Family Centered Care Current and Future Directions Ayaz Samadani MD,DCH,DTM&H,FAAFP Health care cost and to keep it affordable Rationing of medical care
Disclosure
Ayaz M Samadani MD I have NO actual or potential conflict of interest in relation to this activity. I do not have any relevant financial relationships with any commercial interests.
Affordability
Yes or No • You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? • It is immoral to apply monetary considerations to saving lives — but is that stance tenable?
Healthcare Expenses
Health Expenditure per Capita
Healthcare Cost Share
Choices
Cost Comparison Procedure
Country
Cost in $
Laceration repair
Korea
$19.00
ER + X-ray
Mexico
$14.00
Thailand
$11.00
USA
$500.00 to $2,500.00
USA verses Elsewhere Procedure
USA
Cost of procedure
Country
Hip replacement
$33,000
$12,500
Mexico
Knee replacement
$34,000
$16,500
Singapore
CABG
$88,000
$21,000
Taiwan
Gastric bypass
$25,000
$8,200
Malaysia
Spinal fusion Fertility treatment
$41,000 $15,000
$9,500 $4,400
India Costa Rica
Having a Baby Normal delivery
CS
Hospital 1 night stay
US $9,280
US $ 14,374 to $20,000
US $3,949
Argentina $1,291 Spain $3,145 Germany $362
Getting Value for Money Measures
Cost vs Quality (Satisfaction Surveys) Infant Mortality Rate Life Expectancy
Choices What is the cost to extend life for one year
Factors Affecting Patient Outcomes
Recommendations Exercise Nutrition Prevention
Solutions Preventive Care Children Adults Women Seniors
Preventive Services for Children – Haemophilus influenzae type b – Hepatitis A – Hepatitis B – Human Papillomavirus – Inactivated Poliovirus – Influenza (Flu Shot) – Measles, Mumps, Rubella – Meningococcal – Pneumococcal – Rotavirus – Varicella – Diphtheria, Tetanus, Pertussis
Preventive Services for Children • Iron supplements for children ages 6 to 12 months at risk for anemia • Lead screening for children at risk of exposure • Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. • Obesity screening and counseling • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years. • Phenylketonuria (PKU) screening for this genetic disorder in newborns • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk • Tuberculin testing for children at higher risk of tuberculosis
Preventive Services for Adults • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked • Alcohol Misuse screening and counseling • Aspirin use for men and women of certain ages • Blood Pressure screening for all adults • Cholesterol screening for adults of certain ages or at higher risk • Colorectal Cancer screening for adults over 50 • Depression screening for adults
Preventive Services for Adults • Type 2 Diabetes screening for adults with high blood pressure • Diet counseling for adults at higher risk for chronic disease • HIV screening for all adults at higher risk • Obesity screening and counseling for all adults • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk • Tobacco Use screening for all adults and cessation interventions for tobacco users • Syphilis screening for all adults at higher risk
Preventive Services for Adults • Immunization vaccines for adults--doses, recommended ages, and recommended populations vary: – Hepatitis A – Hepatitis B – Herpes Zoster – Human Papillomavirus – Influenza (Flu Shot) – Measles, Mumps, Rubella – Meningococcal – Pneumococcal – Tetanus, Diphtheria, Pertussis – Varicella
Preventive Services for Women • special needs related to the health conditions that affect their reproductive organs such as breast, uterine, and cervical cancer. • Prenatal care and delivery, while essential to the health of both mother and baby • Women are more likely to live in poverty at all ages
Preventive Services for Seniors • Tobacco Use Cessation Counseling • Screenings – Bone mass measurement – Cervical cancer screening, including Pap smear tests and pelvic exams – Cholesterol and other cardiovascular screenings – Colorectal cancer screening – Diabetes screening – Flu shot, pneumonia shot, hepatitis B shot – HIV screening for people at increased risk or who ask for the test – Mammograms – Medical nutrition therapy to help people manage diabetes or kidney disease – Prostate cancer screening
Environments
Cardiovascular Disease Screening • screening blood tests for cholesterol, lipid, and triglyceride levels every 5 years. These screening tests help detect conditions that may lead to a heart attack or stroke.
Diabetes Screening risk factors • High blood pressure (hypertension) • History of abnormal cholesterol and triglyceride levels (dyslipidemia) • Obesity • History of high blood sugar (glucose) • Overweight • Family history of diabetes (parents, brothers, sisters) • History of gestational diabetes (diabetes during pregnancy), or delivery of a baby weighing more than 9 pounds
Hepatitis B risk factors • Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection.
Prostate Cancer Screening • Digital rectal exam: Once every 12 months • Prostate Specific Antigen (PSA) test: Once every 12 months
Mammograms Screening • Women age 40 or older • Women between 35-39 can get one baseline mammogram
Abdominal Aortic Aneurysm Screening
• You have a family history of abdominal aortic aneurysms. • You’re a man age 65 to 75 and have smoked at least 100 cigarettes in your lifetime.
Bone Mass Measurement Bone Density Screening • A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings • A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures • A person taking prednisone or steroid-type drugs or is planning to begin this treatment • A person who has been diagnosed with primary hyperparathyroidism • A person who is being monitored to see if their osteoporosis drug therapy is working
Cervical & Vaginal Cancer Screening • Once every 24 months for all women • Once every 12 months if you’re at high risk for cervical or vaginal cancer, or if you’re of childbearing age and have had an abnormal Pap test in the past 36 months
Colorectal Cancer Screening
• Barium enema every 48 months if you're 50 or over and once every 24 months if you're at high risk for colorectal cancer. • Colonoscopy: once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, once every 120 months, or 48 months after a previous flexible sigmoidoscopy. • Fecal occult blood test: once every 12 months if you're 50 or older. • Flexible sigmoidoscopy: once every 48 months for most people 50 or older. If you aren't at high risk, test 120 months after a previous screening colonoscopy.
Colorectal Cancer
Cologuard™: multi-target stool DNA test Screening • once every 3 years for people who meet all of these conditions: – They’re between 50–85. – They show no signs or symptoms of colorectal disease including, but not limited to, lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test. – They’re at average risk for developing colorectal cancer, meaning: – They have no personal history of adenomatous polyps, colorectal cancer, inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis. – They have no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.
Glaucoma Screening • You're at high risk if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic American and 65 or older.
Diet Supplements
Ayaz Samadani MD,DCH,DTM&H,FAAFP Health care cost and to keep it affordable Integrated medical care
Could a diet supplement supercharge your eyesight?
Diet
Disclosure
Ayaz M Samadani MD I have NO actual or potential conflict of interest in relation to this activity. I do not have any relevant financial relationships with any commercial interests.
Thank you Ayaz M. Samadani MD, FAAFP
DCH(London)DTM&H (Liverpool) Beaver Dam, WI 53916 USA 920-887-7731 Ayaz@samadani.com