Tuesday, October 27, 2009
What Medical Condition Costs the Most?
What medical condition costs the U.S. Health system the most in disability and overall costs? If you said heart disease or cancer or pulmonary disease you would be wrong! I would have said one of those myself.
The answer...slow drumroll....is musculoskeletal disease. Yes, 50% of the adult population reported having a disabling musculoskeletal condition in 2008. The expenditures for these problems include the costs of preventive care, the cost of direct care, the cost of care in hospitals, by physicians, therapists and other caregivers. It also includes the loss of productivity. In 2004 it was estimated that the cost of care for musculoskeletal problems was $840 billion. (Hey, isn't that about equal to the bank bailout?)
What are musculoskeletal conditions? They include that old nemesis: Low back and neck pain. Spine problems are among the most common problems that bring patients for medical care. That's why the chiropractic industry is booming.
Another leading cause of disability is osteoarthritis, which affects almost 22% of all adults. Osteoarthritis leads to millions of Advil and Tylenol doses and often culminates with total joint replacement (hips and knees). With the influx of baby boomers, the increase in total joints will ensure orthopedic surgeons decades of future employment.
Osteoporosis (bone loss) is another disease of aging that causes hip, spine and humerus fractures in people older than 65. All of those Sally Field commercials for Boniva are aimed at consumers and the expense to diagnose and prevent bone loss adds to the overall cost of treatment.
About 60% of all injuries involve the musculoskeletal system and falls are the most common cause. The emergency department, doctors offices and hospitals all deal with patients with bone and muscle injuries. Patients that are admitted to a hospital spend an average of 5 days in the hospital. Ching, ching!
Despite these facts, the NIH research budget for musculoskeletal conditions has been decreasing with time and they are not in the top 10 conditions that receive funding. In addition, the proportion of orthopedic surgeons to the aging population is not keeping pace. We aren't training enough orthopedic surgeons to keep up with demand and the projected need for 2020 is woefully short.
With declining Medicare payments and rising malpractice insurance costs, physicians are shying away from specialties that take care of "old" people. Rheumatology, geriatrics, primary care and orthopedic surgery are all specialties that are going to be needed, but we have done no workforce planning as a nation to ensure there will be enough to care for the population.
Posted by Toni Brayer, MD at 9:22 PM