Why Are Heart Disease Treatment Costs Escalating

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Why are heart disease treatment costs escalating

There are two main reasons that the costs for treating heart disease are escalating: Doctors and patients. Doctors are continually expanding the range of available treatments, and the patients themselves are making behavioral choices that increase coronary risk while also demanding more advanced care.
Doctors are continually developing new methods of treating heart disease. These new treatments for heart disease are sophisticated and often more expensive, and their use is becoming widespread as doctors strive to keep up with an evolving "standard of care". Some of these new expensive heart treatments include:

• drug-eluting coronary artery stents
• implantable cardio-defibrillators
• gene therapy
• heart and lung transplants
• pharmaceutical, or drug, treatments

Also the behavior of the patients themselves is causing an increase in health care costs due to lifestyle choices that cause heart disease. In the article How many deaths in the United States Are Caused By Heart Disease the point is made that over a third of the deaths in the United States are caused by behavioral or lifestyle factors. Some of the poor choices of individuals that lead to preventable heart disease include alcohol use (a significant cause of high blood pressure ), obesity caused by poor diet and lack of exercise, and tobacco use.

And patients are better informed about these advanced treatments because of the media and the internet. These patients are increasingly demanding what they see as quick technological fixes to their heart conditions. Patients often do not have the patience and perseverance to undertake the lifestyle changes to reduce coronary risk, and even in some cases reverse the coronary damage (see "The China Study"). This pressure for quick fix, as well as the time limitations on doctors to oversee long term lifestyle changes, forces doctors to prescribe more advanced and expensive methods of coronary treatment to their patients. (White, Ministry of Healing, Health Education, 1902)

How can the costs of cardiac healthcare be contained?

• HMO's, also known as managed care, have tried to limit or ration the supply of healthcare, but this has not worked well
• A better approach may be to restrict demand. Demand can be restricted by encouraging patients to learn about and apply self-management guidelines

Chapter 113 of the Twelth Edition of Hurst's "The Heart" focuses on the most important behavioral and psychological factors that influence the course of coronary artery disease, also known as CAD, and how the course can be modified. Some of the patient behavioral factors include:

• smoking
• diet
• obesity
• psychological factors
• depression
• chronic stress

Many of these factors can be addressed through behavior modification. Stages Of Behavior Change talks more about a model that leads to longer term behavior modification.

On page 2448, the authors point out:

"Approximately 36 percent of all deaths that occurred in the United States in 2000, most of which were caused by heart disease, were attributable to behavioral or lifestyle factors, including tobaco use, poor diet, physical inactivity, and alcohol. Although genetic factors undoubtedly contribute to individual susceptibility to these factors, a prime ingredient of this risk is the person's behavor. The costs of treating heart disease are escalating at an increasingly rapid pace because of the widespread use of sophisticated and increasingly expensive treatments such as drug-eluting coronary stents, implantable cardio-defibrillators, and gene therapy. Most efforts to contain the increase in healthcare costs have focused on limiting supply (a largely unfulfilled promise of managed care) and imposing some sort of rationing. However, as long ago as 1993, Fries and others pointed out that restricting demand could achieve the same objective. They identified six factors, four of which are directly relevant to this chapter. They include the following facts:

1. Much disease is preventable
2. Risky behavior costs money. Lifetime medical costs, which averaged $225,000 per person, have been clearly related to health behavior. For example, costs are approximately one-third higher in smokers compared to nonsmokers.
3. Self-management can result in savings. Several studies have shown that providing medical consumers with information and guidelines about self-management can lower the use of medical services by 10 percent or more
4. The promotion of healthy behavior at work has successfully reduced costs. This has also been documented in numerous studies."

See also:

• How many deaths in the United States Are Caused By Heart Disease

Sources:

• Twelth Edition of Hurst's "The Heart", Chapter 113, Page 2448
  • The chapter was written by Nina Riecmann, Karina W. Davidson, Lynn Clenow, Daichi Shimbo, and Thomas G. Pickering.

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