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Focus on wellness

Incentives to promote healthier lifestyles will have a greater effect than increasing medical 'preventive interventions.'

September 20, 2009|William H. Frist | William H. Frist is a heart surgeon, a member of the Robert Woods Johnson Commission to Build a Healthier America and the former Republican majority leader of the U.S. Senate.

Conservatives have made clear their opposition to President Obama's healthcare reforms. So does that mean they think the system works well as it is? We asked four prominent conservatives to think beyond their objections to the Democrats' ideas and propose ways to make the American healthcare system better.


The Obama administration has suggested that savings from preventive health services will pay for much of the $1-trillion cost of health reform. Is that true?

Not according to a comprehensive 2009 review article in the journal Health Affairs, which summed up its findings in its subtitle: "An Overwhelming Percentage of Preventive Interventions Add More to Medical Costs Than They Save."

The key word is "interventions." Think about it: Having more people getting more health screenings, mammograms, pap smears and colonoscopies has to cost more money.

While we want such services to be widely available, reform that concentrates merely on offering more of those things isn't the way to fix what ails the nation. Instead, we need a system that concentrates on keeping us well, so we need less "healthcare" and fewer "preventive interventions" in the first place.

The major determinants of health are not doctors, hospitals, universal insurance, public plans and expanded health services. Much more significant is behavior -- things such as diet, exercise, smoking and drinking -- basic education and socioeconomic status. So if the goal is to make us healthier, to lower the burden and thus the societal costs of disease, policymakers in Washington must actively promote health and wellness. And the way to do that is by providing incentives for the implementation and sustained use of employer-backed wellness programs.

Washington should be looking at wellness solutions like the Vitality program (full disclosure: I've advised Vitality's board of directors). It's an outcomes-oriented program that is data driven, designed to educate and motivate individuals to engage in healthy behavior. Such programs show results: One U.S. manufacturing company found that the average healthcare cost of those with increased engagement in their own health was more than $100 less per member, per month, after the first year of the program.

The facts supporting such initiatives in lowering the burden of disease are irrefutable. Chronic disease is the No. 1 driver of rising healthcare costs, accounting for more than 75% of all healthcare spending. Much of the burden of chronic disease can be prevented or alleviated through sustained behavior change.

And the most important behavior to change is what and how we eat.

Obesity is the root cause of chronic disease, accounting for nearly 10% of what the U.S. spends annually on healthcare. It is linked to the explosion in diabetes. It is a primary driver of the "cost curve" rising so much faster than wages. Indeed, obesity is linked to about a third of the increase in healthcare spending over the last 30 years. It has been estimated that an obese person has 40% more annual medical costs each year than a non-obese person. And obesity continues to increase every year; today, a third of our population is overweight.

In addition to providing incentives for employer-sponsored wellness programs, reforms must include lowering co-pays on preventive care, returning physical education to our schools, requiring school lunches to meet nutritional standards and community planning to include places to exercise and sources of healthy foods.

True healthcare reform requires a radical reorientation of our health sector to emphasize staying well. For the first time in history, we are raising a generation of children who will live sicker and shorter lives than their parents. Where and how we live, learn, work and play have a greater impact on how long and how well we live than added medical services.

This means that any serious healthcare proposal must include a robust component that aggressively "incentivizes" healthier lifestyle choices and removes obstacles to such choices.

A culture of health with true cost savings will be the legacy.

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