The Relation of the Chronic Disease Epidemic to the Health Care Crisis

Abstract

Currently, some 50% of the US population has a chronic disease, creating an epidemic, and 86% of health care costs are attributable to chronic disease. The medical profession and its leadership did not recognize or respond appropriately to the rising prevalence of chronic disease. As a consequence, a health care crisis emerged, with inadequate access to care and quality of care together with excessive costs. In the years since the 1950s, when the chronic disease prevalence grew, the clinical literature did not follow. It remained preoccupied with acute disease. Similarly, medical education did not change. Studies and critiques gave little or modest attention to the rising dominance of chronic disease and neglected elements of good care. Recently, some health services responding to their growing number of patients with chronic illness have designed and tested new ways of providing care. They have found that, as a result, the patient's health outcomes were improved, costs of care were lower, and patient satisfaction was higher. These results and experiences provide examples of what can be done. The health care crisis and the emergence of a chronic disease epidemic coincided to a substantial degree. Although the epidemic did not cause the crisis, it contributed significantly. Now, the medical profession and its leadership are confronted by the responsibility to build a practice of medicine and a health care system that better meet the needs of patients with chronic illness and reduces the health care crisis.

Figure 1

Death rates per 100 000 US white men. Solid lines represent death from infectious and parasitic diseases. Dashed lines represent death from lung disease, excluding pneumonia and influenza. Adapted with permission from Division of Vital Statistics, National Center for Health Sciences.

Figure 2

Comparison of the national health expenditure (NHE) annual cost per capita with the annual cost of living. CPI, consumer price index. Adapted with permission from Center for Medicare and Medicaid Servicces (CMS) Office of the Actuary, Bureau of Labor Statisitcs.