Healthcare – Outcomes for Older Patients

The LA Times reports:

Costly diseases, many of them related to obesity and smoking, are more prevalent among aging Americans than their European peers and add as much as $100 billion to $150 billion a year in treatment costs to the U.S. healthcare tab, a new study says.

The study by researchers at Emory University’s Rollins School of Public Health found higher rates of several serious diseases — including cancer, diabetes and heart disease — among Americans 50 and older as compared with aging Europeans.

Thorpe said the findings suggested that “we spend more on healthcare because we are, indeed, less healthy.”

The study has implications for the continuing debate over healthcare reform and attempts to illustrate the economic consequences of lifestyle choices often viewed as intensely personal.

Does the Emory study mean that Americans are actually sicker than Europeans, or that their illnesses are more likely to be diagnosed and treated? Both, the authors said.

Physicians such as Rob Blackman, a Los Angeles internist, already counsel their patients to take a cue from Europeans in the way they eat — less fast food — and the way they pace their lives. Six-week vacations and afternoon siestas help reduce stress that makes people vulnerable to disease, he said.

Such conventions are commonplace in Europe but unheard of in the U.S., so the advice is often easier given than taken.

“Last year I took a 15-day vacation — first time I took more than 10 days in 30 years,” Blackman said. “I couldn’t believe how much better I felt. It’s like the old saying, ‘You don’t know how sick you are until you get better.’ “

Other studies have sought to explain the spending gap between the U.S. and Europe by comparing factors such as capacity, access to technology and prices.

The U.S. healthcare system — driven by when and how providers get paid — does not promote prevention or effective and efficient disease management, Thorpe said.

Instead, he said, “We wait for people to get sick. They show up. We treat them. And doctors and hospitals get paid. That’s not a very good way for managing disease.”

The Emory study compared 2004 data on disease rates among adults 50 and older in the U.S. and in a group of European countries: Austria, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden and Switzerland.

Let me just repeat one quote… this is something I’ve said before, as have others:

The U.S. healthcare system — driven by when and how providers get paid — does not promote prevention or effective and efficient disease management…

The thing about markets… they provide motivations and constraints. Outcomes are usually predictable. If you want to change the outcomes, you have to change the motivations and constraints. Sometimes, in order to do that, you have to change the entire market, perhaps replacing it with a completely different one.