Since 1950, the developed world has experienced a continual increase in life expectancy at birth as well as a decline in fertility rates. Together, these trends imply that the population of the developed world is aging. This means that the age demographics of society as a whole are shifting towards a higher and higher share of elderly people. But why has life expectancy been increasing steadily for centuries? A big part of the reason is the gigantic strides that have been made in both medical understanding and medical technology.
In modern times, the leading causes of death include heart disease and lung cancer. And while medical advances continue to be made to help prevent and slow these diseases, it comes with a cost: an increase in health expenditures. Heart failure is a chronic condition in which the heart can’t pump a sufficient supply of blood to deliver oxygen to other organs in the body. Some 6.5 million Americans are living with heart failure and an additional 650,000 new cases are diagnosed each year, according to the American Heart Association, though Medicare data suggest the number is higher. As a result, heart failure is the single most common reason why Medicare beneficiaries end up in the hospital.
To counteract this high rate of hospital admissions due to chronic heart failure along with its hefty contribution towards health care expenditures, cardiac rehabilitation programs are beginning to open up for patients to attend regularly. With chronic heart failure being one of medicine’s most debilitating and costly illnesses, the goal for these programs is to give patients a chance to improve their functional capacity and quality of life and keep them out of the hospital by offering supervised exercising and counseling.
But will this decrease in hospital admissions actually reduce health care expenditures? The problem with assuming that a particular disease will greatly reduce expenditures is that it does not take into consideration competing risks, or the inevitable rise in hospitalization and mortality from other causes. For example, say that these cardiac rehab programs could actually help to completely prevent heart failure in the future. In this case, the rate of mortality and morbidity from all other diseases would just increase. These programs would be keeping the elderly alive long enough just for them to end up in the hospital due to some other degenerative disease. As a result, we would end up with elderly people living longer, thus contributing to our aging population, and eventually they would all end up in the hospital one way or another. Instead, maybe an increase in the age of when a person is eligible for Medicare would be a better solution to try to lower health care expenditures.