Performance Of The US Health Care Delivery System

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Performance of the U.S. Health Care Delivery System: Coordination of Care for Patients with Alzheimer’s disease and Other Neurodegenerative diseases

Neurodegenerative diseases, Alzheimer’s dementia (AD) being the largest subset, are irreversible, progressive brain diseases. Over the past few decades, AD has become a part of the world’s collective knowledge, and many people have or will be touched by AD at some point in their lives. As the global population grows and ages, while the average life span increases, neurodegenerative diseases like AD will become a very pressing public health concern. On January 1st 2011, the first of the 75 million “baby boomers” (1946-1964) turned 65 years old, and over the next 20 years, a baby boomer will turn 65 every 7 seconds {{113 Trojanowski,John Q. 2012;}}. The implications of this for health care policy are significant, because after age 65 the incidence of AD rises exponentially, doubling every 5 years {{113 Trojanowski,John Q. 2012;}}. Using these estimations, by the time baby boomers reach 85, about half of them will have AD or another neurodegenerative disease. The current health care delivery system will not be equipped to handle the burden and needs of this growing demographic. Currently, there is no cure for any type of neurodegenerative disease, including AD. Current pharmacological treatment is primarily cholinesterase inhibitors {{15 Sloane,Philip 2002;}}. Numerous randomized studies, with thousands of patients, have verified small to moderate effects of cholinesterase inhibitors on cognitive and physical functioning for patients who respond to the medication and do not have intolerable side effects {{15 Sloane,Philip 2002;}}. However, as many as two thirds of patients fail to respond to the medication, and these medications only temporarily effect the course of AD {{15 Sloane,Philip 2002;}}. Without an obvious pharmacological treatment available, providers, payers, patients, caregivers, and policy-makers need to come together to provide the best care. The first step in evaluating and improving the performance of AD treatment in the U.S. health care system is to look at the costs. Total payments for health care, long-term care, and hospice for people with AD and other dementias are expected to increase from $200 billion in 2012 to $1.1 trillion in 2050 {{122 Anonymous 2012;}}. These cost estimates include the direct costs of care to all payers including, Medicare and Medicaid, out-of-pocket costs for patients and families, and private insurance {{123 Alzheimer’s Association 2010;}}. However, the $200 billion does not include the value of unpaid care provided by families and friends, estimated to be 17.4 billion hours of unpaid care, valued at more than $210 billion {{118 Lin,Pei-Jung 2013;}}. These numbers are staggering and difficult to conceptualize on an individual level. In 2008, total per person payments for all sources of health care and long-term care for individuals with AD versus individuals of the same age without AD was $43,847 and $13,879 respectively {{122 Anonymous 2012;}}. The two main reasons for this difference in annual cost for people with and without AD is the need for more long-term care, and more expensive and frequent hospitalizations. The necessity for long-term care is due to the ever-increasing needs associated with the disease. The hallmark symptom of AD is memory impairment. In mild AD, a person may seem healthy but is actually having increasing difficulty making sense of the world around them {{28 Rodgers,Anne;}}. The realization that something is wrong often comes gradually. As the disorder progresses cognitive impairment extends to language (aphasia), skilled movements (apraxia), recognition (agnosia), and functions related to the frontal and temporal lobes of the brain (decision-making and planning) {{6 Bhat,Smita 2011;}}. There are also behavioral changes associated with AD. Disinhibition, outbursts of violence,
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