Cleaning up the System to Afford Care for Chronic Conditions

Nancy Muller Health Pro
  • Without a doubt, the evolution of health services in the U.S. is being impacted significantly today by the continuing rise in chronic illnesses. According to the Robert Woods Johnson Foundation (1996), chronic conditions are believed to account for three out of every four deaths in this country. They have completely displaced infectious diseases and accidents as reasons for mortality. Half of all Americans are said to be living with one or more chronic conditions and illnesses such as heart disease, chronic pulmonary disease, and neurological diseases such as multiple sclerosis and conditions such as spinal cord injury.

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    Highly sophisticated diagnostic equipment, rapidly intervening emergency response, and minimally invasive means of treatment including medications to manage symptoms have allowed people to extend their lives when such circumstances would have led to quick or imminent deaths in decades past.


    While industry - through its evolving technology - and providers - through their responsiveness to innovation - have gotten us to where we are, cumbersome public policies, inefficient infrastructure, and an outmoded public payer system of health care delivery fail miserably in accommodating the face of today's patient populations across America.


    A case in point is new research that was recently publicized illustrating huge, unexplained variations in the amount, intensity, and cost of care to patients with chronic illnesses. The study covered Medicare patients at the nation's leading academic medical centers, such as the Mayo Clinic, UCLA, the Cleveland Clinic, Mass General in Boston, and Johns Hopkins. The report came from the 2008th edition of The Dartmouth Atlas of Health Care and was exposed in a New York Times April 7th editorial this year. The chief finding was that the cost of care for patients with chronic conditions in their last two years of life in the finest of America's medical meccas varied by as nearly 100%, from $53,432 at Mayo to $93,842 at UCLA. Understandably, officials at the Congressional Budget Office (CBO) asked how the costs could vary so greatly at two facilities both considered "the best."


    Clearly, community hospitals and teaching facilities across the U.S. must revamp their strategies, their structures, and their protocols. But they can't do it alone. Washington has to get its head on straight and be single-directed, with a sense of responsibility for how we compensate and what we compensate for. Integrated delivery systems must be taken into consideration, both inside and outside of the hospital walls, to include rehabilitation following episodic bursts of a chronic illness or condition. Communication must be seamless, electronic, timely and readily accessible to everyone who needs it. Family and patient education must be part of the equation and covered as a necessary element of chronic care. The list doesn't stop here. What else would you add?


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Published On: August 15, 2008