Payment and Economic Evaluation of Integrated Care

Abstract

The rapid growth and ageing of global population accompanied by unhealthy health behaviour (i.e. smoking, physical inactivity, unhealthy diet and harmful use of alcohol) lead to increasing prevalence of chronic diseases. Worldwide, non-communicable diseases (NCDs) cause more than 63% of all deaths, a number that is expected to increase by 15% at 2020 and by more than 20% at 2030. These mortality rates affect females and males almost equally. Many non-communicable diseases are chronic diseases, like cardiovascular diseases (48% of total deaths due to NCD), cancers (21%), chronic respiratory diseases (12%), and diabetes (4%), which are on the top list of the deadliest NCDs. Twenty five percent of the deaths from NCD occur before the age of 60. Chronic diseases have high impact on global morbidity too. Seventy seven percent of total disability adjusted life years (DALYs) are caused by chronic diseases; mostly by cardiovascular diseases (23% of total DALYs), neuropsychiatric conditions (20%), cancers (11%), respiratory diseases (5%), and diabetes (2%). Furthermore, chronic diseases disproportionately affect people at lower socioeconomic status. At patient-level, chronic diseases and poverty create a vicious cycle whereby poverty exposes people to behavioural and environmental risk factors for chronic diseases and, in turn, the resulting chronic diseases may become an important driver to the downward spiral that leads families towards poverty. At country level, 80% of deaths related to NCDs occur in low-middle income countries. Furthermore, the social impact of chronic diseases is even larger taking into account that they influence the mortality and quality of life of their informal care givers and family.