Put
Preventive Medicine to Work for You
by Randal P. Schober, Ed.D. |
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Chances
are, your doctor does an adequate job in addressing your immediate
short-term medical needs. Unfortunately, if they are in an
HMO or PPO setting, the "cost effectiveness quotient"
they operate under often means sacrificing your long-term
health and wellness. A thoughtful analysis of your health
care provider's approach will reveal whether your long-term
health care needs are being addressed. If they are not, you
may need to adopt preventive measures as part of your health
care regimen.
Why?
Because managed care is forcing the US health care system to
place a monetary value on human life. The current quality of
care provided by the health care industry is often determined
solely by the cost-effectiveness of the services provided within
a specific health plan. Since the emergence of HMOs, health
plans increasingly concentrate on the immediate health concerns
of the American population. The resultant medical coverage and
treatment attempts to cover the medical costs if, and only if,
the medical event occurs. For the sake of profitability, health
care organizations calculate the monetary value of treatments
and the short-term expenses associated with them.
The
"Proactive" Approach
Preventive
medicine is the "proactive" approach to health management.
This is different from the traditional reactive practice of
medicine that deals primarily with already existing illnesses.
It consists of comprehensive health strategies, examinations,
screenings and educational programs for the purpose of early
diagnosis and prevention of disease.
Preventive
medicine generally includes promotional health services such
as smoking cessation, stress management, blood pressure and
cholesterol control, weight management, exercise and nutritional
counseling, health risk appraisals and preventive examinations.
Such programs will eventually result in savings, since these
services lower the incidence of subsequent illness and disease.
The problem is, many health care providers do not subscribe
to this logic.
What
Your HMO Really Thinks of Prevention
Most
likely, you belong to an HMO or PPO. How does it view preventive
services? Most organizations compare the efficacy of prevention
with the emergence and treatment of an illness or disease. Paying
for regular preventive examinations is not always cost-effective
for the HMO when you compare the number of exams with the number
of diseases detected.
There's
a better way to look at cost-effectiveness. Consider this
basic equation:
Cost
of the prevention (including medication, doctor visits, tests,
and treatment of adverse effects)
-
cost to treat disease
= cost effectiveness.
Unfortunately,
once the calculations have been made, preventive care is often
more expensive and, therefore, generally not covered.
When
it's all said and done, the greatest threat to preventive
health care is its intangible worth and the absence of adequate
research to determine its cost savings. More research is necessary
to demonstrate whether preventive medicine actually reduces
health care costs. Early detection and treatment using preventive
exams and medications can be expensive and particularly difficult
to justify, since their ability to prolong life is uncertain.
Other
Services under the ax
Preventive
measures are not the only thing being scrutinized by HMOs;
so-called secondary prevention, such as cardiac or pulmonary
rehabilitation programs, are also under the health
care ax. For example, an individual who suffers a heart
attack may not be covered by insurance for rehabilitation
and educational services that are focused on preventing further
complications. The cost of providing extended education and
care to members is perceived to be a drain of funds for HMOs.
Prescription
drugs make up the greatest cost increase in the health care
industry. According to the American Association of Retired Persons
(AARP), monies spent on prescription drugs among the elderly
account for 34% of medical expenditures. This amount is greater
than both hospital expenses and the cost for physician services.
That means that HMOs are less likely to cover prescription drugs
used for preventive medicine, such as anti-hypertensive drugs
and cholesterol reducing agents.
What
You Can Do
Become
an Educated and Active Patient
- Perform
self-examinations (i.e. breast exams, testicular exams,
etc.)
- Know
the 7 cancer warning signs
- Be
aware of the preventive guidelines provided by the U.S.
Preventive Task Force
Know
your physician
-
How do they feel about preventive care?
-
Do
they follow the preventive guidelines?
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Know
the coverage provided by your HMO regarding preventive
exams
-
Ultimately,
if you are unhappy, change physicians
Know
where to go
-
Inquire
with your occupational health department at work
-
Locate
Internet sites for education (e.g. American Cancer Society)
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Inquire
with local community clinics
Randal
P. Schober,Ed.D obtained his doctorate in education and exercise
physiology from the University of West Virginia in 1996.
His extensive background in health care spans a number of
areas. He served as professor of physiology at the University
of North Carolina from 1996-97. Dr. Schober has also worked
as a consultant on corporate health and wellness programs
and is currently an on-staff exercise physiologist at Sharp
Memorial Hospital in San Diego.
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