Otis W. Brawley, MD, FACP

Transcription

1 The Transformation of American Medicine (A Cancer Prospective) Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer Society Professor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University 2010, American Cancer Society, Inc.

2 ACS Leadership Roles Informa5on Research Quality of Life Preven5on and Early Detec5on

3 The American Cancer Society We are dedicated to helping People: Get Well Stay Well Find Cures Fight Back

4 Healthcare Reform The ACS as a player in this area Overview of the situa5on The economy Poor health IQ The urgency of the situa5on The need to focus on Preven5on (transform from a treatment and consump5on based economy to one that values preven5on)

5 The Amicus Brief With AHA and ADA Our organiza5ons believe that cri5cal pa5ent protec5ons in the Affordable Care Act, including those that end discrimina5on in the insurance market against people with chronic diseases, would not be sustainable without the individual responsibility requirement.

6 AARP American Academy of Family Physicians (AAFP) American Cancer Society Cancer Ac5on Network (ACS CAN) American College of Physicians (ACP) American Medical Associa5on (AMA) American Nurses Associa5on (ANA) Catholic Health Associa5on (CHA) Na5onal Community Pharmacists Associa5on (NCPA)

7 Three great threats to America s Future Apathy Ignorance Greed

8 Reforming how healthcare is paid for Vs. Transforming how we view and consume it ( We is at mul5ple levels)

9 Transforming American Healthcare Decrease Costs Decrease Dispari5es Improve Quality

10 True Healthcare Reform Requires: Broad cri5cal thinking An understanding of the scien5fic method The use of Evidence Based Care and Preven5on That is: the ra5onal use of medicine not the ra5oning of medicine

11 Factor Increasing Cancer Risk in U.S. Issues: Irra5onal pa\erns of consump5on A lack of educa5on (MD s and Pa5ents) A lack of basic preven5on (obesity, lack of exercise, high caloric intake, smoking)

12 Factor Increasing Cancer Risk in U.S. The Aging of the popula5on 30 million over age 65 in million over age 65 in 2030

13 Dispari5es in Health The concept that some popula5ons (however defined) do worse than others. Popula5ons can be defined or categorized by: Race Ethnicity and Culture Area of geographic origin Socioeconomic Status

14 How Can We Provide Adequate High Quality Care (to Include Preven;ve Care) to a Popula;on That Has So OBen Not Received It?

15 Adjusted Colorectal Cancer Survival by Stages and Insurance Status, among Pa5ents Diagnosed in and Reported to the NCDB

16 Toward an Efficient Healthcare System Some consume too much (Unnecessary care given) Some consume too li\le (Necessary care not given) We could decrease the waste and improve overall health! Evidence Based Medicine

17 U.S. Health Care Spending In 2009, the U.S. spent $2.53 TRILLION on Health Care

18 Spending in Context 2009 $2.53 trillion $1.4 trillion 17.30% $1.1 trillion Gross Domestic Product * Excludes alcoholic beverages ($150 billion) and tobacco products ($92 billion) Source: Bureau of Economic Analysis; National Bureau of Statistics of China, MGI analysis

19 American Healthcare 16.2% of GDP in % of GDP in % of GDP by 2019 (projected) 25% of GDP by 2025 (projected)

20 Spending: US vs. Other Countries Per capita health care spending, 2006 $ at PPP* Per capita GDP ($) * Purchasing power parity. ** Es5mated Spending According to Wealth. Source: Organiza5on for Economic Co opera5on and Development (OECD)

21 Healthcare in Three Countries (2009) Canada Switzerland U.S. Infant Mortality per 1000 live births White Male Life Exp years Per Capita Costs US Dollars Propor5on of GDP 9.6% 11.2% 17.3%

22 At the Level of the Employer Heath insurance costs: Year 2000 $2,471 for an individual $6,438 for a family Year 2009 $4,824 for an individual $13,375 for a family

23 Why the Overu5liza5on (A Mul5 level Problem) Pa5ents who believe in cost containment un5l you are talking about them as the pa5ent Doctors are paid to treat Hospitals and Clinics are paid to treat Insurance is big business

24 Medical Glu\ony Screening tests of no proven value Treatments of no proven value Laboratory and radiologic imaging done for convenience. Cannot find original. Legal defense (real or imagined). Tradi5on.

25 U.S. vs. Canada CT Scanners per million popula5on. U.S. dominates by 3 to 1 ra5o MRI Scanner per million popula5on. U.S. dominates by 5 to 1 ra5o

26 Reforming how healthcare is paid for Vs. Transforming how we view and consume it

27 Treatment vs Preven5on Our healthcare system is heavilly focused on addressing illness. The system needs to transform to one that values preven5on of disease!

28 Poor Nutri5on and Lack of Physical Ac5vity Obesity, high caloric intake, and lack of physical ac5vity is increasing rates of: Diabetes Cardiovascular Disease Orthopedic Injury Cancer

29 Trends in Obesity* Prevalence (%), Children and Adolescents, by Age Group, US, *Body mass index (BMI) at or above the sex-and age-specific 95 th percentile BMI cutoff points from the 2000 sex-specific BMIfor-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term overweight to describe youth in this BMI category. Source: National Health and Nutrition Examination Survey, , , , , National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, : Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, JAMA 2008; 299 (20): : Ogden CL, et al. Prevalence of High Body Mass Index in US Children and Adolescents, JAMA 2010; 303 (3):

30 How Can We Provide Adequate High Quality Care (to Include Preven;ve Care) to a Popula;on That Has So OBen Not Received It?

31 The Transformation of American Medicine (A Cancer Prospective) Otis W. Brawley, MD, FACP Chief Medical and Scientific Officer American Cancer Society Professor of Hematology, Medical Oncology, Medicine and Epidemiology Emory University 2010, American Cancer Society, Inc.