Easier, cheaper "upstream prevention" – for example, the installation of air conditioning or the payment of a taxi ride to the …

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March 14, 2019

A simpler and cheaper "upstream prevention" – for example, the installation of AC or the payment of a taxi ride to the doctor – could save the taxpayer

In 2017, health spending in the United States rose to $ 3.5 trillion or nearly 18 percent of the country's gross domestic product.

But not all of these expenses help make us healthier. In fact, that's appreciated a third or more Health spending in the country – or more than $ 1.1 trillion – does not lead to better health outcomes.

Two researchers from Arizona State University's College of Health Solutions now suggest that even this eye-catching figure probably underestimates the scale of the problem.

In one new research paper published in the American Journal of Preventive Medicine, Mac McCullough and Matthew Speer – together with a team from the UCLA Fielding School of Public Health lead by Jonathan Fielding and Steven Teutsch – examine the actual extent of the public health disaster in the United States.

The paper is part of a broader collaboration between research teams from ASU and UCLA. Together, they explore the causes and solutions to waste problems in healthcare.

Editor's note: The answers are a joint effort by McCullough and Speer.

Mac McCullough

Question: What is a waste of health?

Reply: Health spending that does not make us healthier can be considered a "waste".

When a patient is subjected to repeated tests because no information has been exchanged between the providers, or when a person visits a hospital because of a condition that could have been prevented by a simple procedure, this is considered a waste. Welfare of health costs us all because we pay more for our own health insurance or more for taxes to support programs like Medicare and Medicaid.

Our health care system invests a lot of money to treat health conditions that could have been prevented if we could better manage the non-clinical needs that affect health outcomes. These include factors outside the clinical environment that affect a person's health, such as reliable transportation, adequate housing, clean air and water, or access to healthy food.

In our work, we use the example of a heart failure patient whose health has been exacerbated by the stress of a hot summer day. The cost of visiting the patient in the emergency room would easily exceed $ 50,000 if a $ 200 window-mounted air conditioner installed in their apartment could have prevented the episode altogether.

However, the system is not designed to promote these often simpler and cheaper forms of care, such as: As the installation of a functioning air conditioning, the promotion of a doctor's visit or the mold control.

It is undoubtedly a positive thing that there are life-saving treatments. At the same time, it is not the hallmark of a well-functioning system that mechanisms are available to pay tens of thousands of dollars for care, but fewer mechanisms to pay a few hundred dollars to avoid hospitalization altogether.

Our work aims to shed light on these misalignments and ultimately achieve the goal of reducing unnecessary expenditure to ensure that the expenditure already incurred has the greatest impact on health outcomes.

Matthew Speer

Matthew Speer

Q: Are healthcare providers, insurers or governments currently doing something to combat waste resulting from non-clinical factors such as housing, transportation or access to healthy food?

ON: The rising and unsustainable health care costs in the United States have led stakeholders at all levels to prioritize lavish spending.

States are beginning to adopt ways to enable programs such as Medicaid to pay for the types of services highlighted here, such as safe housing, reliable transportation to health visits and much more. Initially, these programs target fairly limited services, especially those that have strong and consistent evidence that links them to better health outcomes and cost savings.

Healthcare providers also play an important role as advocates of the unmet social needs of their patients, which may later translate into poorer health outcomes. However, much more needs to be done to reduce the waste of health services resulting from non-surgical prevention options.

Q: Whose responsibility is it to support non-clinical prevention opportunities? Could insurance companies in the future bear the costs of transport and housing?

ON: clinical Preventive services such as vaccinations or disease exams are regularly provided by the Task Force for Preventive Services of the United States (USPSTF), and an important provision of the Affordable Care Act requires insurance plans to cover their recommended services. However, the USPSTF is not charged with considering all aspects not clinically preventive services that affect our health.

Likewise, housing authorities and schools are usually unable to prioritize health care in their own household. In many ways, we tend to fund public programs in silos and then rate them.

From a narrow perspective, it does not seem logical for health insurance companies to pay for a taxi ride. However, there is evidence that there are certain times when this can lead to better results at a lower cost.

It is obvious that the more we can view our health and social services holistically, the more synergies we will see. As a result, it is likely that the joint efforts of these stakeholders, government agencies and all other health organizations will be needed to rebalance our system's incentives and share responsibility for upstream prevention.

Top photo courtesy of Pixabay.com

Katherine Reedy

Katherine Reedy

Responsible for media relations, media relations and strategic communication

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