Friday, July 16, 2010

Outsourcing Prevention

Several weeks ago, the members of the Costs of Care team attended the Massachusetts Health Data Conference. The dozen or so speakers differed in the methods they proposed to cure an ailing healthcare system but not so much in what needs to be changed. Common themes appeared again and again: change the fee for service payment system, expand coverage to as many individuals as possible, and find a way to fiscally motivate prevention in place of treatment. While many alternatives to fee for service were proposed, a program that somehow motivates prevention seems to be a piƱata no one has the strength to break open.

I am not writing this to present some revolutionary plan, but rather to point out a growing possibility that may act as a stepping stone to pro-prevention systems: paying people to stay healthy. In a modern hospital somehow encouraging patients to take a proactive attitude towards improving their health before they get sick is near impossible in the financial sense, as well as in chronology (they’re already in the hospital!) so perhaps the best method is to remove the responsibility of prevention from the hospital entirely. Instead, it should manifest in other organizations.

Japanese health reform that began several years ago comes to mind in this context. As part of a nearly decade long plan, measuring waistlines of people between 40 and 74 became a mandatory part of annual checkups. In the end, financial penalties will be placed on companies and local governments that fail to meet certain quota. In this method, the burden of motivating lifestyle changes falls not on the hospitals but rather on employers who are also often responsible for medical coverage for their employees in the Japanese system. The architects of the waistline limit hope to show payers that they have the most to gain by motivating improved general health in the people.

This lesson is already something that many American companies have latched on to, without the nudge in the right direction from the government. Many employers offer plans with monetary benefits if employees quit smoking or lose weight. In the context of the employer/provider prevention is simple to motivate financially as they save the most money. However, can this ever emerge in healthcare? Possible plans for patient incentives in the UK show that in a nationalized healthcare system, prevention becomes crucial to long term success. With an effectively limitless need for care and an entirely different paradigm of what a patient is, the UK does not suffer from the fear of ‘loss of profit’ that comes with successful prevention in the US.

One day the US may create a system like Great Britain’s but until then it seems that hospital care may be focused to dealing with the sick, while motivating lifestyle changes and preventive medicine should be left to employers and insurers who have the most to gain from the noticeable savings. An ounce of prevention is worth a pound of cure.

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