RSNA: Zerhouni paints bleak picture for radiology in U.S.
Elias A. Zerhouni, MD, former National Institutes of Health (NIH) director
CHICAGO—The current U.S. economic and political environment will continue to adversely impact healthcare, according to Elias A. Zerhouni, MD, for director of the National Institutes of Health (NIH), who provided the national perspective in the View from Above lecture on Nov. 29 at the Radiological Society of North America (RSNA).

In discussing the current political environment, he noted that healthcare has lost “powerful advocates” in Congress for advances in science and medical technologies, such as Arlen Specter, D-Penn., Dave R. Obey, D-Wis., Edward M. Kennedy, D-Mass., Robert C. Byrd, D-W. Va., without any “obvious new champions.”  He added that political gridlock is the most likely scenario for the next two years with the current administration and the recent turnover of the U.S. House of Representatives.

“While healthcare reform and its implementation have injected both hope and uncertainty with unclear impact on costs and policies, deficit reduction on the both state and federal level will lead to decreasing federal budgets for science,” Zerhouni said. The Obama Administration is recommending a 5 percent reduction in the NIH budget, but the Republicans are recommending a 9 percent reduction.

In discussing the current economic environment, most experts predict a prolonged and slow global recovery process (1 to 2 percent), with more growth in Asia and less growth in Europe and the U.S., according to Zerhouni. “Due to companies having to structurally reduce costs—mainly through layoffs—and improved productivity; yet, there is a reluctance to hire new workers and invest in new capacity, which is dampening the recovery,” he said.

Therefore, he predicted a “slow-growth decade with limited new investments and job creation.”

Why is this important to radiologists? Zerhouni asked. “It will become increasingly important to reduce healthcare costs, because at 17 percent of the gross domestic product, these healthcare costs are imposing a tremendous burden on economic growth. Therefore, it will continue to dominate discussions,” he added.

Current public health challenges are primarily related to the rise of chronic disease and aging population, with 75 percent of all healthcare costs attributed to chronic diseases. Therefore, 20 percent of patients are responsible for 80 percent of costs, and 30 percent of all costs are occurring in the last six months of life.

“Therefore, there is a huge heterogeneity and imbalance between where the costs are, and where the needs are,” Zerhouni said. “Most of the public health needs are in prevention and most of the spending is done in non-preventive areas.” Also, the current system is designed for acute care in high-cost settings, and this will have to change, he added.

He also stressed that payors believe that medical technology is a key culprit in increasing costs and tend to see innovation as a problem, not a solution. “The insurers believe every medical advance results in increasing costs, which is a real problem for imaging services that will remain a target for costs reduction strategies. A key global advocacy goal would be to fight that perception,” Zerhouni noted.