The recent CDC report on how poorly we are doing in preventing the leading cause of death in the US, cardiovascular disease, despite the availability of inexpensive effective treatments, is pretty disappointing. It is probably a good surrogate for how people think about illness.
If the symptoms are silent and merely precursors for what might happen, people tend to be indifferent and less interested in paying any associated expenses. If they are sick with symptoms that are uncomfortable, make daily activities impossible, or they are told they are dying from the disease, they will do just about anything and pay just about anything to eliminate the symptoms or disease.
I believe this reflects both a healthcare systems failure and tremendous patient apathy that suggests they don’t feel responsible for expenses (thinking either insurance or the government should pay) related to the consequences of their own poor health.
The report concludes:
“Although treatment of high blood pressure and high cholesterol is very effective and relatively low-cost, most people with these conditions remain at elevated risk for heart attacks, strokes, and other problems.”
- By the Numbers – High Blood Pressure
- 1 in 3 Adults has high blood pressure
- 1 in 3 Adults with high blood pressure does not get treatment
- 1 in 2 Adults with high blood pressure does not have it under control
- By the Numbers – High Cholesterol
- 1 in 3 Adults has high cholesterol
- 1 in 2 Adults with high cholesterol does not get treatment
- 2 in 3 Adults with high cholesterol do not have it under control
The insurance coverage focus of healthcare reform will probably make little difference in these numbers. In this same CDC report, it is noted that more than 80% of patients who lack control of theses cardiovascular disease symptoms already have insurance. Additionally, the cost to treat these conditions is relatively low with many highly effective treatments now available as inexpensive generic drugs.
Unfortunately, over the past several decades while healthcare provider systems battled Pharma companies over drug prices and Pharma companies focused on driving the market for “new prescriptions,” a huge market of untreated and ineffectively treated patients was building.
Why should we care?
Well, Pharma should care because there are tens of millions of potential patients yet to be treated. Perhaps not all these potential patients will be willing or able to pay high prices for branded products but some may and will.
More importantly, beside the thousands of people suffering debilitating consequences or even dying prematurely, this same CDC report notes that cardiovascular disease costs the nation $300 billion each year.
So how do we improve and expand the treatment of patients with high blood pressure and high cholesterol?
The CDC report includes several suggestions and recommendations for programs, systems, and incentives for prevention and improving the treatment of cardiovascular diseases. Unfortunately, many are similar to tactics being deployed today, previously suggested, or that have been tried before.
I believe the solution to this dilemma is to make the patient take responsibility for their health. Pharma companies can make effective treatments available, physicians can prescribe the life style changes and medications, insurance companies and the government can pay for the treatments. But, if patients don’t seek out and comply with the life style changes and treatment regimens, there is little the rest of the healthcare provider system can do to help patients prevent cardiovascular disease.
So how do we get patients to take responsibility? This may be a little radical but what about making patients personally, financially responsible for the consequences of not seeking diagnosis and treatment or complying with their treatment regimens. If you have high blood pressure or high cholesterol and you choose not to find out (get checked) or be treated or not to be compliant with your prescribed treatment (including life style changes), that’s fine, but you become personally responsible to pay for any medical expenses related to your heart attack or stroke.
While people have a hard time appreciating the health consequences of a heart attack or stroke until it happens, they seem to understand the financial consequences without experiencing the event. That is why people buy insurance and why health insurance is so important to them when seeking employment. They can relate to the financial implications more than the health consequences.
Want more patients to have their high blood pressure or high cholesterol controlled? Make them financially responsible for the consequences of not seeking treatment and not staying in control of their disease.