Chronic diseases, who will pay the bill? 

The incidence of chronic diseases is constantly increasing worldwide! The direct and indirect costs associated with these diseases can be counted in the thousands of billions of euros. Who will be able to pay such a bill? Not to mention that the development of chronic diseases has only increased. How can we cope with this? Where can we find the money to provide care for all? We know that it is possible to prevent the development of chronic diseases by modifying the interaction of each person with his or her environment, wouldn’t this be a solution?

Reading time : 15 minutes

Summary

Chronic diseases in a few figures
The cost associated with chronic diseases
Who pays for it ?
Prevention through consideration of the exposome : the solution? 

Chronic diseases in a few figures

Every year in the world, more than 70% of deaths are due to chronic diseases.¹

These diseases are defined as long-lasting, progressive and impacting on daily life. Thus, cancers, cardiovascular diseases, respiratory diseases, diabetes… are chronic diseases (non-communicable diseases). These diseases can result from predisposing genetic factors but are also the result of the interaction of each person over time with his or her life environment (exposome).

In Europe, chronic diseases are one of the major causes of morbidity and mortality, with approximately 36% of the European population reporting suffering from at least one chronic disease.

In the US, the most affected country,

6 out of 10 adults have a chronic disease

i.e. 133 million Americans and 4 adults out of 10 have 2 or more!

These long-term pathologies are often due to an aging population but also to lifestyle factors such as diet, physical activity, exposure to pollutants, smoking…

The chronic diseases causing the most deaths are: ischemic heart disease (8.8 million), stroke (6.2 million), lower respiratory tract disease (3.2 million), chronic obstructive pulmonary disease (3.1 million), respiratory cancers (1.7 million), type 2 diabetes (1.6 million).

The costs associated with chronic diseases

More than 75% of healthcare costs in the U.S. are due to chronic diseases, including very costly pathologies such as cardiovascular diseases, cancers, respiratory diseases and psychiatric diseases. In 2023, in the US, the direct and indirect costs of chronic diseases, treatment and related economic losses, are estimated at 4,200 billion dollars.

In Europe, the situation is not much better, since chronic diseases account for 70% to 80% of the costs of the healthcare system. In Europe, cardiovascular diseases alone cost the healthcare system 111 billion (2015) and cancers about 97 billion euros (2018). The associated costs for premature deaths due to chronic diseases of the working age population amount to more than 115 billion euros (OECD). Absenteeism from work as a result of chronic diseases results in a loss of 2.5% of annual GDP.

A final cost that should not be overlooked is the cost in DALYs (“Disability Adjusted Life Years”), a synthetic indicator of the health burden. A DALY is a measure of the overall burden of disease, expressed as the cumulative number of years lost due to ill health, disability or premature death. In concrete terms, 2 DALYs represent, for example, the sum of 2 years of life lived in poor health (or premature death). In Europe, chronic diseases are responsible for approximately 115 million DALYs, i.e. the European population loses 115 million years of life in good health.

Who pays for it?

The patient

The first impact is of course the patient: deterioration of his quality of life, decrease in productivity, possible loss or voluntary termination of his job, and in many countries the health system does not cover or only partially covers the costs associated with the disease.

The caregivers, often close to the patient, are also impacted (increased fatigue, stress, sharing of the remaining monetary costs…) and can put the patient before their own well-being, creating a vicious circle and a risk for them to develop a chronic disease as well (especially if they share the same environment and lifestyle).

Insurance and mutuals

Insurers/mutual insurance companies are financially affected when their policyholders develop chronic diseases. Out-of-pocket expenses and co-morbidities, which are very often present in patients suffering from or developing a chronic disease, represent a significant additional cost.

Companies

Companies are impacted economically and organizationally, and the increase in the legal retirement age makes it possible to imagine the challenges that companies are and will be facing in the coming years.

For companies, the annual cost of sick leave related to diagnoses of chronic diseases such as cancer is estimated at nearly 525 million euros.

