The current onslaught of people suffering in the battlefields of daily life from chronic disease, illnesses, and injuries is disturbing. However, even more, disheartening is that many, if not most, of these medical conditions, could be avoided or significantly delayed – if only those people could turn back the hands of time and alter the millions of small but significant daily choices that led to those unintended consequences.
The harsh reality is that large, how we live dictates how we die. But just as counting the dead is not enough when considering the full cost of war, we would be better served to consider the full value of health rather than the inexorable cost of dying. Yet, the current medical care system in the early twenty-first century remains focused on treatment and repair, with very little focus on prevention and promoting the health of people.
A study conducted by the American College of Occupational and Environmental Medicine (ACOEM) and the Integrated Benefits Institute (IBI) examined over 300,000 pharmacy claims,
Using the traditional view of assessing medical and drug costs alone, the study found that the top ten health conditions driving costs in the companies studied were cancer (other than skin cancer), back/neck pain, coronary heart disease, chronic pain, high cholesterol, diabetes, sleeping problems, hypertension and arthritis.
Using the traditional view of assessing medical and drug costs alone, the study found that the top ten health conditions driving costs in the companies studied were cancer (other than skin cancer), back/neck pain, coronary heart disease, chronic pain, high cholesterol, diabetes, sleeping problems, hypertension and arthritis, arthritis, hypertension, obesity and anxiety.
Chronic health conditions that are largely preventable are responsible for more than half of all deaths in the world and are projected to account for two-thirds of all deaths in the next 25 years (World Economic Forum, 2008). Currently in the USA, there are over 133 million people with one or more chronic conditions. Furthermore, 70 percent of all deaths as well as 75 percent of our $2 trillion healthcare expenditures are related to chronic conditions. In fact, chronic conditions drive 96 percent of the costs in the Medicare system and 83 percent of the costs of the Medicaid system as well as being responsible for two thirds of the rise in overall healthcare costs in the USA since 1980 (Kenneth, 2008; Thorpe, 2006).
The World Health Organization estimates that one-half of the world’s population is malnourished. However, the sad truth is that obesity is now equaling or surpassing hunger as the leading cause of malnourishment globally (World Economic Forum, 2008). Yet, it is estimated that 40 percent of cancer, 80 percent of heart disease and 80 percent of type 2 diabetes are preventable (Kenneth, 2008). The main driver of increasing healthcare costs is greater utilization of health services due to the growing burden of health risk and chronic illness. Other problems are the growing labor shortage and the ever-increasing number of working age people between the ages of 18 and 65 who are collecting health-related disability benefits rather than earning paychecks. The high rate of employees quitting their jobs because of health-related issues is alarming because it stresses the “federal budget and leads to dire predictions of the benefits safety net failure.
Throughout the past 20 years, while superficial efforts of healthcare cost avoidance reigned supreme, a hurricane of illness was brewing on the horizon because of the ill-fated lifestyles and health risks within the population. That storm of health risk is now unleashing its fury on our healthcare systems in the USA as well as internationally and we are on the verge of witnessing the inadequate levees of old cost containment strategies breaking apart from a flood of chronic illness that could lead to a profound change in the economic landscape for governments. In fact, unless we address these issues in the USA with a sense of urgency, the financial viability of Medicare, Medicaid and social security systems are in peril.”
Available statistics indicate that prevention and a culture of healthy lifestyle as opposed to just more treatment and cure can lower health risks, reduce the burden of illness, improve productivity and lower total health-related costs. Healthcare providers need to be more focused on the quality and effectiveness of care rather than just the quantity and efficiency of the care. The high cost of healthcare can be reduced if healthcare providers puts in place systems that reduce the burden of chronic illnesses and health risk amongst its members.
As the old adage says “an ounce of prevention is worth a pound of cure”. Preventive strategies that have been tested and shown to improve health and keep people working can be applied at several levels in different domains. Health promotion, health education, lifestyle management, nutrition, prenatal care, immunizations and other wellness services are all relevant primary prevention strategies because they help people stay healthy and productive. Screening and early detection programs, health coaching, biometric testing and proactive work disability prevention programs are also relevant secondary prevention strategies because they can identify conditions earlier than they would have been by typical clinical manifestation.
Disease management, evidence-based quality care management, return to work programs, disability management and vocational rehabilitation are tertiary prevention strategies that can be utilized because they provide earlier interventions, limit the destructive and often disabling impact of serious medical conditions on function in daily life and work, protect or restore productive lifestyles, and reduce future costs.
In fact, a study at the Milken Institute has calculated those seven chronic conditions (cancer, heart disease, hypertension, mental disorders, diabetes, pulmonary conditions and stroke) are costing the US economy alone more than $1 trillion per year – with anticipated growth rates of the prevalence of those seven conditions to yield an illness burden of $4 trillion per year by 2023. However, as compared to this “business as usual” scenario, plausible estimates of potential gains (avoided losses) associated with reasonable improvements in prevention, detection and treatment of just those seven conditions would cut annual treatment costs in the USA by $217 billion and reduce health-related productivity losses by $905 billion by 2023. Furthermore, just lowering obesity rates alone could lead to productivity gains of $254 billion and the avoidance of $60 billion in treatment expenditures (Devol et al., 2007)” It is also well documented that reducing health risk, lowering the prevalence of illness and improving the quality of care management for those with illness does lower total cost (Loeppke, 2008; Burton et al., 2004, 2006; Goetzel and Ozminkowski, 2008).
Health care services needs to be patient centered with nurses and community outreach personnel that visit patients and offer medical advice and care support right in their homes. These services could for instance be offered through the application of targeted care management and robust health information technology. Physicians can start focusing on what the patient needs, rather than on what the insurance they have.
To help improve service delivery and reduce healthcare costs, Health Care Facilities such as medical centers should establish patient-centered medical homes that are intended to provide preventive and primary care for patients with acute and chronic health care needs, coordinate necessary specialty care, and follow up on recommended testing. This strategy will help patients detect illnesses at an early stage thereby avoiding hospital and ER admissions that usually turn out to be very costly. These centers should also be involved in health promotion, health education, lifestyle management awareness and other related wellness programs that help population to stay healthy and productive.
We need to start making more strategic investments in healthcare and health-enhancing services that support people to stay healthy enough to work if we are going to maintain a workforce that is both able and available to employers competing in the global economy. That said, innovative, integrated population health and productivity enhancement solutions are emerging. These technology-enabled, data-driven, outcomes-oriented solutions will empower the consumer-provider relationship and drain the floodwaters of chronic illness through better quality of care management as well as reducing health risks upstream through primary, secondary and tertiary prevention strategies.