MANAGED CARE October 2006. ©MediMedia USA
Patients refuse to take responsibility, and every other player in the health care system is reluctant to take charge
Managed Care's July cover story, "Employers Push Plans in Direction of Wellness [1]," should fall under the "duh" principle. Since prior to my first day in medical school in 1982, I have been certain that preventing disease is cheaper than trying to repair poor health. Proactive is cheaper than reactive, regardless of the area of life in which we would use that as a measuring device.
Simple math
For instance, it's cheaper to provide maintenance for our car than to repair it after it has broken down on the road. Simple mathematical business point. So why has medicine, or more importantly or correctly, the insurance companies, taken so long to come around to this fact? Quite possibly because they live by the motto "One in the hand is worth two in the bush." If the insurance company can save a buck by not providing service now, then it saves on the other end by knowing that most patients switch insurances with jobs or by company change, and therefore the patient becomes another insurance company's problem.
For years, a patient couldn't go to the doctor and have a general physical exam covered, but he could get coverage if he was ill or injured. I myself have gone to doctors years ago for a "full physical" and gotten a confused look from the physician.
It's been my opinion for years that two things must be done to improve our medical fitness. We must find ways to impress upon our citizens the importance of good health and a healthy lifestyle, and insurers must back that up. It's un-American and un-democratic to force our employees and patients to adopt a healthy lifestyle. It smacks of Big Brother behavior. And patients have a cavalier attitude. How many times have we all heard (as doctors) a patient say, "My insurance will cover this so why shouldn't I have it" (or the reverse).
Ditto the comment, "Why can't you just give me a pill for this instead of asking me to watch what I eat?" Of course, years of the medical profession pushing a prescription into their hands and showing them the door have created a patient population with that mentality! The bottom line is that if they don't have to pay for it, they don't take personal responsibility.
I would love to participate — on either side — in a debate about providing medical care for a smoker or an obese, noncompliant diabetic patient. Of course, this would be held before or after the debate on whether health care is a right or a privilege. Again, I could argue either side.
Many employers try to encourage health the long way around. They provide insurance but discouraged patients from taking time off to go to doctors. From a business standpoint, this is understandable, and it is further encouraged by our habits of working long hours. Also, employers discourage sick employees from staying home, thereby spreading disease to other employees.
Think it through
Again, from a business standpoint, a sick employee at home is not helping the bottom line, or is he? If you have one sick employee and now because he is at work you have five sick employees — think that one through. And when an employee has an entangled illness or injury, instead of the employer having resources to help that patient improve and create better health, there are roadblocks. I know, patient confidentiality and all that.
Businesses and insurers must find a way to provide for health (not just illness) as well as find a way to change the public's view of responsible behavior. It really does come down to the patient's participation.
More companies need to be like the ones mentioned in the article. My daughter works for Rodale Press. Rodale has a gym on site and a trained person to help utilize resources. It encourages exercise. My daughter is currently training for her second marathon sponsored by Prevention Magazine (the part of Rodale she works for). Rodale's cafeteria serves really good, nutritious food, too.
Of course this is America, and we can't force people to do anything. However, if we don't find a way to get our citizens to buy into the idea of wellness, it won't matter what employers and insurers do. I, for one, am tired of being held responsible for the results of an event that I tried to prevent.
We all know the drill too well. We tell patients what they need to do and why. They, in turn, ignore us, suffer the consequences, and then want to blame anybody but themselves.
Patients call 1-800-LAWYER and say we never told them what would happen or why they needed to get tested. It's not their fault. It's the doctor's fault.
It is a good thing that I learned how to nag my kids and husband because it's a skill I use frequently in trying to ensure that patients follow through with recommendations, and understand advice regarding whatever it is they're seeing me for. I can't tell you how many times I've had patients sign progress notes outlining informed consent and informed refusal.
Stupid behavior
These are not stupid people, but they are behaving stupidly (for whatever reason). A previous partner had a favorite saying: "People have a right to make stupid decisions." Yes, they do, but I'm very tired of having to pick up the tab for it, whether it is social, financial, legal, or what-have-you.
I spend a lot of time providing patient education. Some patients are receptive and some are not. The receptive ones will benefit from the incentives discussed in Martin Sipkoff's article. It's the other group of patients that must be reached for any of this to make a difference.
What about small business employers who can't afford wellness plans or even offer insurance? Or what about the 42-plus million people who are uninsured and underinsured? That is a large sector of our society unreachable by the health plans . These are our citizens that fall through all the cracks and end up costing us the most in health care dollars.
Our current system is being "penny wise and pound foolish."