Maintaining the employment of people suffering from chronic illnesses through an internal organization that allows the employee to be directed towards a more appropriate position, or by adapting the position, can limit the costs for the company. Similarly, the implementation of preventive actions to protect the health of employees is a win-win situation.

Company

Society, which indirectly finances the health care system, is also affected by the increasing costs of these diseases.

In France, on average, a patient with diabetes costs 5,900 euros per year, a patient with coronary artery disease 5,764 euros and 5,577 euros for a patient with severe hypertension!

The average costs for chronic diseases range from 3400 euros to 16 720 euros with an average of 7000 euros per year per patient.

Prevention through consideration of the exposome: the solution?

The elements presented above can be frightening and yet the development of a chronic disease is far from being a fatality!

By reducing the risk factors, 80% of all cases of vascular heart disease, stroke and type 2 diabetes could be avoided, as well as more than 40% of cancers.

By influencing the environment, it is possible to drastically reduce the risks even with a genetic predisposition to certain chronic diseases.

Thus, for chronic diseases, the proverb “Prevention is better than cure” takes on its full meaning! We must allow the citizen to become an actor of his health. To do this, each stakeholder must be involved in the implementation of prevention actions and the highlighting of risk factors.

Environmental factors that play a role in the development of chronic diseases are the following:

Poor diet
Alcohol
Air quality
Tobacco smoke
Radon
Lack of physical exercice
Sedentarity
 
Noise
UV
Professional exposure

By informing on environmental factors, at risk and by making visible the invisible (indoor and outdoor air quality, noise, UV, pollen …), the various stakeholders can :

Government, mutual and insurance companies

They can already raise awareness and begin to make citizens more aware. Coupling this information with advice and actions to modify risky behaviors is the second necessary step to bring about a sustainable reduction of risks and thus allow the citizen to be at the heart and actor of his health

Companies

Companies also have a role to play, as their positioning allows them to be at the crossroads of occupational health and public health. They can enable employees to stay in better shape by initiating actions to fight against poor indoor air quality, high noise levels, stress, smoking, by providing nutritional advice, and by encouraging the practice of sports. A sedentary person who starts practicing regular physical activity and sports in the workplace improves productivity by 6 to 9% (Goodwill and al., 2015).

Citizens

Citizens can be proactive by modifying risky lifestyle habits but also by learning about the family history of health problems. Indeed, if family members have diabetes, cardiovascular disease or cancer, they may also have a predisposition and targeted prevention actions can be implemented to reduce the risk of developing these diseases. In the same way, it is possible to prevent some diseases by being followed by the medical system (vaccines, screenings…).

Chronic diseases are bound to increase in the coming years but with the right prevention tools and actions (mobile prevention applications, sensors, educational articles, webinars, public prevention events, education in schools on these issues from an early age…), their development can be slowed down and even decreased. People already suffering from a chronic disease can also see an improvement in their condition by also following targeted and personalized prevention actions.

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Sources :

[¹] https://www.un.org/fr/chronicle/article/les-maladies-liees-au-mode-de-vie-un-fardeau-economique-pour-les-services-de-sante

https://www.euro.who.int/__data/assets/pdf_file/0008/96632/E93736.pdfhttps://www.cdc.gov/chronicdisease/about/index.htm

https://www.who.int/chp/chronic_disease_report/overview_fr.pdf

https://www.healthline.com/health/top-10-deadliest-diseases

https://nationalhealthcouncil.org/wp-content/uploads/2019/12/NHC_Files/Pdf_Files/AboutChronicDisease.pdf

https://assurance-maladie.ameli.fr/sites/default/files/2006-10_cout-ald-2004_points-de-repere-3_assurance-maladie.pdf

https://en3s.fr/articles-regards/51/COURTIAL.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451498/

https://knowledge4policy.ec.europa.eu/health-promotion-knowledge-gateway/cost-non-communicable-diseases-eu_en

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