Chronic disease is the major cause of disability in the United States, the major reason for use of medical services, and consumes 78 percent of the nation's healthcare expenditures. As the prevalence of chronic disease increases, we will see consequent increases in healthcare utilization, healthcare expenditures and disability rates. The healthcare system, constructed to address acute disease, does a very poor job of managing chronic disease. The healthcare crisis is, in significant part, a consequence of this inadequacy. Effective and efficient care of chronic disease patients requires a different pattern of health services, particularly medical practice.
The changes that need to be made are well-known and well-tested. They include better integrating and coordinating patients' care; improving physician-patient communication; recognizing patients as principal caregivers and developing their self-management skills; and paying more attention to patients' feelings about themselves and their disease. These relate broadly to the roles of patients and physicians, and the sites and character of care. Fortunately, implementing these changes does not require new buildings or technology, but it does require changes in behavior and perception on the part of physicians, other clinicians, patients, and healthcare leaders. Without these changes, the healthcare crisis cannot be resolved.