by Kimberly Allen, RN
As the reality of the Affordable Care Act sets in this year, many health care experts are looking for ways to lessen the burgeoning cost of keeping Americans healthy. One of the surest ways is through preventative care. In the US we currently spend approximately $8,000 per person for medical care for approximately 80% of the population. While on the other side of the pond in the UK they spend less than $3,500 per person for health care for their entire population. And here’s the kicker, not only do they spend less but they get an extra year of life for their money.
On of the reasons is their prevention programs. In the US less than 5% of the health care budget is spent on prevention. The rest is spent on treatment, paperwork and salaries. Despite studies that show spending a little on prevention can save a lot in treatment costs, very little has been done to change the treatment vs prevention paradigm. One recent study showed that the Tobacco Control Program, instituted in California, which cost $1.8 billion to initiate, paid for with cigarette taxes, saved the state $86 billion in health care costs. There are numerous other similar studies showing prevention saves money. But it’s not just money that prevention saves, it saves lives, especially when you factor in all incidence of heart disease, obesity and diabetes that won’t require treatment if proper preventative measures are taken.
So why does the US spend more on health care than almost every other nation? Actually there are several factors, including the cost of education. Most doctors have over $100,000 in education related debt when they graduate. Then there’s the lawyers that take advantage of the permissive tort laws in the US and profiteer off the health care system. But the single largest problem is that the current health care system is actually a disease care system. In the US, $.95 of every dollar spent on medical care is spent treating diseases after they develop. And at least 75% of that is spent treating chronic diseases like Type II diabetes and heart disease, both of which are preventable.
One study showed that we could save $81 billion in health care costs with programs aimed at prevention and disease management. However, the billing system in our health care system favors specialists. A recent study showed that the difference in earnings between primary care physicians and specialists is significantly higher in the US than in other comparable countries. In fact, a general surgeon receives two and a half times as much money than primary care doctors. For example, a surgeon receives over $30,000 to amputate the foot of a diabetic despite the fact that the amputation most likely could have been prevented with good foot care which, as a rule, is not covered by health insurance.
Or better yet, consider heart disease, America’s #1 killer. The causes of heart disease, poor diet, stagnant lifestyle, and smoking can all be addressed with preventative programs. If the health care system spent more money paying general practitioners for office visits where they could spend time teaching patients about diet, the importance of regular exercise and eliminating bad habits like smoking, heart disease could be prevented. However, an office visit is not considered a procedure so reimbursement is minimal. By the way, that’s also where a lot of fraud comes in as well. Because doctors are reimbursed more for procedures than office visits, they sometimes perform unnecessary procedures.
So what happens is after years of eating a high-fat diet, sitting around watching TV while smoking and drinking, you have a heart attack. That’s when the money starts to pour in. First you’re taken to the emergency room (have you seen how much an ambulance ride costs?) where they run lots of expensive tests, then you go to the cardiac catheterization lab or operating room where doctors (specialists) perform life saving procedures. Can you hear the money? And just think, it all could have been prevented with a prevention program that focuses of healthy eating, exercise and programs to help quit smoking.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.