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Fig. 1.1
Mortality in Life Threatening Situations (lower is better)
adapted from and courtesy
of Dr. Brent James of Intermountain Health
However, well over 90% of Medicare spending is for patients with chronic diseases
such as diabetes, hypertension and coronary artery disease. [
2
] I'm aware of unpub-
lished data that suggests that around 70% of spending for younger families whose
care is paid for by an employer is due to chronic disease. Key economic differences
between the acute high technology care we excel at here in the US and the care of
chronic disease are that chronic disease care takes place mostly outside hospitals,
uses little advanced medical technology and is, therefore, relatively inexpensive and
less profitable for hospitals and providers.
While inexpensive to treat directly, if not managed well, chronic diseases cause
complications that are expensive to treat. For example, poorly controlled hyperten-
sion can lead to stroke, heart attack or kidney failure. Moreover, chronic diseases
can cause other chronic diseases. Diabetes, for example, is a major risk factor for
heart disease. This compounds the cost problem because those patients with multiple
conditions account for a much greater proportionate share of spending. [
2
]
