Why It's Still Useful , But Nearly Impossible to Estimate All Health-Related Costs
I came across a very interesting discussion that deals with questioning the cost of healthcare in America. Most of those participating were comfortable to quote the often repeated $2.4 Trillion dollar tag. But, even this grossly conservative underestimation is probably not the "total" package we are all experiencing. You can't just look at the question of the problem of healthcare without giving some sort of solution which might improve spending so rapidly at the rate it's going in healthcare as well.So, I have offered some advice on it.
Probably the $2.4 T - 2.6T that is spent annually on healthcare is again "only" a rough low ball park estimate of direct medical care. Direct medical care is care received by a health professional from the physician, nurse, respiratory therapist, or physical/occupational therapist or from hospital stays, clinics, medications, as well as outpatient surgerie. These are those direct services from a therapit.
A Second category would include Indirect costs of healthcare. These may include a insured's loss of wage earnings, a company's loss of labor force personel, cost of rehiring and retraining, sick day leave, cost of transportation, home health provision , rehabilitation and the insurance associated with rehab, nursing home care and hospice care.
Another dimension that is an indirect impact from healthcare costs that we need to start looking more at today are the tertiary economic impacts that stem from someone who loses a mortgage , can't continue to pay bills or files bankruptcy(800,000 Americans) as a direct effect of a major medical issue. From there we have to look at the effects on the social dynamics and breakdown of the family and how it can become unstable.
I think the social and psychological impact is overlooked as more become depressed and anxious about their situation. This may cause isolation,anger, attempted suicide and death as a consequence.These all may require psychological or psychiatric counseling as well as a consequence.
If a major bread winner becomes incapacitated other family members may turn to illicit or criminal behavior for relief or to subsidize income. This directly leads to wider community disruption and destabilization.
This is a broader scope of the economic,social and pyschological impact of healthcare cost we do not often associate with health at all in the first place.
Other healthcare costs that need to be figured into the model are the costs of HMO/Insurance paperwork, administration, cost of legal judgements, medical liability, the increasingly longer living baby boomer population who live with more chronic illnesses, a rising population of children who appear to have premature "adult-like" disease , and the cost of R & D and sales for drugs. Three hundred thousand people succumb to morbidity due to iatrogenic(health professional induced) causes and 15,000,000 nonlethal medical errors occur annually as well. These mistakes and deaths attribute to costs.The costs of practioners using "defensive medicine" due to high medical liability rates is another cost factor.
If we look at the Towers Perrin Helthcare cost survey(www.towersperrin.com), 51% of our population is predicted to be obese by 2029 and that health care costs of 2.6 Trillion will become 4.3 Trillion. the USA today has reported that medical cost of obesity will be between $300-350 Billion. Obesity is what causes most chronic illness in this country including heart disease, diabetes and cancers.
Heart disease cost some $735 Billion in 2008 and Cancer cost $895 Billion in 2010(Economic Impact of Cancer,ACS).Diabetes costs some $200 Billion annually in 2007(OECD).
The reason a lot of guess work may have to be extrapolated from data is that "real time" disease is rising too rapidly. nearly 750,000 have a heart attack annually, In 2001 553,000 died of cancer, one-third of all Americans are obese and another third is overweight. Stemming from obesity rises we see a rise in chilhood high blood pressure, heart disease, diabetes and liver disease.
If we just look at the top 3 disease's medical expenditure occurs from, we the $2.4 Trillion is already spent for the top 3 illnesses in the U.S , but we know these are not the only diseases that we are treating and spending for. So, the $2.4T has to be an underestimation to say the least.
SOLUTION:
Most of the approaches to treatment are based on a "fee-for-service" from only acute and chronic care. There is no incentive to drive the costs of healthcare down with prevention in this model. Prevention acts to counter revenue which in a pure business model is enhancing the profit margin.There is no incentive to reduce profit or reduce disease states if you look at the objective statistics, mathematically. The biggest impact on these data would be to determine what would change these statistics and make them opposite. Well, that would be creating a prevention program that is covered along with acute and chronic care medicine.
This Prevention Program goes beyond just the "lip service" of get your once-a-year pap, pelvic , mammogram and rectals , blood pressure, glucose and prostate check . We are talking about impacting "lifestyle" daily with Prevention Education and Wellness. This is the health promotions programs being utilized by numerous coroporations to assure healthy workers , less sick days, better production and reduced premium rates. This helps create a "culture of wellness".
A real Prevention Program that promotes healthy lifestyles would have to do several things:
1)Subscribe to Prevention Education
2)Promote Fitness not just mere exercise
3)Give Nutritional Support by teaching and giving healthier foods
4)Foster Behavior Motivation and Modification
5)Call for individuals to take more Personal Responsibility for their health
Maybe, by the next generation from kids who are now 5 or 7 can we begin to see universal results as the program is implemented over the next 5 to 10 years to curb steep healthcare expenditures enough to plateau then begin to see the reverse effect take effect over the subsequent 10-20 years. But, it would have to be implemented along with an acute and chronic care system we now have as soon as possible to have best effects.
