The changing health care environment

Abstract

In 1985, the rate of growth of national health expenditures was more than twice the overall rate of growth in prices in the United States, while the percentage of health expenditures relative to the Gross National Product reached a record high of 10.7 percent. There have been almost no changes in the fraction of direct patient payments for medical care since 1980, or in the fraction paid by third parties or the government. Consequently, cost increases in the gross price of medical care are being transferred directly to the patient population. The expense associated with medical treatment and the availability of managed care systems (Health Maintenance Organizations and Preferred Provider Organizations, among others) have contributed to the increasing cost consciousness of patient and physician alike. One of the areas in which the spiralling costs of medical care are most deeply felt is in the treatment of hypertension. The direct costs for treating this condition, which affects more than 25 percent of the American population, exceed $8 billion annually. Furthermore, hypertension is a chronic condition in which the cost of treatment is continuously apparent to the patient. Moderate and severe hypertension is more likely to affect elderly and black patients, the people who are least able to pay for therapy. Difficulty in paying for therapy is becoming an increasingly important problem due to the trend among physicians to prescribe newer and more expensive antihypertensive drugs instead of the more commonly used diuretics and beta blockers. Due to the cost-conscious attitude of patients, the physician who chooses the more expensive drugs may run the risk of losing patronage among middle- and upper-income patients. In the case of lower-income patients, prescribing expensive drugs may result in noncompliance. In order to guard against incursions by managed care systems and ensure the best care for low-income patients, physicians must assume a cost-conscious attitude toward the treatment of hypertension.