4 changes for global governments to slash healthcare spending

Low- to middle-income countries (LMICs) spend billions of collective dollars each year on healthcare, Journal of the American College of Cardiology editor-in-chief Valentin Fuster, MD, PhD, and colleagues wrote in a recent JACC article—but they aren’t necessarily spending those funds effectively.

According to Fuster et al.’s paper, a 2011 World Economic Forum report outlined a set of cost-effective “best buy” interventions and risk factor reductions for LMICs that would be easily implementable and save millions of lives. Implementing the entire suite of recommendations between 2011 and 2025 across all LMICs would be a costly $170 billion, Fuster and co-authors wrote, but implementing just “best buy” solutions would decrease cardiovascular disease (CVD) deaths by 10 percent for a $120 billion price tag. In addition, they said, the countries would see a combined $377 billion projected economic benefit.

This is how Fuster and his team suggest medical professionals cut costs and keep their populations healthy:

1. Curb tobacco use

More than 100 studies have proven increased taxation on tobacco products discourages smokers from continuing to buy cigarettes. The Lancet Commission on Investing in Health found that a 50 percent price hike on cigarette taxes in China would save 20 million lives and generate $20 billion in revenue over five decades.

An old regulatory trick is still working, Fuster et al. wrote—tobacco warning labels on cigarettes are still proving useful in educating users on the cardiovascular risks. Mandating smoke-free workplaces and public spaces, banning tobacco promotion and increasing taxes could also be useful, they said.

“With tobacco-related illnesses projected to kill 8 million people annually by the year 2030, a combination of taxation and regulatory measures can be expected to decrease tobacco-related CVD significantly,” the authors wrote.

2. Reduce harmful alcohol use

According to the U.S. Centers for Disease Control and Prevention, alcohol can be safely enjoyed in moderation, which means one drink a day for women and two drinks a day for men. The American Heart Association reports heavy drinkers are at higher risks for developing hypertension, obesity, stroke and a handful of non-heart-related chronic illnesses.

Fuster and co-authors again suggested tax increases for alcoholic beverages, citing evidence that decreased access to unhealthy drinks has saved many lives from CVD. Restricted access to alcohol and bans on alcohol advertising were also recommendations.

3. Change unhealthy dietary habits and sedentariness

In Mexico, the authors wrote, a sugar tax of 1 peso/l has resulted in a 7.6 percent reduction in unhealthy purchases and is projected to save the country $983 million by lowering the incidence of diabetes, stroke and myocardial infarction. Similar effects have been seen in other countries, including the U.S., when sugary drinks are subject to higher price points.

In addition to hiking costs, Fuster and colleagues also cited a recent meta-analysis that found a 10 percent decrease in the price of healthy foods and beverages increased consumption of those products by 14 percent.

4. CVD and diabetes counseling and treatment

Public health education comes into play here in a big way, the authors wrote. Even small changes like integrating additional services to routine medical visits and conducting screening programs in high-traffic areas could prove useful, as can multidrug therapy and counseling for patients at risk for heart attacks and stroke—even if CVD hasn’t been formally diagnosed.

In addition, Fuster et al. said, patients who have experienced myocardial infarction should be treated with aspirin, which is a safe, cheap way to lower CVD risk in a high-risk population.