A healthier society and more effective medical care
Health care costs in the United States exceed those of any other nation. Millions of Americans are uninsured, partly because of rising premium costs. With health care reform issues taking the political center stage, is this not a good time to step back and assess the problem from a more basic point of view: that reducing the need and thus the demand for medical services is the key to a healthier society and a more equitable distribution of limited medical resources? As an added bonus, reducing the demand for medical care would reduce the number of payday loans in Wyoming needed to cover uninsured emergency expenses.
Broader access and lower medical costs don’t necessarily mix
Presumably, the goals of various medical reform packages are to broaden access to health care and, at the same time, reduce medical costs. The merits of any particular political agenda aside, however, medical industry reform will present new costs, more restricted access, rationing of services, and adverse economic effects on health-care providers, especially small businesses. Clearly, broadening access and reducing costs at the same time is a difficult proposition.
Education is the key
Without illnesses and accidents, obviously, there would be no health care costs. According to an article by James F. Fries and C. Everett Koop in the New England Journal of Medicine, (Reducing Health Care Costs by Reducing the Need and Demand for Medical Services, Volume 329:321-325, 1993) in the last century, medical costs have soared as a result of the increase in chronic disease, despite a decrease in the occurrence of acute illness. Heart disease, adult-onset diabetes and other avoidable chronic illnesses, along with unnecessary emergency room and doctor visits are an enormous drain on medical resources.
Unhealthy lifestyle choices are expensive
Generally speaking, healthy people don’t smoke or consume alcohol to excess. They exercise regularly, eat wisely, wear seat belts, and take preventive health measures. Not all preventive measures have been shown to save money, but it is probably safe to say that an emphasis on disease and accident prevention and individual restraint in the use of medical services would, over all, reduce societal health care costs.
Proper use of medical services reduces demand
A health policy directed at reducing demand would be unlikely to make a major contribution to lowering costs if a number of conditions were not present: if preventable illness made up only a small fraction of the demand, if risky behavior were not expensive in terms of lifetime medical costs, if approaches involving self-management did not reduce costs, if the present system already linked the use of resources closely to the requirements of illness, or if health-promotion programs in the workplace increased overall health care costs.
Preventable illness and injury inflate the demand for medical care
Fries and Koop, et al, state that preventable illness and injury account for eight of the nine leading causes of death in the United States. They cite sound authorities to support what would seem to be inarguable from a common sense point of view: Lifetime medical costs are clearly linked to lifestyle choices and poor health habits. Fries and Koop point out such obvious things as increased physical activity being associated with fewer visits to the doctor, health costs as well as morbidity rates being significantly higher among smokers, and medical costs among people with several risk factors (smoking, obesity, hypertension, hypercholesterolemia, and diabetes) being double that of people with no risk factors.
Education cuts down on demand for medical care
Many studies have shown that educating patients about self-management, especially when coupled with modest medical intervention offering objective guidelines to help decide whether medical assistance is needed, reduces the demand for medical services. This is true even for people with chronic disease.
Not only are overly intensive services for terminal illness extraordinarily expensive, they are undesired by most people. Fries and Koop note that “Seventy percent of people request no life-sustaining treatments for themselves when they are dying, and 89 percent desire living wills and other advance directives. Yet only 9 percent have made such directives.” An emphasis on educating patients about the importance of health care directives could result in enormous health care savings, as well as provide more humane care.
Education saves money
It costs money to educate people, especially on a wide scale. But if the entities now bearing the costs of skyrocketing medical care – insurers, industry, and government – were convinced that programs designed to reduce the demand for medical services could actually save money, they’d fund be funding the education, without a doubt.
