Wednesday, June 2, 2010

Soaring Health Costs: It Ain't The System, It's Aging

TORONTO – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system… Official figures show that senior citizens will make up 25% of the population by 2036.”

“Soaring Costs Force Canada to Reassess Health Model,” Reuters, May 31, 2010

In the U.S., we carry on endlessly that it’s the system – whether it be government-controlled or market –based – that drives health costs.

The truth is: it may be neither. It may be that we, like the Canadians, are simply getting older. When we age, we inevitably develop multiple vascular diseases. It cost money to treat these diseases.

As the Welsh poet, Dylan Thomas, reminded us, we do not go gentle into that good night,

Do not go gentle into that good night,

Old age should burn and rage at close of day ;

Rage, rage at the closing of the light.

Citizens of U.S, and Canada, As compassionate and civilized peoples , rage, they must, but that will not change the age of our arteries, as Thomas Sydenham, the English physician reminds us, “Man is as old as his arteries.”

Years ago, the Framingham heart study folk made this chart to help us calculate our vascular age,

Risk Factor Points

1. Age, Men, Women
30-34, 0, 0
35-39, 2, 2
40-44, 5. 4
45-49, 6, 5
50-54, 8, 7
55-59, 10, 8
60-64, 11, 9
65-69, 12, 10
70-74, 14, 11
75+, 15, 12
2. Total cholesterol
<160, 0, 0
160-199, 1, 1
200-239, 2, 3
240-279, 3, 4
280+, 4. 5
3. HDL cholesterol
<35, 2, 2
35-44, 1, 1
45-49, 0, 0
50-59, -1, -1
60+, -2, -2
4. Choose A or B.

A. Systolic blood pressure (not treated)
<120, -2, 3
120-129, 0, 0
130-139, 1, 1
140-149, 2, 2
150-159. 2, 4
160+, 3, 5
B. Systolic blood pressure (treated)
<120, 0, -1
120-129, 2, 2
130-139, 3, 3
140-149, 4, 5
150-159, 4, 6
160+, 5, 7
5. Smoker?
No, 0, 0
Yes, 4, 3
6. Diabetes?
No, 0, 0
Yes 3, 4

Your Total

Step 2: Convert points to risk

Find your total points (top row) to determine your vascular age (bottom rows).

Total Points ≤-1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17+
Vascular Age: Men <30 30 32 34 36 38 40 42 45 48 51 54 57 60 64 68 72 76 80+
Vascular Age: Women <30 <30 31 34 36 39 42 45 48 51 55 59 64 68 73 79 80+ 80+ 80+

As you review this chart,note there is one figure you can do nothing about: namely,the fixed vascular risk depending on your age and your sex. If you are a 75 year old man, you have at least a minimal vascular age of 72, no matter how good your other risk factors are.

Which brings me to one of my favorite medical bloggers, “D.B.”s Medical Rants, “ who shares these thoughts

Soaring health care costs … in Canada?

1 June, 2010

"Soaring costs force Canada to reassess health model"

"Wait, Canada has universal coverage, long queues, and much better primary care penetration than the US. Why do they have soaring costs? Clearly we in the US suffer from higher overhead, less primary care and too many imaging machines, but trying to understand Canada's problems might eventually help us.

I do not really know, but here are my thoughts:

1. We have transformed many diseases with short life span into chronic diseases. The best example is end stage kidney disease. We offer dialysis to almost everyone, and the costs while on dialysis are significant. CHF used to have a short life expectancy, but now we markedly extend life span. HIV/AIDS has become a chronic disease for those who take antiretrovirals and prophylaxis. The costs associated with these and other chronic diseases are truly new costs to our respective health care systems, and those costs increase consistently.

2. We have new devices and imaging machines that provide better outcomes and information. AICD saves lives, but it is not cheap. MRI machines make diagnoses at a very high cost. You can think of other important examples.

3. We have markedly increased life expectancy. As life expectancy increases, costs mount. Older patients more often have multiple diseases that we control at high cost.

I invite the readers to suggest other reasons for soaring costs in Canada. But I will speculate on what my thoughts mean. We may not be able to "bend the cost curve" if we try to provide everything for everyone. We must consider true rationing.

The US public will never be happy with the concept of rationing, and I suspect Canadians are no different. We can control some health care costs through better use of resources, but my reasoning above suggests that successes of medical care induce costs.

So either we develop a rationing strategy, or we spend a higher percentage of the GDP on health care each year. Which direction should we go?"

There is, of course, another direction - disruptive and decentralized innovations that lowers cost by redirecting care to less sophisticated and less established institutions and allowing patients to pay outside for what they want and need outside of government, health plans. and other third parties. This is already occurring. The rage to live in good health and die in dignity never dies.

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