Why Care?

Why Care?

Why Should Individuals Care About Their Impact on The Healthcare System?

The unsustainability of health care costs is becoming common knowledge, and even with such great expenditures the quality of care delivered in the US often leaves patients and physicians dissatisfied.
Although publicly there is a great deal of debate as to how to fix the healthcare system, there is presently little doubt that some kind of change is needed. For example, it is common knowledge that healthcare costs too much. The united states spends more than 2 trillion dollars on healthcare annually, greater than 15% of its GDP, while no other industrialized nation spends more than 10% of its GDP.1 Additionally, the percent of insured workers with deductibles greater than $1,000 increased to 31% in 2011, up from 18% in 2008, suggesting that individuals are having to bear a greater percentage of health care costs.2 Furthermore, even with such great expenditures the quality of care delivered in the US often leaves patients and physicians dissatisfied.

In an address given to the senate finance committee in 2003,3 Karen Davis, president of the Commonwealth Fund, identified several goals for improving health care from an administrative standpoint. These goals include “reducing errors, eliminating waste and duplication in clinical care, modernizing and streamlining administration, promoting transparency and accountability for performance, and aligning financial incentives for physicians, hospitals, and other health care providers to reward high-quality and efficient care.”

Absent from these goals and from most discussions of health care reform, is the question as to how patient or individual behaviors affect health care spending and quality. Every individual is a patient at one time or another, and every person and their health impacts the health care system. Because the US economy can only support a finite amount of health care spending, it should be the goal of every citizen to ensure that health care dollars go to the best causes.

What is The Role of Individuals in Health Care?

Sadly, alarming statistics about waste in the US health care system produced by modifiable patient behaviors are common. For example, this author (and a very large portion of the US population) has at one time or another failed to adhere to the particular details of a prescription regimen, without realizing that medication non-adherence is projected to account for 100 to 300 hundred billion dollars of unnecessary medical costs annually.4 This, and other evidence of waste are particularly upsetting if considered in conjunction with evidence of implicit (non-standardized and perhaps even unintentional) rationing of health care spending. For example, in an investigation into the consequences of being one of the 46 million working age uninsured Americans today, the National Academies found that “uninsured patients who are hospitalized for a range of conditions are more likely to die in the hospital, to receive fewer services, and, when admitted, are more likely to experience substandard care and resultant injury than are insured patients.”5

Half of patients one year after suffering a heart attack stop taking their potentially life saving cholesterol lowering medications.7 These and other so called modifiable behaviors are estimated to account for 70% of all medicare spending.8
 Reforming health care from an individual standpoint may seems like a daunting task. Especially, after acknowledging that the most significant change an individual could make is to live a healthier life. As many of us know, trying to be healthy is a daily commitment, one which is often physically and psychologically exhausting. As a result, despite 60 years of public health outreach we as Americans remain relatively unhealthy. Smoking is still the number one preventable cause of death in the US, claiming 400,000 lives each year, 50,000 of which are due to secondhand smoke.6 Similarly, it’s estimated that 400,000 annual deaths in the US are attributable to poor diet and physical inactivity. Even more disturbing is the fact that half of patients one year after suffering a heart attack stop taking their potentially life saving cholesterol lowering medications.7 These and other so called modifiable behaviors are estimated to account for 70% of all medicare spending.8

The Health Care Field is Hungry for Solutions

The stagnation of so many public health efforts has inspired practitioners and public health officials to attempt to change the culture of modern health care. Traditionally, health care practitioners have sought to unilaterally solve health problems by mandating patient compliance, an approach which commonly alienates patients and fails to identify barriers to cooperation. However, respect for patient autonomy is increasingly becoming a cornerstone of quality health care.

Traditionally, health care practitioners have sought to unilaterally solve health problems by mandating patient compliance, an approach which commonly alienates patients and fails to identify barriers to cooperation. However, respect for patient autonomy is increasingly becoming a cornerstone of quality health care.
The importance of patient autonomy is illustrated by what is called the patient centered primary care movement. The institute of medicine defines patient centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”   As a result of patient centered care, health professionals are increasingly asking for participation instead of cooperation.

Our goal is to empower patients to be at the center of health promotion, and health care improvement. To achieve this goal we hope to facilitate a discussion between practitioners and community members about how patient involvement may improve the quality and efficiency of the US health care system. With the input we gather we will compile a list of health care conscientious goals and tips, from which patients can pick and choose ways to participate which work for them. We will also continue translate the discussion into an animated series, in order to present the information in an appealing and digestible manner.

Examples of how patients may get involved in healthcare improvement include; understanding the role of patients in patient centered care, following appropriate preventive health recommendations, preparing questions for medical appointments, keeping track of medical information, improving communication with physicians- for example by expressing concerns about a given treatment plan, and committing to doing your best to see a treatment plan through. Improving at any one of these behaviors has the potential to greatly benefit your health, the health of your community, and the health of the American economy. We will also explore the field of health behavior change and examine barriers to health promotion and health care improvement in American society.

References:
  1. Heffler S, al. e. U.S. Health Spending Projections for 2004–2014. Health Affairs. 2002;24. content.healthaffairs.org/content/early/2005/02/23….
  2. Altan DP. The Falloff in Utilization: “There’s Something Happening Here, What it is Ain’t Exactly Clear”. Kaiser Family Foundation. www.kff.org/pullingittogether/altman_falloff_utili….
  3. Davis KP, Cooper BS. American Health Care: Why So Costly? Testimony for the Senate Appropriations Subcommittee. 2003. www.commonwealthfund.org/Publications/Testimonies/….
  4. Bosworth HB. Medication Adherence: Making the Case for Increased Awareness. ScriptYourFuture.org. scriptyourfuture.org/wp-content/themes/cons/m/Scri….
  5. Care Without Coverage, Too Little, Too Late. Institute of Medicine, Shaping the Future for Health. 2002. www.iom.edu/Reports/2002/Care-Without-Coverage-Too….
  6. Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA. 2004;29(1):1238-1245. www.csdp.org/research/1238.pdf.
  7. Fries J, Bloch D, Harrington H. Two-year results of a randomized controlled trial of a health promotion program in a retiree population: The Bank of America Study. American Journal of Medicine. 1993;94:455-462. www.ncbi.nlm.nih.gov/pubmed/8498389.
  8. Loewenstein G, Brennan T, Volpp K. Asymmetric paternalism to improve health behaviors. JAMA. 2007;298(20):2415-2417. jama.jamanetwork.com/article.aspx?articleid=209557.

 

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