The Five Percent: Our Sickest Take Half Our Resources

the five percent, health care

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Five percent of people account for 50 percent of the health system’s spending.   This number has been around for a while now.  Those patients represent a gross failure and a huge opportunity.

The Washington Post broke these numbers down a bit further recently.  Health-care spending currently accounts for one-fifth of our economy.  This means the five percent are taking up 10% of our gross domestic product.  In other words 15 million Americans account for $1.5 Trillion in medical care.

The article goes on to talk about the environment for the five percent.  Often these patients are living in poverty, have difficult home situations, can be resistant to doctor instructions, and sometimes suffer from mental illness.

But there is more to the picture.  While the elderly and poor are over-represented so too are baby boomers, white Americans and women.  Children and young adults are disproportionately towards the bottom five percent according to a HuffPo article.

It appears the five percent are in two baskets.  The poor, elderly and/or mentally ill who can not advocate for themselves and slip through the cracks until their medical situations become dire and the sophisticated, likely more educated group of Americans who know how to work the system to get the care they need and possibly more than they need.

For those who are struggling to get adequate care there seems to be a lack of social services to support them.  Visiting nurses who can ensure a patient regularly takes their pills, support staff who can help arrange transportation to medical appointments, etc.

For those in the five percent who are getting all the access they need (and perhaps more) how do you ease their anxieties about their conditions and have them appropriately use the medical system?

No one is questioning that these people are truly ill.  But they require a two-pronged approach to give the best possible care while keeping costs down.

As of 2010 there are 49.9 million people without health insurance and they definitely make up part of the five percent.  They hold off on care until absolutely necessary because medical costs can be so debilitating to a household’s finances.

The Washington Post article suggests we start funding social services more so that we can take the pressure off the medical system when the sickest of the sick arrive at ERs and doctor offices around the country.

What are some solutions that could improve outcomes both financial and medical for the five percent?  Should we beef up medical coverage or social services?  Can the health insurance industry help provide answers?  What do you think?

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