CHICAGO — “We must begin to face the facts in healthcare. The current ‘system’ is not sustainable. Minor patches will not address the long-term problems. The required major fix will be painful.”

So asserted Raymond Gibbons, MD, president of the American Heart Association (AHA; Dallas) in his opening plenary address launchingthe association’s Scientific Sessions 2006 here at the McCormick Place convention center.

The main focus of his plenary address comments, he said, was to move the “elephant” of inefficient healthcare “out of the corner” and put it “center stage.” Without doing so, Gibbons said, it will be impossible to meet the AHA’s goal of “reducing coronary heart disease, stroke and risk by 25% by 2010” — a daunting goal in the best of circumstances, we might note.

Without taking the necessary, painful steps of improving patient education, advancing disease prevention, putting more emphasis on allied healthcare staff — and a variety of other changes — he said that there will be a continuing cascade of adverse events and the “current crisis will soon worsen.”

That crisis, he said, consists of increasing numbers of the uninsured, growing racial and ethnic disparities in the provision of healthcare, increases in cardiovascular disease and stroke driven by an explosion in the number of “boomers” turning 65 and the ever-growing costs of healthcare.

Well aware that he was speaking to attendees drawn to the AHA conference from around the world, Gibbons repeatedly noted that the U.S. is not alone in the growing healthcare crisis.

“Many countries will have similar increases in the elderly,” he said. “The percentage of the population over the age 65 will increase similarly in Canada and Australia. Italy, Japan and Germany already have an older population, and they will maintain their lead. China currently has a lower percentage of citizens over age 65, but this will double by 2030.”

And Gibbons cited a variety of other problems internationally: in Germany, healthcare costs outpacing the growth in gross domestic product; increased waiting times in Canada for surgery and other treatments; and that, in the UK, “Patricia Hewitt, the health secretary, recently admitted that the extra billions of pounds invested in the NHS have failed to make much difference to patients.”

Despite worldwide cost increases, a broad range of data indicates that the economics of healthcare do not match quality, Gibbons charged. As just one example, he noted that “Of the five [U.S.] states with the lowest Medicare spending per beneficiary — Hawaii, Utah, New Hampshire, Oregon and South Dakota — all rank in the top 20 in quality. Of the five states with the greatest Medicare spending — Louisiana, Texas, California, Florida and Maryland — only Maryland ranks in the top 40 in quality.”

As an example of the inefficiencies in this spending, he cited “the rapid growth of stress cardiac imaging procedures in the United States,” saying, “I doubt that this 6% increase per year” is efficient. “It dwarfs the rate of increase of cardiac catheterization, revascularization, or acute MI, and is three times the absolute rate in Canada.”

And he suggested that increased healthcare costs were related more often to the availability of care than to the appropriateness of care.

These bleak trends in the demographics of aging, the growing economic burden and the mismatch between dollars and quality, he said, “will dramatically increase cardiovascular disease and stroke.” But, he added, “In the face of this escalating crisis, there has been remarkably little public discussion of the need for fundamental change in the healthcare system.”

He classified all of these problems via metaphor: as “the ‘elephant in the corner’ that everyone tries to politely ignore.”

Saying that his intent was to promote discussion of these issues, Gibbons acknowledged that he was not offering “detailed solutions” but that he had several “suggestions” that could be applied to several countries. These included:

• increased emphasis on health education to promote personal responsibility for healthcare;
• increased focus on disease prevention;
• greater use of “allied health staff,” such as “nurses, exercise physiologists, physician extenders, dieticians, and others”;
• increased spending on research and increased emphasis on efficiency in healthcare delivery;
• increased emphasis on quality, saying “We have only scratched the surface of how to measure and improve quality. Performance measures are in their infancy”;
• and an increase in “appropriate incentives ... linked to quality and efficiency.”

Without such changes, Gibbons said, “Our ability to reduce death and disability from cardiovascular disease and stroke is threatened by the growing crisis in healthcare delivery. The elephant must be led out of the corner to center stage. We must look beyond short-term concerns in the interest of long-term progress.”