Sep 1, 2009 - companies and Medicare to pay for preventive care. ... clinics, private practitioners) and managed care plans that promote and integrate ...
Preventive Care Services and Health Care Reform September 2009
Eric Adjei Business Analyst Mayo Clinic 200 First Street S.W. Rochester, MN 55905 www.mayoclinic.org
BACKGROUND The United States spends far more on healthcare than any country in the world. National health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (National Coalition on Health Care, 2009) 1 . Per capita spending is almost 50% higher than in the next most expensive country (UC Atlas of Global Inequality, 2009) 2 but these spending are not reflected in the health of Americans. According to the World Health Organization report, the United States compared with 189 other countries ranked thirty-seventh overall in health system efficiency and performance. Life expectancy in the US falls below the median in international comparisons and infant mortality rates are among the very highest in the world. For example, the United States ranks 50th in life expectancy, and 180th in infant mortality according to the CIA World Factbook (Cohen, 2009) 3 .Escalating costs, problems with quality, rising numbers of under-insured and uninsured, the likely reduction of Medicare/Medicaid reimbursements, and the aging of the population in the U.S. all threaten the health of all Americans and the business viability of health care organizations. Pressure to reform the healthcare system in the U.S. has never been more intense due to these factors. The Obama Administration, Republican and Democratic members of Congress, the American Medical Association, Healthcare Providers and America's Health Insurance Plans, which represents the insurance industry, all have agreed the system needs to be changed. A central point of the Obama’s administration plan is to create a government-sponsored health insurance program that would be an option for all Americans. They have also said they will "like to see" prohibitions against insurers discriminating against people with pre-existing conditions and increase in Preventive Services. Republicans have also proposed increasing incentives for people to build health savings accounts, and allowing dependent children to stay on parents' policies until age 25 (Cohen, 2009). It seems all the attention is now focused on insurance for all Americans, little attention has been paid on Preventive Services, but this should also be a national priority. Preventive Care would help increase the quality of care the U.S. delivers and reduce the rising health care cost. The U.S. medical model emphasizes medical interventions after a person has become sick rather than focus on preventing the diseases. People think specialists provide the best quality care so they always bypass preventive care and primary care, which does not increase quality care but increase health care costs. Health involves much more than the provision of adequate medical care, though medical care obviously has an important part to play in the establishment and in the maintenance of effective health, preventive care services are equally important if the US are to increase health quality and reduce cost. Therefore just as important as the U.S. has advance technical knowledge (contributing to the advancement of medical research), it should also contribute to the advancement of preventive care services.
Recommendations on Preventive Care Services Three recommendations could be followed to promote preventive care services and they are described below. The first recommendation is that the U.S. should increase investment in preventive care services to help reduce rising costs and improve health of Americans. Preventive Service is under-valued and poorly supported in the U.S. healthcare system; studies suggest about 95 percent of health care dollars in the United States (national budget) are spent on treating 2
diseases and complications. Promoting preventive care require increased scientific research as well as extensive public education to help confront the attitudes, fear, and misunderstanding that remain associated with preventive care. The U. S. should continue to build science base and improve public awareness of preventive care services. The second recommendation is the government should have legislation that requires Insurance companies and Medicare to pay for preventive care. Whether the Obama Administration goes with private insurance only or in conjunction with the government option, there should be policies that require insurance companies (including Medicare) to pay for all preventive care. Currently most insurance plans pay for services only when a person becomes sick, or develops a condition requiring medical evaluation; but they should also include preventive care like regular physical examinations to keep people healthy. The final recommendation is the government should provide incentives to employers, community services, health care providers, health plans and insurance companies, local and state governments to promote preventive care services. All parties must become partners in strengthening preventive care services. There should be incentives for providers (hospitals, clinics, private practitioners) and managed care plans that promote and integrate wellness and health promotion into their medical delivery. There should also be incentives for community organizations and employers who provide education about preventive care services and promote wellness programs. Finally, there should be incentives to states that ensure that public programs and policies are consistent with wellness goals – promote preventive care services. People assumed that the advance medical technology in the U.S. lead to very high quality, but that is a wrong assumption. The government should provide incentives to the parties described above to educate people that value or quality is not received from increase use of specialists and advance technologies alone but preventive care services are equally important. In conclusion, the U.S. health care system requires major reengineering, especially the need to increase quality and reduce rising costs. Even though healthcare reform should involve providing insurance for all Americans and focusing on quality instead of quantity among others, preventive care services should be a major focus in all reform discussions also. The curative medical model of health care delivery in the U.S. contributes to the rising health care costs and does not lead to quality health care. Preventive care services are less costly to deliver and save money through the early detection and treatment of more serious illness. There should be an increase investment in preventive services; government should provide incentives to social organizations, employers, health plans, and state governments that promote preventive care services; and there should be policies that require health plans to pay for preventive care services. 1
National Coalition on Health Care (2009). Health insurance cost. Retrieved August 28, 2009, from http://www.nchc.org/facts/cost.shtml
2
UC Atlas of Global Inequality (2009). Health Care Spending. Retrieved September 1, 2009 from http://ucatlas.ucsc.edu/spend.php
3
Cohen, Elizabeth (2009). What you need to know about health care reform. Retrieved August 29, 2009 from http://www.cnn.com/2009/HEALTH/06/18/ep.health.reform.basics/
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