Changing the Debate: Role of NCDs as a Healthcare Cost Driver

8/3/2019 Changing the Debate: Role of NCDs as a Healthcare Cost Driver

1/14

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


2/14

2

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?


3/14

3

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


4/14

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


5/14

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


6/14

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


7/14

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


8/14

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


9/14

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


10/14

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


11/14

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

11


12/14

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

12


13/14

13

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


14/14

14

Documents

Changing the Debate: Role of NCDs as a Healthcare Cost Driver