong places in chronic disease can yield the largest savings. Chronic conditions are responsible for the major part of the national health budget, and this is due to using costly, ineffective methods to address emergencies instead of spending less money on education, lifestyle changes, and disease management. We're using acute care tools instead of prevention and management.

More than three-quarters of the national health budget is spent on chronic disease. Yet the potential savings from improved chronic care are given short shrift in today's debate, and "chronic" is not even mentioned in a recent review of the budgetary implications of health plan proposals. (1) Experts agree that major changes in chronic care are urgently needed--changes that could save lives, improve the quality of life, and save money. But today, "current payment systems generally do not reward providers for effectively managing patients with chronic illnesses or educating patients about preventing disease through lifestyle changes such as exercise, improved nutrition, and smoking cessation."(2)

Chronic conditions, unlike acute diseases, can not be cured and are likely to last more than a year, limit what one can do, and require ongoing medical attention. In the U.S., chronic conditions affect about 125 million people and are the leading cause of illness, disability, and death. An estimated 60 million people have two or more chronic conditions.

As a nation we ignore, underuse, and--through poor allocation of resources--actually prevent implementing--a variety of effective chronic care strategies. We believe that a wide range of non-acute as well as chronic conditions can be managed with new strategies.

New models of chronic care have the potential to reduce urgent and emergency care and to reduce the side effects of chronic disease and non-acute conditions, thus leading to an improved quality of life and significant cost savings in the total care of patients. Diabetes is perhaps the best-known success story. People with diabetes need to be educated in the management of their condition, to monitor their blood sugar levels, and to use diet, exercise, medications, and injections of insulin to minimise the impact of diabetes on their health. Sleep apnea, a common sleep disorder and chronic obstructive pulmonary disease (COPD) are also chronic/non-acute conditions that respond to continuing daily care and management by the patient.

Sleep apnea syndrome in the national health care debate

Clearly, society needs to inform and educate people with sleep apnea syndrome while creating the capacity to treat them. Despite the large number of people suffering from sleep disorders, including sleep apnea syndrome and snoring, these problems are hardly mentioned in the national debate about health care costs and priorities in the United States. Here is a major health problem which, thanks to scientific and medical progress, can be readily diagnosed and treated. Yet society has not yet allocated the resources to educate the public to help identify and overcome it. Nor has society yet provided an adequate supply of trained people and institutions that would suffice for the diagnosis and treatment of sleep apnea syndrome. A comprehensive program would include financing for public education, a treatment system, and continuing research and professional education. The costs of such a program would more than likely be small compared to the economic benefits for society as well as for the individual sufferer.

...Successfully treated [sleep apnea] patients may expect a longer life span, a lower risk of cardiovascular disease, a marked improvement in cognition and ability to function, and the restoration of a healthy emotional outlook. Some cardiopulmonary diseases are caused by sleep apnea syndrome, and treatment reduces this risk. Treatment can reduce the burden of car crashes and other accidents caused by fatigue due to apnea and possibly reduce the escalating cost of complications in cardiovascular disease.

Public education, identification of patients, and treatment for those severely affected by sleep apnea syndrome should be made a high national health care priority. Growing evidence that effective treatment of sleep apnea syndrome can reduce the negative health impact strengthens this argument.

The greatest challenges facing the world of sleep medicine are as much political and policy matters as they are medical. While the knowledge of sleep science is imperfect, and even the best treatments tend to require a sometimes demanding, long-term effort by people with a sleep disorder, nevertheless medical science has shown how to diagnose and treat people with sleep-disordered breathing. But only a small fraction of the people who could benefit from treatment have been reached. There are millions of people with diagnosed sleep apnea. You could join with them to support more research; better methods of diagnosis and treatment; better education for primary care physicians and other health care workers; and increased public awareness.

More about chronic disease The chronic disease crisis

More about the impact of sleep apnea and how to improve the treatment and management of this major chronic health problem. A challenge for patients, doctors, and society

From: Sleep apnea syndrome in the national health care debate In Sleep Apnea:The Phantom of the Night T. Scott Johnson MD, William Broughton, MD, and Jerry Halberstadt; with contributions by B. Gail Demko, D.M.D. Forewords by Carl E. Hunt, M.D., Director, National Center on Sleep Disorders Research, NHLBI, NIH, William C. Dement, M.D., and Colin E. Sullivan, M.D. Copyright 2003, 2009 New Technology Publishing, Inc.

(1) Congressional Budget Office E C O N O M I C A N D B U D G E T I S S U E B R I E F, The Budgetary Treatment of Proposals to Change the Nation’s Health Insurance System, MAY 27, 2009