Healthcare And Coranare Heart Disease Essay, Research Paper

Coronary Heart disease is a disease where the coronary arteries that supply blood to the heart become blocked. The blockage is in the form of a blood clot that can block a percentage of all five arteries. Cholesterol deposits cause this blockage. This fact has allowed doctors to determine that diet has a significant role in who develops this disease.

People’s diets are affected by their economic class and by other social factors. The poor of our country generally eat meals that contain high fat and cholesterol. Their diet puts them at higher risk. However, the risk is not significantly higher because of the high amount of overweight people in America, which span all economic groups.

Exercise is another important factor. The more exercise people get the lower the risk of heart disease. Part of the reason for this is the fact that people that exercise tend to have more healthy lifestyles, which include lower levels of alcohol use and lower fat diets.

My stepfather had coronary heart disease. He talked about it freely before he passed away. Over the course of 10 years he had two triple bypass surgeries. He believed he contracted the disease due to poor diet, smoking and a family history of the disease. Throughout the entire time his outlook remained very positive. There were several dramatic changes that the disease caused. He quit smoking after the first heart attack. On the first year after surgery many things went on like they had before the surgery. Family activities didn t change much. The only noticeable difference was the fact that he quit smoking.

Each year, 900,000 people in the United States have a heart attack. Of these, roughly 225,000 die, including 125,000 who die before ever getting any medical attention. But advances in treatment have meant that even more victims can survive and go on to live normal, healthy lives (www.intellihealth.com) Even with these new treatments the disease is a killer. Doctors have found ways to extend the life of people with the disease, but they have not found a way to completely cure the disease. Once people contract Coronary Heart disease they eventually die from having it.

When looked at across the population, Heart disease is possibly the most expensive disease. The AHA estimates the cost of cardiovascular diseases and stroke in 1999 at $286.5 billion. This figure includes direct costs, which include the cost of physicians and other professionals, hospital and nursing home services, the cost of medications, home health and other medical durables and lost productivity resulting from morbidity and mortality (indirect costs). (www.americanheart.org) This huge cost is large financial burden. A percentage of these costs could be avoided if Americans would chose to live more healthy lifestyles. According to 1996 estimates 58,800,000 Americans has one or more forms of cardiovascular disease (CVD). (www.americanheart.org). This high number of people with heart disease is going to lead to even higher cost in the future. Furthermore, the aging of the population is going to put a huge strain on the already overtaxed Medicare and Medicaid system.

This disease is a killer and there are a great number of things that can be pointed to that cause it. Overall, we can improve our odds of survival by not smoking and living healthy lifestyles. However, all of us will not be able to avoid the disease. The fact that so many people have the disease and the fact that so much money is spent on the disease has caused drug companies and private groups to make great advancements in the diagnosis and treatment of the disease.

Coronary heart disease has several levels of severity. These

varying levels of severity have caused the evolution of several treatments for heart disease. There are three main types of treatment that go along with changing diet habits and increased exercise. The three main treatments are open-heart surgery, balloon angioplasty, and stinting, which can be subsequent to the angioplasty.

Balloon angioplasty is the process of lapthroscopacly going into the veins and inflating a small balloon to push open the blockages. The use of stentscan come after this procedure. ” Stents are scaffolding devices that maintain vessel patency after an interventional procedure, usually balloon

angioplasty. Coronary stenting is now used in more than 50% of patients

undergoing nonsurgical myocardial revascularization. [1] It is considered a

routine adjunct to coronary angioplasty”(Saunders).

Doctors have several techniques that they use to determine which procedure to use for treatment. One of the most common is the arteriogram. This procedure allows the doctors to determine the level of blockage in the coronary arteries. Nurses also perform some diagnostic procedures. An echocardiogram is a process that images the heart structure and the bloodflow through the valves. This procedure is an inevasive procedure that doesn t require any special conditions. It is not possible to see the blockage with this procedure; however, it is possible to see the effect of blockage.

Managed care and other economic factors have caused patients to have long delays in waiting for diagnostic tests to be run. One reason for this is that, Over the past two decades there has been an exponential increase in the use of all cardiovascular diagnostic and therapeutic procedures, especially coronary angiography. These tests represent a large cost to managed care companies. Some believe that managed care companies are more concerned with their profits.

Profits are based on pricing, and pricing is in part determined by benchmarks for certain procedures. The following chart contains Benchmark prices, DRG numbers, Average Length of Stay and cost information for several procedures (www.mecqa.com).

