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Poor health, high medical expectations complicate care

By: Emily Bregel
(Contact)

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Jim Brexler, CEO Erlanger hospital

The declining health of Americans and expectations that modern medicine can cure any ailment contribute to growing demand for health care services, providers say.

“The overall cost of health care is escalating because we’re not taking responsibility as individuals for our own health,” said Jim Brexler, chief executive officer of Erlanger hospital. “We’re expecting the doctors and hospitals to be there to save us.”

Over the last century, the kinds of diseases that kill Americans have changed from infectious diseases to chronic conditions, such as cardiovascular disease, cancer and diabetes.

Chronic diseases are the most prevalent, expensive and preventable of health issues, according to the U.S. Centers for Disease Control and Prevention.

Underpinning many of those chronic conditions are unhealthy lifestyles, reflected in rising rates of obesity in adults and children.

“Part of the chronic disease conundrum is lifestyles,” said Dr. Clifton Cleaveland, a retired physician from Chattanooga and former president of the American College of Physicians. “As we become more sedentary and tend to eat more energy-dense food, our weight goes up, our type-2 diabetes increases. That’s the great challenge right now — effective and affordable management of chronic diseases.”

A surge in diabetes has followed the obesity epidemic in the United States, with 17.5 million Americans diagnosed with diabetes.

“Even teenagers are becoming type-2 diabetics, which was basically kind of unheard of” in the past, said Dr. Mack Worthington, a Chattanooga physician and president of the Tennessee Medical Association.

In Tennessee, 9.1 percent of the population has diabetes, compared with 7.3 percent nationally, according to the Tennessee Department of Health.

Research also has linked health to income, wealth and education level. Providers point to delayed primary care and inaccessibility of care among the uninsured and underinsured populations as contributors to the escalating health needs of lower-income Americans. That translates into higher costs that must be absorbed by providers and the commercially insured.

The system drives people without health insurance to emergency rooms in response to illness that requires immediate intervention, rather than primary or preventive care, Dr. Cleaveland said.

Dr. Farrokh Ghamgosar, a family practice doctor at the Southside/Dodson Avenue Community Health Centers, said that many low-income patients opt not to take medication for chronic conditions such as diabetes and high-blood pressure because they believe they cannot afford it.

“The most important thing for them is to be able to eat (and) not being hungry. So medication and medical care usually for them is on the bottom. If it’s too much and they can’t afford it, they forget it,” he said.

Patients end up returning to the clinic when their conditions have worsened to a serious degree.

“Now they need more medication, the blood pressure’s much higher, the damage to the heart and kidneys is much greater. We cannot manage it as an outpatient anymore. They need inpatient (care) now,” Dr. Ghamgosar said.

The community health centers serve a population that is about one-third Medicaid, onethird Medicare and one-third uninsured, he said.

Disenrolled from TennCare in 2006, Soddy-Daisy resident Eva Mahan said primary care services such as an annual mammogram are a luxury she cannot not afford right now.

A September emergency room visit for a severe kidney infection left her with a $4,200 bill, which she is paying off in $50-a-month increments, said 62-year-old Mrs. Mahan, who lives on Social Security disability.

“You can’t afford to pay $90 to $150 for an office call to a doctor’s office, just to walk in and have them say, ‘Well, you’re OK,’” she said.

The retired furniture maker said she cannot get affordable private insurance because she has asthma and because she had breast cancer, now in remission since 1986. Her monthly premium from BlueCross BlueShield of Tennessee would have been more than $900, she was told.

“If the good Lord wills it and I live three more years, I can get on Medicare,” she said.

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