Healthier lifestyles reduce health care demands
Health-care costs in the United States exceed those of any other nation. Millions of Americans are uninsured, partly because of rising premium costs, and more and more, they resort to payday loans to finance both emergency and routine medical expenses.
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? Is it really possible to have a healthier society and more effective medical care without, first and foremost, reducing the need and thus the demand for medical treatment?
Broader access and lower costs do not 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, absent a reduction in the demand for medical treatment, industry reform will only serve to create new costs, further restrict access, ration limited services, and adversely affect the economic interests of health-care providers, especially small businesses. Clearly, broadening access and reducing costs at the same time is an oxymoronic proposition.
Education is the key to more effective health care
Without illnesses and accidents, obviously, there would be no health care costs. According to a New England Journal of Medicine article by James F. Fries and C. Everett Koop, et al., (“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 an enormous increase in chronic disease, despite a concomitant reduction in the occurrence of acute illness.
Obesity, heart disease, adult-onset diabetes, and other avoidable chronic illnesses, along with unnecessary emergency room and doctor office visits cause enormous wastes of medical resources. Generally speaking, healthy people don’t smoke or consume alcohol to excess. They aren’t overweight, and they exercise regularly, eat wisely, wear seat belts, and take advantage of readily-available preventive health-care measures.
Not all preventive health-care measures have been shown to save money. But despite an overwhelming societal reluctance to admit it, an emphasis on disease and accident prevention and individual restraint in the use of medical services would, over all, reduce health-care costs.
Proper use of medical services reduces demand
A health policy directed at reducing medical demand would make a major contribution to lowering societal health-care costs because:
- Preventable illness makes up an inexcusably large portion of our current demand for medical treatment;
- Risky behavior is expensive in terms of lifetime medical costs;
- Approaches involving self-management have been shown to reduce unnecessary medical treatment;
- Health-promotion programs in the workplace have been shown to reduce overall health-care costs; and
- Our present health-care system does not closely link the use of medical resources to the requirements of illness.
Unhealthy lifestyle choices are expensive
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 a very simple proposition, one that is 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 lifestyle-induced risk factors (smoking, obesity, hypertension, hypercholesterolemia, and adult-onset diabetes) being double that of people with no such risk factors.
Education reduces the 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 has been found to be true even in cases of chronic disease.
Education reduces the demand for life-sustaining treatment
Not only are overly intensive services for terminal illness extraordinarily expensive, they are not desired 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 an enormous reduction of health-care costs. It would also promote more humane medical treatment and a more effective allocation of limited medical resources.
Deep pockets stand to save by spending on education
It costs money to educate people, especially when that education involves altering long-standing lifestyle choices, and, even more so, on a wide scale. But if the entities now bearing the costs of skyrocketing medical care – insurers, industry, and government – were convinced that educational programs designed to reduce the demand for medical services could actually save money, they’d be funding those programs right now, without a doubt.