ABSTRACT

INTRODUCTION Three 20th century trends have converged to create today’s technology-driven health care system [1]. First, increasing life expectancy (49.2 years in 1900 vs. 77.2 years in 2001 for the United States) means that people live long enough to develop more chronic diseases [2]. Second, greater societal wealth permits a larger portion of society’s resources to be spent on health care (3% of US gross domestic product in 1900 vs. 13.6% in 1997) [1-3]. Finally the development of medical insurance provides a large pool of funds for medical expenses (paying 0% of US medical expenses in 1900 vs. 83% in 1990) [1]. These trends are particularly important for acute coronary syndrome (ACS) patients who are typically older and whose 30-day medical costs ($17,251 in 1995) [4] are 3.7 times the annual per capita health expenditures in the US [5].