Should we be fixing our sickcare system?

Why people living longer with more conditions is crippling health systems and what we can do about it

Healthcare systems as they exist today are not sustainable in the long-term, in terms of patient outcomes, inefficiency and rising costs. This is largely due to the current focus on reactive treatment of diseases, rather than proactive prevention and eliminating inefficiencies within and between medical organizations.

If a patient suffers from multiple chronic conditions, this has a multiplying negative effect. Patients suffer exponentially more, and costs rise dramatically. To give you an example: if you suffer from obesity, smoke and have heart issues, the simultaneous occurrence of these three conditions will be 8 times more harmful to your health and more costly, multiplying by 2 for each condition (2 x 2 x 2= 8 times the impact).

Globally, due to an aging population and unhealthy lifestyles, the number of people living with multiple chronic conditions (MCCs) ‒ generally considered as two or more chronic conditions that affect a person at the same time ‒ is dramatically increasing, posing a serious health issue on an individual and a societal level.

Why am I so passionate about this topic? Currently, MCCs affect one in three adults around the world, which is why we need to act fast as the healthcare landscape is quickly deteriorating. Though they are prevalent among the elderly – MCCs affect 81.5% of those aged 85 years and above – studies show that 35 year olds also suffer from them. Their occurrence tends to be the highest in emerging markets, and lifestyle choices are strong contributing factors. So MCCs occur at a younger age and faster in emerging markets, which has a negative compound effect. 

MCCs have been acknowledged as the single biggest challenge to our collective health, and global collaborations to mitigate their impact, such as the partnership between Teva Pharmaceuticals and the Arnhold Institute for Global Health at Mount Sinai which was launched at the World Economic Forum (WEF), can make a huge impact. I am happy to see that the topic is being addressed on global (health) stages, like the UN General Assembly and WEF Annual Meeting where I spoke about it in the last couple of months.

MCCs comprise of both non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, as well as communicable diseases (e.g. HIV and hepatitis). NCDs cause 70% of all deaths globally, according to the World Health Organization (WHO).

The four main issues are:

1.The substantial impact of MCCs on patients and their families. Patients experience a significant deterioration in quality of life. Functional impairment increases with the number of different chronic conditions a person suffers from. In addition, individuals with MCCs are thought to experience an increased incidence of depression (25%), two to three times higher compared to those without chronic conditions. The individual’s ability to continue to work can be compromised and there can be a considerable toll on caregivers and their wellbeing. Risk factors such as a lack of exercise and poor diet or obesity may initiate a domino effect – for example, an increased risk of chronic conditions such as diabetes could in turn compound the risk of stroke and heart disease. It is evident that societal factors can have a substantial future impact on our health.

2. Medication non-adherence. It has been reported that adherence to one medication per day falls from 79% to 51% for four medications per day, demonstrating that fewer dosing regimens may result in better compliance. Non-adherence to complex treatments can have serious implications. Symptom control is suboptimal and patients run an increased risk for loss of autonomy.

3. Healthcare costs have been shown to significantly increase with each additional chronic condition. This is due to the provision of primary and specialist care, ER visits, hospital admissions and polypharmacy. Individuals also experience challenges with out-of-pocket expenses, such as prescription medication costs, which can easily escalate as both medication use and costs significantly increase with each additional condition. Experts suggest it may be 16 times more costly to treat a patient with four conditions compared with just one.

4. Individuals diagnosed with MCCs are often the most difficult for physicians to care for. Due to sub-specialization, physicians do not always feel comfortable treating a patient for a disease that is not within the realm of their own specialty. Therefore, patients are seen by multiple physicians, which adds another layer of complexity to the patient journey. As the delivery of health services is currently geared towards this “siloed” approach that focuses on a single chronic disease, or even a single symptom, existing healthcare infrastructures and delivery systems are not well-equipped to tackle the current burden and future impact of MCCs.

Looking ahead, additional funding for MCCs and intervention research is needed. In the meantime, we can already start to address the issues in the current sickcare system, deploying solutions that are available now. This starts with breaking down the silos between departments, hospitals and home care. Digital solutions and connectivity can be instrumental. At the same time, we can enable people to live healthy lives and take preventive actions when they belong to a risk group. Finally, collaboration between all stakeholders in the healthcare ecosystem is necessary to tackle this challenge.

Ultimately, of course, care should be focused around the patient’s overall health and wellbeing rather than treating each individual disease in isolation. Look out for one of my next articles that will highlight solutions to address the MCC challenge, with the goal that any initiatives help turn our reactive sickcare system into a proactive healthcare system.