TheSpectrumofConciergeCareScientific,Ethical,andPolicyIssues.ppt

Address Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: Low education: 245,000 Racial segregation: 176,000 Low social support: 162,000 Individual-level poverty: 133,000 Income inequality: 119,000 (population-attributable mortality – 5.1%) Area-level poverty: 39,000 (population-attributable mortality – 1.7%) (AJPH 2011;101:1456-1465) Address Social Factors Responsible for Illness and Death Deaths in 2000 attributable to: AMI – 193,000 CVD – 168,000 Lung CA – 156,000 AJPH 2011;101:1456-1465 Deaths per year Tobacco = 400,000 (+ 50,000 ETS) Obesity = 300,000 Alcohol = 100,000 Microbial agents = 90,000 Toxic agents = 60,000 (likely higher) Firearms = 35,000 Sexual behaviors = 30,000 Motor vehicles = 25,000 Illicit drug use = 20,000 Major Contributors to Illness and Death 40% of US mortality due to tobacco, poor diet, physical inactivity, and misuse of alcohol Every $1 invested in programs covering above items saves $5.60 in health care costs Prevention 2-4% of national health care expenditures Every $1 spent on building biking trails and walking paths would save nearly $3 in medical expenses Every $1 spent on wellness programs, companies would save over $3 in medical costs and almost $3 in absenteeism costs Public Health Spending Public health spending minimal Mortality rates fall 1-7% for every 10% increase in public health spending Address Racial Disparities in Health Care Equalizing the mortality rates of whites and African-Americans would have averted 686,202 deaths between 1991 and 2000 Whereas medical advances averted 176,633 deaths (AJPH 2004;94:2078-2081) Solutions Close some academic medical centers Consolidate redundant educational and clinical programs in nearby teaching hospitals Solutions Reduce costs through Quality improvement programs Improved governance and decision-making Augmenting philanthropic contributions Increasing alliances with industry? Risks undue corporate influence on academic institutions’ agendas Sol