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American Health Care Trends: Old, Fat and Lazy
The AMA’s recent executive summary “Health in the United States: Trends in Health Care” contains both a little hope and a lot of sadness.
Demographic trends
By 2050, the segment of the population over 65 will double from today to 83.7 million. This means that the prevalence of chronic diseases will increase dramatically. Since 1990, smoking has fallen from 29.5% to 18.1% of the adult population. Probably as a result, strokes fell by 34%, heart disease by 27% and cancer by 17%. Sounds good but…
fat and lazy
Since 1990, the adult obesity rate (defined as a BMI over 30) has risen from 12% to 29.6%. During the same period, diabetes fell from 4.4% to 10% of all adults. Not old adults, all adults. The CDC predicts that by 2050, thirty percent of adults will have diabetes. As a result, obesity is now the leading cause of heart attacks. Physical inactivity is a major reason. Only 21% of adults get the US Department of Health and Human Services to recommend 150 minutes of exercise per week. My observation is that most don’t exercise. Many employers now offer wellness programs that financially reward healthy behaviors. This could be a big step in the right direction. Of course, punitive actions denying health insurance to morbidly obese or uncontrolled diabetics could also be forthcoming, especially if the federal government leaves the health insurance industry to private companies.
Is there a doctor in the zip code?
The AMA reports that primary care physicians are closing their practices and retiring early or moving into non-clinical fields like assurance, quality management, the pharmaceutical industry or even medical informatics. As the demand for healthcare services will increase dramatically, an increasing percentage of primary care will be provided by physician assistants and nurse practitioners. I expect them to have increasing independence. This is not necessarily a bad thing, many of these caregivers are excellent and provide compassionate and comprehensive care. A possible by-product of this trend could be an increase in demand for referrals and sub-specialty care, such as referring diabetics to endocrinologists and COPD patients to pulmonologists.
Take responsibility or someone else will
A dystopian future is looming where the cost of medical care is more than our resources can handle. In this rather terrifying situation, someone will have to be refused services, probably either the helpless or those who refuse to adopt the mandatory sanitary instructions. We are not there yet. We still have time to make the recommended changes in diet and activity. Remember, who could have predicted that everyone would quit smoking?
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