PREVENTION VERSES TREATMENT

 

            Among the many reasons why health care costs are so high in the United States, expenditures for treating existing health conditions are among the highest.  Health care expenditures are continually increasing due to the rising number of chronic diseases and high treatment costs.  Money spent on prevention and treatment differs greatly in the United States.  Although the United States spends more on health care than any other country, the poorest health exists among Americans.  The impact on overall health and costs show a dramatic decrease with prevention spending as opposed to treatment.  In order for this shift to occur in health care spending funds must be allocated towards prevention.  A focus on either prevention or treatment results in positive and negative outcomes within the health care system. 

            Because the United States expenditures are devoted so highly to health care there are high expectations for high quality care, yet mediocre ratings are produced.  Of the United States Gross Domestic Product (GDP) about 1.7 trillion dollars or almost fifteen percent is spent on health care which is more than any other industrialized country.  On a per capita basis, America spent 5,267 dollars per person on health care compared to the median of 2,294 dollars per person among the countries in the Organization for Economic Co-Operation and Development (OECD) (National Governors Association, 2005).  The main reason for this imbalance of health care expenditures is the lack of spending for prevention activities.  While ninety-five percent of the trillion dollars spent on health care goes to treatment, only five percent goes toward health improvement that could assist in preventing forty percent of deaths.  On the contrary, ten to 15 percent of mortality among Americans could be avoided by quality medical care.  The daily choices related to diet, exercise, sex, and our coping strategies to manage stress are some of the central behavior patterns contributing to prevention (McGinnis, Williams-Russo, Knickman, 2002).  These behavior patterns, although almost entirely preventable, accounts for approximately 40-50 percent of morbidity and mortality (Thorpe, 2005).  Since obesity is recognized as a risk factor for coronary heart disease and is associated with hypertension, diabetes, certain cancers and other chronic diseases, at least 90 billion dollars in health care costs are a direct result of obesity (Daviglus, 2005).  Effective behavior change programs in worksite, school and community settings create an average savings of about four dollars for each dollar invested (Thorpe, 2005).  Although consumers spend about 33 billion dollars yearly on weight reduction products, many are not following the recommended methods of nutritious diet and proper exercise leading to ineffective weight loss attempts (Daviglus, 2005). 

            America’s health care system could be referred to as a “disease care” system because of the focus on treating diseases and managing illness as opposed to encouraging healthy living to prevent disease.  Insurance companies lack in providing coverage for prevention, but tend to focus on medical care of illnesses (Natural law party).  More than 75 percent of America’s 1.4 trillion dollars spent on medical care is due to treating chronic diseases.  The National Center for Chronic Disease Prevention and Health Promotion states that “hospitalizations for pregnancy-related complications occurring before delivery account for more than one billion dollars annually (National Center for Chronic Disease Prevention and Health Promotion, 2005).”  Annually, the total medical costs of diabetes are approximately 132 billion dollars, arthritis accounts for more than 22 billion dollars; more than 75 billion dollars in costs associated with smoking; roughly 300 billion dollars spent on all cardiovascular diseases; in the year 2000, 76.6 billion dollars went towards illnesses related to physical inactivity and virtually 68 billion dollars is used up on dental services (National Center for Chronic Disease Prevention and Health Promotion, 2005).

            Health care expenditures in other countries differ greatly from the United States when comparing prevention and treatment.  England, for instance, improved health over the previous 200 years by changes in food supplies, sanitary conditions, and family size than from medical care and treatment (McGinnis, Williams-Russo, Knickman, 2002).  In 1987, Brazil, although a poor community where education levels are inadequate, has shown a model of health care desirable for other countries in similar circumstances.  Trained nurses who made monthly visits to provide the essential health services to families in local communities improved child health status and vaccinations, prenatal care, and cancer screening in women.  Since salaries for health care workers were normal, few medications were prescribed and no physicians were used, the cost of the program was low and used a small portion of the health care budget.  Health problems similar to the Unites States have emerged in India including cardiovascular diseases, diabetes, cancer, obesity and tobacco use.  As a result, the government has taken preventative action to employ programs with components such as: training and health education, strengthening treatment and diagnosis facilities for cardiovascular disease, promoting affordable drugs, intervention programs to reduce risk factors, and increasing awareness of nutrition and behavior patterns (World Health Organization, 2002). 

            The impact of overall health costs of prevention greatly decrease health care spending through intervention programs and health promoting behavior.  Effective intervention programs focus on several causes of disease, such as genetics, physical activity, proper nutrition and tobacco cessation; whereas treatment only focuses on a single symptom.  By promoting physical activity the risk of heart attacks, strokes, and diabetes is substantially reduced.  Change is difficult for many people, therefore; in order for these promotion programs to be implemented effectively the quality of life needs to be the focal point (McGinnis, Williams-Russo, Knickman, 2002).  One example of much needed programs is school-based interventions.  In the year 2000 roughly 15 percent of school-age children were obese which is double the percentage from the previous 30 years.  This rise in obesity has also been the cause of social and mental disorders among school-age children.  Under the No Child Left Behind Act, as well as academic achievements, standards could be expanded to include an increase in physical activity by requiring at least 30 minutes of exercise daily.  In many schools, the current recommendations concerning a well-balanced diet are not being met, hence; a program to improve school lunches need to be applied (Thorpe, 2005).  