Specialty

DRG Description ALOS Benchmark

THORACIC SURGERY

104 CARDIAC VALVE PROCEDURES W CARDIAC CATH

9.9 $29,857.84

THORACIC SURGERY

105 CARDIAC VALVE PROCEDURES W/O CARDIAC CATH

7.9 $23,410.59

THORACIC SURGERY

106 CORONARY BYPASS W CARDIAC CATH

9.10 $30,212.90

THORACIC SURGERY

107 CORONARY BYPASS W/O CARDIAC CATH

9.50 $22,562.30

THORACIC SURGERY

108 OTHER CARDIOTHORACIC PROCEDURES

8.60 $24,503.24

THORACIC SURGERY

111 MAJOR CARDIOVASCULAR PROCEDURES W/O CC

5.1 $9,101.59

THORACIC SURGERY 110 MAJOR CARDIOVASCULAR PROCEDURES W CC

7.4 $17,015.00

Providers that are members in managed care networks are held to the above prices. If the can perform the treatment for less than the benchmark they keep the difference as profit. If they are unable to provide the service for that price, they must book a loss for that procedure. The prices are dictated by the networks not the hospitals. So, in effect, insurance companies determine what treatment we get.

This problem is of particular importance to the cardiologists, which are the primary physicians for heart problems. They have to give diagnostic tests and perform surgeries in accordance with insurance company s policies. In addition the drugs they prescribe must be approved for payment.

There are several drugs used in the treatment of heart disease. Doctors prescribe Valium for relaxation, blood thinners, and antacids, anti rejection drugs are used in some circumstances. All these drugs are used in addition to any that are needed for post operative complications.

All the procedures and all of the treatments can help us survive a heart attack. However, we must take personal responsibility for keeping ourselves healthy. All heart treatment programs recommend that smokers stop smoking. In addition, they suggest that diet and exercise also contribute to survival of coronary heart disease.

It is widely accepted that a choosing a healthy lifestyle is good for us. These lifestyle choices can effect how long we live, and if the right decisions are made we can extend our lives. It is known that smoking has a direct relationship to heart disease. Some studies indicate that smoking doubles someone s chance of having heart disease.

Exercising is a great way to keep a body healthy. Exercise strengthens the heart and allows it to work more easily. Exercise promotes the development of small blood vessels in your heart muscle, increasing blood flow to the muscle. It also improves the strength (AOL..HEART). A healthy diet is a very important in keeping a heart healthy. Saturated fat and cholesterol can cause blockage in the arteries and lead to heart disease. The phytochemicals in fruits and veggies may help your heart, too. Recent epidemiological studies suggest that a diet rich in fruits and vegetables results in a lowered risk of cardiovascular disease that can’t be attributed to major macronutrients or known vitamins and minerals (www.mayohealth.org/index.html).

Unfortunately, many Americans do not follow healthy lifestyles. Over 33% of Americans are considered obese (www.coloradohealthnet.org). This obesity leads to high cholesterol, increased blood pressure, and can even cause diabetes. As a society is seems that Americans have decided to live the way they want and to hell with what is good for us.

The American Heart Association provides enough free information, which if used properly, could drastically reduce the amount of heart disease in this country. They give dietary recommendations and nutrition information on just about every type of food. They also spend tens of thousands of dollars each year trying to help people stop smoking.

Currently, there are no quick fixes for heart disease. The only true fix is prevention, and unfortunately most people won t work that hard to prevent it. All it takes is choosing to live a healthy lifestyle. Once that lifestyle becomes a part of someone s life it can take hold. Once that lifestyle becomes rooted in the person, they often wonder what all the fuss was about when they were trying to decide and change. Once a lifestyle becomes habitual, you don t feel as though it is a sacrifice to eat healthy. You just eat healthy and don t even feel like eating greasy foods. The same goes with exercise. Once someone takes the time to get into an exercise regiment they seldomly give it up to go back to being a couch potato.

In addition to the private sector, the government also offers a lot of services and resources for people willing to use them. They offer the Healthy Heart Book for Women to help let women know that they are not immune to heart disease. They also sponsor the National Heart Attack Alert Program. The National Heart Attack Alert Program (NHAAP) was launched in June 1991 and is the newest of the National Heart, Lung, and Blood Institute’s (NHLBI) national education programs. The NHAAP has the overall goals of, first, reducing morbidity and mortality from AMI through rapid identification and treatment and, second, heightening the potential for an improved quality of life for patients and family members (www.nhlbi.nih.gov/index.htm). Part of the reason for the government s interest in people health is because they pay the largest portion of the national health bill. If the government can reduce heart disease by ten percent they can save billions. This financial motive has generated a lot of valuable free information on heart disease. You can find everything from research at their web site to a recipe for Chicken Ratatouille.

