WHO CARES: Chronic Illness in America
WHO CARES: Chronic Illness in America

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Richard BringewattFailing People's Basic Needs
By Richard Bringewatt

America's health care system is both out of date and out of touch with the majority of people it serves. People with chronic conditions, such as heart disease, lung disease, and Alzheimer's disease, account for more than 75 percent of all health care expenditures. They are health care's largest, highest-cost, and fastest-growing service group, yet health care frequently fails to meet their most basic needs.

Children with asthma routinely end up going to the emergency room with breathing difficulties because parents have not been adequately trained to prevent acute attacks through changing the child's environment. Too often drug therapy is focused on stopping asthma attacks, but not on preventing attacks through more ongoing health maintenance.

People with diabetes can reduce disease and the onset of disability through diet, exercise, and blood sugar monitoring, yet our health care system often only focuses on medication and routine office visits. People with a hip fracture or stroke routinely go through repetitious and cumbersome admission and discharge procedures, while receiving therapy from several unrelated programs. Many people with heart disease and other conditions receive care from multiple physicians and wonder why their doctors never talk to one another. Millions of older people need long-term care, yet these people and their families invariably find our care system to present burdensome obstacles to getting what they need and want.

This is a crisis, pure and simple. Chronic conditions impact every aspect of life and at some point will affect nearly everyone. Health care professionals are decent, caring people, yet the system they find themselves working in has failed to adapt to the radically different needs of modern health care consumers. People with chronic conditions typically have multiple, interrelated and progressive problems, yet each care setting or medical discipline generally operates independently from each other.

There are some specialized programs for people with chronic conditions, but their numbers are limited. In some areas, special programs facilitate environmental audits of homes where children with asthma live and help reduce exposure to known asthma triggers. In other communities, centers have been established to help people with diabetes manage their diet, exercise, lose weight, and monitor and manage glucose levels and various cardiovascular risk factors. Disease management companies have emerged for people diagnosed with Type II diabetes, congestive heart failure, and other chronic conditions to help them manage their medications and implement self-care procedures. Geriatric clinics, case management services, and caregiver support programs have been established, in some areas, to help older people with multiple, complex problems manage their conditions, and live safely at home for as long as possible.

Most of these special efforts remain "add-ons" to traditional medical care, though they should become standard operating procedure. But prevailing practice patterns, financial restrictions, and various regulatory barriers reinforce business as usual. While it is easy to cast blame in the current health care morass, finger-pointing won't bring about the needed change. Success requires all parties - doctors, insurance companies, community service agencies, policymakers, and ordinary citizens -- to rise above self-interest and work together to find real-world solutions to one of the most complex health care problems of our time.

Bringewatt is President and CEO of the National Chronic Care Consortium.
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Rich Bringewatt calls for health care reform.
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