changing the debate: role of ncds as a healthcare cost driver
TRANSCRIPT
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8/3/2019 Changing the Debate: Role of NCDs as a Healthcare Cost Driver
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Changing the Debate: Role of NCDs as a
Healthcare Cost DriverKenneth E. Thorpe, PhD, Chairman and Professor of Health Policy, Emory
University
February 11, 2012
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Healthcare cost growth is like asink thats overflowing . . .
were so focused on mopping upthe water, no one is reaching up toturn off the faucet.
Why reframe the debate over healthcare costs?
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Global Growth in Non Communicable
Diseases
Cause 60% of all deaths
globally
22% of the worlds NCD
deaths will come from SEA
Over the next 10 years,
deaths from NCDs expected
to increase 21% in SEA.
Over 10 years, 80M people in
SEA will die from an NCD.
Globally, 350M diabetics by
2030.
2.3B adults are overweight.
700M adults are obese.Source: WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (2008)
The WHO list of the most common
non communicable diseases:
Asthma
CancerCardiovascular diseases
Chronic Obstructive PulmonaryDisease
Congenital conditions
Diabetes
Diseases of the digestive system Eye
conditionsGenitourinary conditions (prostate
disorders, nephritis)
Neuro-psychiatric conditions
Skin conditions and musculoskeletalconditions (arthritis)
Skin Diseases
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Partnership to Fight Chronic Disease
Hundreds of national partner organizations around
the globe
Ken Thorpe, Chairman
Professor and Chair, Rollins School ofPublic
Health, Emory University, Former Deputy
Assistant Secretary for HHS
Patient and provider groups
Public health groups
Civic groups
Labor unions
Major employers and business groups
Insurers and other health groups
Academic institutions
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Creating the Value Proposition -- Why Focus on
NCDs?
Reduce long-term healthcare costs
The rising prevalence of chronic disease is a primary driver of rising healthcarespending by people, their families and payers
Many diseases can be prevented, detected and treated to avoid costlycomplications
Improve productivity & economic growth
Chronic disease prevent people from working to their full potential
When sick people go to work, they are less productive, make mistakes, and areinjured more frequently
Family members often take off from work to care for the sick
Reducing the economic burden of disease promotes sustainable growth
Improve quality of life
Improving health increases the quality of life
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Diabetes: Asia-Pacific
In South-Asia, there is expected to bea 72.1% increase in number of adultswith diabetes, 47% in the WesternPacific (2010 to 2030).1
According to studies, a 148.2 millionadults in India have pre-diabetes.
Diabetes is expected to increase by37 million new cases over next 20years in India. This is the largest
absolute increase amongS
E Asiacountries
Source: 1) Estimates http://download.journals.elsevierhealth.com/pdfs/journals/0168-8227/PIIS016882270900432X.pdf ; 2) The list only includes countries where surveys with blood glucose testingwere undertaken for that country http://download.journals.elsevierhealth.com/pdfs/journals/0168-8227/PIIS016882270900432X.pdf; India http://www.nejm.org/doi/pdf/10.1056/NEJMoa0908292;China http://www.japi.org/june_special_issue_2010/Article_02.pdf; Global
Number of Adults with Diabetes (000s)
2010 2030
China 43,157 62,553
Dem. Rep. of Korea 943 1,256
India 50,768 87,036
Indonesia 6,964 11,980
Japan 7,089 6,879
Malaysia 1,846 3,245
Philippines 3,398 6,164
Taiwan 816 1,232
Thailand 3,538 4,956
Vietnam 1,647 3,415
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Economic Impact of NCDs:
Lost National Income Due to NCDs
2006-2015 (cumulative)2005
Lost national income frompremature deaths due to heartdisease, stroke and diabetes
Lost national income
($billions)
Lost national income ($billions)Countries
493Brazil
55818China
2379India
80.4Nigeria
311Pakistan
30311Russian Federation
30.1Tanzania
WHO Chronic Disease Report 2005
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Affordable solutions exist to prevent 40 to 50% of premature deaths
from non-communicable diseases, which could save an estimated
14 million lives per year in developing countries.
Source: Non-communicable Diseases, WHO, ECOSOC High Level Segment, 2009
NCDs Are Preventable
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Non-communicable Diseases
Proven National Policies and Plans
Strengthening health care forpeople with NCDs
Early detection ofhypertension and other riskfactors reduce heart diseasemortality 35-60%
Multi-drug regimens forpatients reduce risk of heartdisease and stroke
Early detection and treatmentof cancers account for 30-
80% reduction in mortality Universal access to
preventive and curative careessential
Reducing the level ofexposures for people andpopulations:
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Source: Non-communicable Diseases, WHO, ECOSOC High Level Segment, 2009
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Goal:Manage Disease to Avoid
Complications and
Disease Progression
Goal:Find and Treat Disease in
Its Earliest Stages to
Stop Its Progression
: Prevention is often defined inaccurately and incompletely, focusing on aspecific category rather than the comprehensive definition
Prevention Encompasses Three Major Areas with Specific Goals
Goal:
Reduce or Eliminate
Risk Factors and
Avert Disease
Primary Prevention Secondary Prevention Tertiary Prevention
Vaccines
Eating
healthy
Getting
exercise
Avoiding
unhealthy
behaviors
Risk-based
screenings
Following
treatment advice
Health
coaching
Blood tests
and other
monitoringTransition
al care
Care
coordinatio
n models
Taking
steps to
reduce
risks
10Most people defineMost people define
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Implications for India
Chronic disease will increase for the foreseeablefuture
Health systems are built to manage acute conditions
They particularly fail those with multiple conditions,the patients who have the most problems andgenerate the most costs
Prevention is important but not enough
Managing patients with multiple chronic conditionsbecomes the main business of health systems
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Implications for India Continued
Health systems must find ways to adapt, and systemsof chronic disease management can be helpful
There are many systems of chronic diseasemanagement, but we lack evidence and need moreinnovation
They cannot be simply imported from other healthsystems but can be adapted
Creating effective chronic disease managementsystems in developing countries is an importantchallenge
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Capitalizing on the Opportunity
THE TIME IS NOW!
Advance policy changes that address themanagement of chronic disease
Work to reorient care systems to focus onprevention
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