Dr. Wells is an Internal Medicine specialist who worked for U.S. Health & Human Services, U.S. Public Health Service while at the National Institutes of Health/NHLBI, and US Commissioned Corp. Dr. Wells has a Master's in Public Health form Emory University with special emphasis in Environmental & Occupational Health
Probably the $2.4 T - 2.6T that is spent annually on healthcare is again "only" a rough low ball park estimate of direct medical care. Direct medical care is care received by a health professional from the physician, nurse, respiratory therapist, or physical/occupational therapist or from hospital stays, clinics, medications, as well as outpatient surgerie. These are those direct services from a therapit.
A Second category would include Indirect costs of healthcare. These may include a insured's loss of wage earnings, a company's loss of labor force personel, cost of rehiring and retraining, sick day leave, cost of transportation, home health provision , rehabilitation and the insurance associated with rehab, nursing home care and hospice care.
Another dimension that is an indirect impact from healthcare costs that we need to start looking more at today are the tertiary economic impacts that stem from someone who loses a mortgage , can't continue to pay bills or files bankruptcy(800,000 Americans) as a direct effect of a major medical issue. From there we have to look at the effects on the social dynamics and breakdown of the family and how it can become unstable.
I think the social and psychological impact is overlooked as more become depressed and anxious about their situation. This may cause isolation,anger, attempted suicide and death as a consequence.These all may require psychological or psychiatric counseling as well as a consequence.
If a major bread winner becomes incapacitated other family members may turn to illicit or criminal behavior for relief or to subsidize income. This directly leads to wider community disruption and destabilization.
This is a broader scope of the economic,social and pyschological impact of healthcare cost we do not often associate with health at all in the first place.
Other healthcare costs that need to be figured into the model are the costs of HMO/Insurance paperwork, administration, cost of legal judgements, medical liability, the increasingly longer living baby boomer population who live with more chronic illnesses, a rising population of children who appear to have premature "adult-like" disease , and the cost of R & D and sales for drugs. Three hundred thousand people succumb to morbidity due to iatrogenic(health professional induced) causes and 15,000,000 nonlethal medical errors occur annually as well. These mistakes and deaths attribute to costs.The costs of practioners using "defensive medicine" due to high medical liability rates is another cost factor.
If we look at the Towers Perrin Helthcare cost survey(www.towersperrin.com), 51% of our population is predicted to be obese by 2029 and that health care costs of 2.6 Trillion will become 4.3 Trillion. the USA today has reported that medical cost of obesity will be between $300-350 Billion. Obesity is what causes most chronic illness in this country including heart disease, diabetes and cancers.
Heart disease cost some $735 Billion in 2008 and Cancer cost $895 Billion in 2010(Economic Impact of Cancer,ACS).Diabetes costs some $200 Billion annually in 2007(OECD).
The reason a lot of guess work may have to be extrapolated from data is that "real time" disease is rising too rapidly. nearly 750,000 have a heart attack annually, In 2001 553,000 died of cancer, one-third of all Americans are obese and another third is overweight. Stemming from obesity rises we see a rise in chilhood high blood pressure, heart disease, diabetes and liver disease.
If we just look at the top 3 disease's medical expenditure occurs from, we the $2.4 Trillion is already spent for the top 3 illnesses in the U.S , but we know these are not the only diseases that we are treating and spending for. So, the $2.4T has to be an underestimation to say the least.
SOLUTION:
Most of the approaches to treatment are based on a "fee-for-service" from only acute and chronic care. There is no incentive to drive the costs of healthcare down with prevention in this model. Prevention acts to counter revenue which in a pure business model is enhancing the profit margin.There is no incentive to reduce profit or reduce disease states if you look at the objective statistics, mathematically. The biggest impact on these data would be to determine what would change these statistics and make them opposite. Well, that would be creating a prevention program that is covered along with acute and chronic care medicine.
This Prevention Program goes beyond just the "lip service" of get your once-a-year pap, pelvic , mammogram and rectals , blood pressure, glucose and prostate check . We are talking about impacting "lifestyle" daily with Prevention Education and Wellness. This is the health promotions programs being utilized by numerous coroporations to assure healthy workers , less sick days, better production and reduced premium rates. This helps create a "culture of wellness".
A real Prevention Program that promotes healthy lifestyles would have to do several things:
1)Subscribe to Prevention Education
2)Promote Fitness not just mere exercise
3)Give Nutritional Support by teaching and giving healthier foods
4)Foster Behavior Motivation and Modification
5)Call for individuals to take more Personal Responsibility for their health
Maybe, by the next generation from kids who are now 5 or 7 can we begin to see universal results as the program is implemented over the next 5 to 10 years to curb steep healthcare expenditures enough to plateau then begin to see the reverse effect take effect over the subsequent 10-20 years. But, it would have to be implemented along with an acute and chronic care system we now have as soon as possible to have best effects.
Dr. Wells is an Internal Medicine specialist who worked for U.S. Health & Human Services, U.S. Public Health Service while at the National Institutes of Health/NHLBI, and US Commissioned Corp. Dr. Wells has a Master's in Public Health form Emory University with special emphasis in Environmental & Occupational Health
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