Chronic illness in a complex health economy: the perils and promises of downstream and upstream reforms

Abstract

Chronic illness is the largest cause of death and source of health care costs in developed countries and a growing problem in developing countries. Here we build on past work in system dynamics and present a generic model of chronic illness, its treatment and prevention, applied to the U.S. population. The model explains the rising prevalence of illness and responses to it, including the treatment of complications and management activities designed to reduce complications. We show how progress in treatment and disease management has slowed since 1980 in the U.S., largely due to competition between health care payers and providers, resulting in price inflation and an unstable climate for health care investments. We demonstrate the impact of moving “upstream” by managing known risk factors to prevent illness onset, and moving even further upstream by addressing behaviors and living conditions linked to the initial development of these risk factors. Copyright © 2007 John Wiley & Sons, Ltd.