A nice reminder of the dramatic progress in health, and the shift from acute to chronic disease.
What is evident is that the causes of death have switched from acute illnesses to chronic illnesses. And we know from insurance companies that chronic illnesses consume about 70-85% of claims paid. What is less well appreciated is that our medical care delivery system was established over the years to deal with acute illness and for one provider to care for one patient. In this regard, think of the internist who treats a pneumonia with an antibiotic or the surgeon who cures a patient by removing the appendix. But patients with complex chronic illnesses need not one doctor but a multi-specialist team to give the best possible care. And the team needs to be well coordinated, probably by the primary care physician or in the case of some situations by a specialist. In both circumstances the coordinator directs – orchestrates – the entire team to offer the patient the highest quality at the least expense. This is a change in how care is delivered that needs to fully occur as illnesses have increasingly become chronic, complex, life long, difficult to manage and expensive to treat.
The authors of the article noted that “In many respects, our medical systems are best suited to diseases of the past, not those of the present or future. We must continue to adapt health systems and health policy as the burden of disease evolves.”