            The impact of health care costs for treatment has not shown to be the most cost-effective plan for health care spending, yet it is the focus of health care in the United States.  Some examples the impact of treatment has had on America are as follows: in 2001, infant mortality was the fifth highest in the industrialized world; in 2000 there were 322 cancers per 100,000 being a level higher than nearly half of all OECD countries; in 2002, the U.S. had the highest obesity rate with the exception of the Slovak Republic; and in 2001 the life expectancy for males (74.4 years) and females (79.8 years) was exceeded by 21 other countries (National Governors Association, 2005). 

            For these necessary intervention programs focusing on prevention to take effect funds must be allocated from different sources such as: the government, financial incentives from employers, federal financial incentives, Congress with health care bills, and taxes.  Although worksite health programs would help slow the growth of future health care spending, only 30 percent of employers have programs and only ten percent are comprehensive.  One proposal is that the government could offer refundable tax credits (50-75 percent of the cost of program) for businesses who implement comprehensive health promotion programs to ensure employee involvement.  Because recruiting employees may be difficult, financial incentives for participants, as well as contacting eligible workers, would aid in the effectiveness of the program.  Another motivation for recruitment in health programs would be to reduce monthly health insurance premiums or cash incentives for involvement (Thorpe, 2005).  Additional suggestions for financial incentives include medical savings accounts rewarding Medicaid and Medicare subscribers for good health, and vouchers permitting Medicaid and Medicare subscribers to have more freedom choosing plans and providers (Natural Law Party).  Tactics to reduce tobacco use consists of raising taxes on cigarettes, constricting use in public places, and penalizing the sale and distribution to minors.  To encourage smokers to quit and succeed in exercise routines, reimbursements for brief interventions would motivate providers to carry out prevention programs.  Along with incentives to quit smoking and succeed in fitness programs, improving air quality and designing walking and biking routes are beneficial to communities (McGinnis, Williams-Russo, Knickman, 2002).

            Outcomes for adjusting the health care system undoubtedly have pros and cons for prevention and treatment.  Prevention has been proven to be cost-effective in the following areas: fluoridation, smoking-cessation programs, obesity, sexually transmitted diseases, diabetes and women’s health.  Every one dollar spent on water fluoridation, 38 dollars is saved in dental treatment.  Smoking cessation programs, the gold standard of cost-effective programs, ranging from 1,108 dollars to 4,542 dollars saves one quality year of life.  An increase in physical activity results in fewer medications and few hospitalization visits (National Center for Chronic Disease Prevention and Health Promotion, 2005).  When targeted to persons in high-risk groups regular diet, exercise and stress management programs decreased health care costs by 46 percent (Natural Law Party).  For every one dollar spent on school-based HIV, other STD and pregnancy intervention programs roughly two dollars and 65 cents is saved on medical costs.  Diabetic women can save approximately two dollars for every one dollar spent on preconception care programs to prevent birth defects (National Center for Chronic Disease Prevention and Health Promotion, 2005).  Along with cost-savings due to prevention quality of life and longevity is also a benefit of disease prevention (Daviglus, 2005).  Due to the Healthy People Initiative, by the end of 2000, infant mortality rates declined by almost 35 percent, childhood death rates dropped to 29 percent and sick days for older adults decreased by around 14 percent.  Because of the success of Healthy People 2000 another initiative with a set of goals is in place for the year 2010.  Downfalls to prevention programs include lack of participation, difficulty in changing behaviors, not a total guarantee of success, and lack of funds (McGinnis, Williams-Russo, Knickman, 2002). 

            If the continuing focus for health care is on treatment in America the outcome will be fewer employees able to afford health care causing more people to rely on Medicare and the State Children’s Health Insurance Program (SCHIP) (National Governors Associaton, 2005).  Premature deaths among Americans are highly affected by treatment, rather than prevention.  By changing behavior through prevention 47 percent of premature deaths, in 1994, could have been avoided and 17 percent by changing the environment.  On the other hand, only11 percent of premature deaths could have been prevented by enhanced medical treatment (Natural Law Party). 

            The amount of money America spends on preventative care compared with treatment is incredibly low, yet money invested in prevention is most cost-effective.  Even though the United States spends more money on health care than any other industrialized country, the poorest health exists among Americans, therefore; to reverse this trend prevention programs must be planned and executed.  When looking for improvement in the United States health care system, one must also compare and contrast health care spending in other countries.  Allocating the funds for prevention programs requires the help of the government, employers and communities.  Although pros and cons exist for prevention and treatment programs, prevention yields the most effective benefits.