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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






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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
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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)
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Vaccines
Antibiotics
Better Nutrition
Improved Housing
Sanitation
Medical Schools Closed Microbiology
Departments/Ended Infectious Training
Programs
INFECTIOUS DISEASES

AIDS (1981)

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4th Leading Cause of Death in World
2nd Leading Cause for African-Americans
No Vaccine
No Curative Medication
Polio and TB
INFLUENZA
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
36,000 Deaths in U.S. Each Year
114,000-200,000 Hospitalizations
H5N1 Strain of Great Concern

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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

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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)


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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


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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



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$1Billion by Federal Government
Current Products (Sunscreens, Clothing,
Computer Chips, Cosmetics)
Future Products (Body Armor,
Prosthetics, CA Diagnosis/Treatment)
Bulk Particles - Nanoparticles
HEALTH CONCERNS
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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

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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

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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

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Need Broad Payment Reforms
Private Premiums Up 11.2% in 2004
Higher Tax Obligations for Workers
Small Firms Dropping Coverage

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68% in 2001
63% in 2004
17% Increase in Part B Premium
Health Costs Projected 18.4% of GDP by
2013
PROGRAM COSTS

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Medicare Cost $281 B in 2003
Drug Costs to Be Added in 2006
85% Beneficiaries 65 and Older
Medicaid Cost $270 B in 2003

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Aged Are 10% Beneficiaries
Consume 60% of Spending
Plus $39 B on Veterans Health Care
MEDICARE
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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
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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)
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Pipeline Problems
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Faculty Shortages
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Practitioner Shortages
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Aging Factors Involved
CONGRESSIONAL
PERFORMANCE
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108th Congress (2003-2004)

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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)
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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

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Fewer Competitive Partisan House Races
Increased Polarization