Sadly, not everyone understands the benefits of prevention. We've become a nation that takes better care of our cars than our bodies. How many of us would go five or 10 years without changing the oil or checking the fluids? We can only hope our bodies are more forgiving than most automobiles.
Preventive health care is not a luxury, yet we've had people with and without health insurance e-mail us about how they cannot afford to do what they know is right and essential for their health. Patricia C. of Ludlow, VT wrote in regarding the situation she and her husband face:
I have not had a mammogram for 20 yrs. or a Pap test for 15....we could afford the tests, but what if they found something? Could not afford to fix it! Better to not know. We see a doctor ONLY when we absolutely have to, do not get BP checks, diabetes, bone density, colonoscopies, etc…This is such a disgrace in the "greatest country in the world???" We have worked hard and lived frugally and there just isn't enough money. A good share of our friends are in the same boat. Please! Help!
An important part of prevention is knowing about and using preventive services that are available to you. If you're a woman over age 40 enrolled in Medicare, did you know that your coverage includes an annual mammogram? More than 40 percent of eligible Medicare beneficiaries either do not know or choose not to take advantage of this preventive service. Likewise, male Medicare beneficiaries age 50+ can obtain annual prostrate screening exams under the program, and many go without.
Going without preventive services is common. In fact, in a study of 12 highly-effective preventive practices, the Partnership for Prevention found that seven of the services are being used by half or less of the people who should be using them. In addition to be an inefficient use of health care dollars, underutilization is killing us. The same report estimates that increasing the use of just five preventive services would save more than 100,000 lives each year in the United States.
In Japan, where incentives reward outcomes rather than procedures, doctors perform approximately one-tenth the number of surgeries per capita than in the U.S. Yet, by most measures, the Japanese are at least as healthy as Americans. The idea of paying for treatment based on proven practices, sometimes called pay for performance, is advocated by many, including Dr. Mark McClellan, former administrator of the federal Centers for Medicaid and Medicare Services. But we are a long way from turning this idea into law and putting it into widespread practice.
We can't prevent all disease, but we can do much more to keep people out of doctors' offices and hospitals. Too often people with persistent diseases get little or no care until a crisis lands them in costly emergency-room settings, hospitals, or nursing homes. In fact, these chronic patients, sometimes known in hospitals as "frequent flyers" - soak up a huge share of the nation's medical spending. Chronic patients make up only 5 percent of Medicare's beneficiaries, but they account for 43 percent of the program's cost.
Beyond keeping people health, prevention can also save us money - and that gains the interest and action of business leaders. Mercer Human Resource Consulting Inc.'s 2001 National Survey of Employer-Sponsored Health Plans and found that more than 90% of employers included increased productivity and decreased health care costs among their most important reasons for coverage of clinical preventive services. In a joint report issued by the Partnership for Prevention and the U.S. Chamber of Commerce, Paul S. Otellini President and CEO of Intel Corporation explained why prevention is a priority for its 92,000 employees: "At Intel, prevention and wellness are a priority. Intel saves on health care costs, and our employees and their families get engaged in managing their health for the rest of their lives. We hear from employees every day how much they appreciate this approach. By working together, we're making a difference in both employee health and the health of Intel."
Benjamin Franklin once said, "An ounce of prevention is worth a pound of cure." What would this founding father think about our nation's current health care system, where the focus is on disease care rather than health, on paying bills and shifting costs rather than on preventing disease and dealing with the chronic conditions that are affecting more and more of our nation's population? Where insurance will pay for quadruple bypass heart surgery but not to encourage healthy behaviors that could prevent heart disease? He might say, as he did at the signing of the Declaration of Independence, "We must all hang together, or assuredly we shall all hang separately." In other words, Divided We Fail.
The time has come for the U.S. to put prevention into practice. Disease prevention can enable us to improve the quality of life for millions of people and make health care affordable. Our government, our businesses, and perhaps most importantly, we ourselves must make disease prevention paramount. We need a society that values and rewards healthy eating habits, healthy exercise, and healthy choices in our daily lives.
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