The Need to Focus on Chronic Diseases

The Need to Focus on Chronic Diseases

12.06.12 | By

In doing some preliminary research, I find that my original premise for a new state policy paper I'm writing is spot-on accurate: greater awareness, prevention and treatment of chronic diseases are the best way to improve health and lower health care costs, not arbitrary cuts and restrictions in state Medicaid drug benefits.

At a time when chronic diseases, including diabetes, cancer, heart disease, stroke and mental illnesses, account for 75 percent of all health care costs, we need to do a better job of preventing these conditions and managing them once patients have them.

And the literature is full of examples of how more effective disease prevention and management help:

  • A National Institutes of Health study showed a 58 percent reduction in new diabetes cases over five years resulting from modest exercise and good diet leading to a five percent weight loss.
  • According to a World Health Organization fact sheet, nearly a third of cancer deaths and their economic costs could be prevented by modifying or reducing key risks, including unhealthy diet, lack of exercise, smoking and excessive use of alcohol.
  • The Mayo Clinic says eating one or two servings of fish a week could reduce the risk of death from heart attack by a third or more.
  • The risk of hospitalization and premature death is 5.4 times higher for hypertension patients who don't take their prescribed medicines consistently.
  • Another study shows diabetics who don't adhere to their medicine prescriptions are 2.5 times more likely to be hospitalized than diabetics who do take their medicines more than 80 percent of the time.
  • Failure to take medicine as prescribed has also contributed to as many as 40 percent of nursing home admissions and an additional $2,000 a year per patient in medical costs for physician visits.

In other words, we must make patients more aware of the importance of good diet and exercise and taking medicines consistently in helping to prevent and manage disease more effectively.

Medicaid drug coverage restrictions and reductions may actually increase costs by leading to avoidable emergency room visits, hospitalizations and surgeries:

  • In one study, Medicaid health plans with more restrictive drug formularies spent an additional $935 on medical care and prescription drugs annually for rheumatoid arthritis patients.
  • In a study of 10 state Medicaid programs published in 2009, it was found that psychiatric patients subjected to medication access barriers had 3.6 times greater likelihood of adverse events, including emergency room visits, hospitalizations, homelessness, suicidal behavior and incarceration.

It's important to remember that no two patients with the same disease are alike and often cannot take the same medicine. Access barriers can deprive patients of the drugs that work best for them and help to manage their conditions to avoid hospitalizations and surgeries.

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