When looking at how institutions operate, the service provided and costs for those services are at the top of the list. Many hospitals are general hospitals. These hospitals must look at a very wide variety of costs and payment methods. One method of payment that is becoming more popular is the DRG. The Social Security Amendments of 1983 eliminated the retrospective cost-plus fixed fee reimbursement for Medicare and Medicaid patients. Instead, a prospective payment system based on a fixed price per diagnosis-related group (DRG) was established for inpatient services. Essentially, a hospital was paid a pre-established price for a patient’s hospitalization based on that patient’s diagnosis (Heater).

DRG s have changed how hospitals do business. These DRG s have forced hospitals to determine how much it will cost for them to perform the procedures. The hospitals that do not cost out procedures have no information on which to base pricing structures. Furthermore, DRG s have spread from Medicare and Medicaid into the managed health industry. This rapid growth has forced even more hospitals to standardize some treatments. This causes a lot of friction between the physicians and the managed health companies because the physicians do not like giving up control of their patient s treatment.

Managed care companies negotiate contracts with hospitals for the prices of the DRG s. Once these prices are determined they are included in the contract. The hospital is responsible for making a profit at those prices. One hospital was sued to release the prices it negotiated with a managed care company. (Tammelleom) The hospital was eventually required to disclose it prices.

Employers’ obsession with reducing health care cost at the expense of medical quality has created a dysfunctional health care market, a consultant warns (Hofmann). This sentiment is what physicians play on when arguing against managed care and this is what patients scream when they feel that they need to spend more time in the hospital with a problem. The real problem is that the medical system is so big that it is impossible to fix. At least it is impossible to fix in a way that will make everyone happy.

The mission stated on the homepage of the Baptist Health System begins, The Baptist Health System is an institution dedicated to the Christian mission of providing quality health care to all persons seeking medical care, hospitalization and other health related services (www.baptisthealthsystem.org). This type of mission is the typical type of mission provided by most hospitals. They don t seem to mention that they are in the business of making money. And they don t mention that we are becoming numbers to them not patients. They are concerned with our satisfaction and with their mortality rates, but overall hospitals are in business to make money.

Baptist hospital in Nashville still primarily operates under fee for service. Very few of the physicians in the hospital are associated with HMO s. The hospitals see that as being something that will inevitable change over time. They are aware that the physicians are resistant to the idea, however, with current industry trends they are aware that it is something that is on the horizon.

Baptist Hospital is currently labeled as a not for profit entity. They are currently expanding do to their high occupancy level. They are involved in regular hospital care. They also have walk in clinics and they also go out to the public and work in home health care. Baptist is committed to preventative care. They host free clinics and screenings, in addition, to classes and siminars. This intense educational effort is nothing less than a citywide campaign to advocate the prevention of disease through healthy lifestyle habits and the early detection and treatment of illnesses. (Internet) They believe that preventative medicine is not only cheaper but that it makes for better and happier patients.

Overall, the medical system in America has a lot of problems. However, I will accept those problems, because I know that if something is wrong with me I can go have it fixed. Peace of mind carries a lot of weight when we consider what to do with this monster of a system we created. Some say shrink it and some say that we should do away with all insurance and that we should socialize medicine. While others believe that we should force everyone into an HMO. I do not pretend to know the answers to these problems. I do not believe that anyone has the right answer. Eventually maybe we will have a Utopian society that has no use for cash, but right now we don t. And as long as there are different groups fighting for profit there will be a great debate as to what to do with our medical system.

References

Heater, Barbara The current healthcare environment: who is the customer?

Nursing Forum, July-Sep 1996 v31 n3 p16 (6).

Hofmann, Mark ‘Cost over quality’ an expensive policy , Business Insurance, April 28, 1997 v31 n17 p49(1).

Saunders, “The growing role of stents in coronary artery disease.”, Patient

Care, May 30, 1999 v33 i10 p43

Tammelleom, David , Public hospital forced to disclose pricing arrangements with HMO. The Regan Report on Hospital Law, March 1997 v37 n10 p1(1).

www.mecqa.com MECQA (Medical Cost and Quality Assurance)

http://www.mayohealth.org/index.htm Mayo Clinic Health Oasis

www.coloradohealthnet.org Colorado Health Net

http://www.nhlbi.nih.gov/index.htm National Heart, Lung, and Blood Institute

www.ama-assn.org/med-sci/amapsite/index.htm American Medical Accredation

Program

www.baptisthealthsystem.org Baptist Health System