It's a simple concept: Healthy people require less health care, so keeping people healthy saves both money and lives.
The U.S. spends twice as much per person on health care compared to other wealthy countries, and while higher U.S. health care prices play a role in this disparity, they are not the only cause. A new study by researchers from the National Pharmaceutical Council (NPC) and Emory University published in the Journal of Chronic Diseases and Management found that the U.S. has substantially higher rates of chronic diseases such as cancer, diabetes and heart disease compared to Europe, contributing to increased health care spending in the U.S.
Researchers found that the U.S. had higher disease prevalence in adults 50 and older for all eight of the chronic conditions examined, as well as higher rates of obesity, which is strongly associated with four of the conditions: heart disease, high blood pressure, high cholesterol, and type 2 diabetes.
NPC’s study also found that the U.S. had a higher share of adults on medications to treat these chronic diseases, contributing to higher spending on drugs in the U.S. than in Europe. For example, 47% of older adults take medication for high blood pressure in the U.S. compared to 37% in Europe and 14% of U.S. adults take medication for heart disease versus 9.1% in Europe.
So how much could the U.S. save on health care spending if we were as healthy as Europe? According to the research, if the U.S. had the same rates of chronic disease as Europe, U.S. health care spending for those 50 and older would have dropped 17%, or about $220 billion per year. If the U.S. had the same rates of chronic disease as Switzerland, the healthiest of the European countries studied, U.S. health care spending for those 50 and older would have dropped 28%.
“Chronic disease was a staggering issue for our country and health care system long before COVID-19 — the pandemic has only furthered the urgency for our fight against chronic disease. The vulnerabilities of people living with one or more chronic conditions has measurable impacts on not just our health care system but also the broader U.S. economy," said Kenneth Thorpe, professor of health policy at Emory University and chair of the Partnership to Fight Chronic Disease. “To reverse the prevalence of chronic disease and alleviate some of the human and economic burdens, it is absolutely imperative that we start prioritizing prevention and fortifying care coordination efforts to help both patients and providers, and ultimately, our nation's economy."
Efforts to improve the prevention, early detection, and management of chronic diseases must also consider and address the disparities in chronic disease prevalence within the U.S. population. Social determinants of health – such as access to safe housing, food, education, job opportunities and health care – can contribute to “stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups, systematically limiting opportunities for members of some groups to be healthy,” according to the Centers for Disease Control and Prevention (CDC).
People of color, for example, face higher rates of obesity, diabetes, stroke, heart disease and cancer. People who live in rural areas are also more likely than those who live in urban areas to die prematurely from chronic conditions including heart disease, cancer, chronic lower respiratory disease, and stroke.
Preventing and treating these chronic conditions requires ensuring access to clinically proven, cost-effective interventions, especially for at-risk populations. For example, a recent Health Affairs blog post stated that reducing disparities in obesity treatment will require addressing insufficient insurance coverage and clinician reimbursement, as well as ensuring patients have access to resources that promote weight loss such as affordable, healthy food and safe places for physical activity.
Chronic disease prevention and management programs in the U.S. must effectively address barriers to care due to both insurance issues and social determinants of health in order to keep people healthier and thus reduce health care spending. High rates of chronic disease in the U.S. must be considered in the dialogue around the drivers of U.S. health care spending, and we must look beyond just health care prices in our efforts to address the growth of health care spending while improving population health.