DEALING WITH THE COSTS OF AGING

Dan Perry, executive director of the Alliance for Aging Research, described the looming challenge of an aging population as a "tsunami of health care costs." He noted that although the debate over health care typically narrows during an election season, Americans must look to the decades ahead. "Seventy-seven million baby boomers are aging, with the first wave eligible for Medicare in six years. Promoting health and independence for older Americans must be a priority."

Mortality rates continue to drop, said Perry, in response to new health care technology and better awareness of personal actions that can sustain good health. The actual number of disabled elderly was significantly lower than projected over the past 20 years, he noted, which resulted in lower costs than expected. But Perry warned that $26 billion in hidden health care costs can be expected to arise from a coming decrease in the ability of older Americans to care for themselves--an ability that declines quickly after age 80. By 2030, he said, nursing home costs could reach $190,600 per bed per year.

Those numbers point to one imperative: "We have to control these diseases," Perry stressed. "Shifting costs won't solve this problem." The good news, Perry said, is that Americans have high expectations for medical research. "They value it and are willing to pay for it. Medical schools and research universities are often the pride of their communities. We must energize our best minds, reduce the impact of disease, and make the U.S. the engine of innovation for the world."

Money spent on technology and research is considered well spent by the American public because it works to avert the impact of numerous diseases. Whether the innovation is as simple as the benefit of taking a daily aspirin, or an advanced product breakthrough such as cholesterol-lowering drugs, ACE inhibitors, and cancer medications, the success of such research is tangible....

Perry believes the rest of this century will bring a series of medical breakthroughs. For example, he expects researchers to find ways to control and possibly reverse Alzheimer's and Parkinson's diseases, with 20 drugs currently in development for each of those ailments. Cures for many cancers will become available, he said, and risks for cardiovascular disease will be identified and targeted for specific preventative interventions.

John Miall, risk manager for the city of Asheville, North Carolina, talked about applying such a model to an entire community. He observed that the incentives in the heath care industry all have to do with someone being sick. He suggested aligning the incentives with the well, encouraging people to stay healthy. The citizens of Asheville, he said, know something about this idea. In an undertaking called the Asheville Project, the community collaborated to improve the conditions of people with chronic diseases. Using diabetes as a chronic condition that needed attention, pharmacists in Asheville were offered a curriculum and certificate to learn hands-on care--foot exams, eye exams, and blood pressure tests--for their customers with diabetes. The state waived co-pays for drugs and glucose testing materials. This established a relationship between the patients, the pharmacists, and the physicians, a constant feedback loop that improved the level of care, Miall said. In the eight years since the Asheville Project began, costs for diabetic care decreased greatly, from $6,127 to $4,651 per patient per year. The project has grown to include many more participants and other chronic diseases. "Sometimes," Miall concluded, "you have to build systems that don't exist."

Dan Garrett, senior director of the medication adherence program for the American Pharmacists Association Foundation, helped implement the Asheville Project. To manage chronic care effectively, he said, health care must be local, and there must be self-management. The person with the condition has to manage the disease.

Fifty percent of all prescriptions written are not filled or not taken, according to Garrett. People with a "silent disease" such as diabetes or heart disease need to understand the importance of taking care of the condition. Local networks of pharmacists need the motivation, training, and time to help patients manage their care. "Align the incentives," he urged, "improve the outcomes, and control the costs."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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