The U.S. health care system is a mess. Health care system is characterized by inputs rather than outcomes. Health care is reactive. The vast majority of health expenditures are to treat sickness. Every service has a code. Billing codes for services performed on patients are sent to your insurance plan. Primary care physicians are the gatekeepers to more advanced care. I went to see my doctor a couple weeks ago. To assess my health concern, my doctor ordered services and made referrals and requested follow up lab work. She also recommended some preventive services. Most of that care is sickness care, not preventative care.
The Wall Street Journal makes the case that the U.S. health care system should shift focus more to prevention rather than sickness care. Great idea, but that is easier said than done. WSJ talked to Alan Tisch, the founder of Atria Health and Research:
“People have basically become resigned to the fact that healthcare sucks, it’s going to get more expensive, access will get worse.”
“All of the incentives in our healthcare system are to treat sick people, and the sicker people are, the more money everyone makes,” he says. “There’s not even a billing code or a system for preventive healthcare. Doctors, scientists and technologists lost control. Healthcare is the only system on earth where both sides of the marketplace are wildly unhappy.”
That raises an important point. Why is the U.S. health care system predicated on sick care rather than prevention? Because our health care system is an insurance-based system of care. Insurance underwrites risk. Preventive services are not a risk. Rather they’re a consumer service; a form of medical consumption. For instance, Atria charges its 5,000 members between $20,000 and $75,000 per year to do preventive medicine.
Consumers have been preconditioned that good health is the norm and they do not need care until something tips the balance and goes wrong. Thus, the notion of spending thousands of dollars per year on diagnostic testing (they probably do not need) is a hard sell after consumers have purchased insurance. What Atria is selling is a high-end concierge medical practice that aggressively pushes technology and specialists on members. In that regard, it’s a luxury service. More of Tisch’s interview with WSJ:
At Atria, every single one of our patients gets whole-body MRI, whole-genome sequencing, quarterly labs, wearable devices, plus all their previous medical records. We’re building longitudinally with serial imaging. Our intention is to use that database and eventually open-source it, such that it can be used for pharmaceutical development as well as policy changes.”
Mr. Tisch concludes:
“To change the population level, we need to change the model. We need to change the incentives.”
The incentives in our health care system are to only perform those services that are reimbursed by insurance. Insurance mostly only covers those services that involve treating illness. If every American receives full body scans, quarterly lab tests, and other diagnostic services annually, total medical expenditure will rise substantially, not fall. The reason is numerous services would be performed on healthy Americans that are not treating any disease. Finding a few cases of cancer earlier will not make up for the extra cost. Careful research has found that preventive care does not save money. Rather, it buys additional years of life at a positive cost per life year saved. After consumers pay sky-high Obamacare premiums and face sky-high cost-sharing, most are in no mood to pay out of pocket for a lot of additional diagnostic services. Only the wealthy can afford that level of services. That doesn’t mean it is a bad idea, however.
Focusing our efforts on preventive care makes a lot of sense. Some lives would be extended while others would experience added peace of mind. For this to happen Americans must control more of their own health care dollars, rather than surrender them to health plans and insurers. We should not pretend prevention will save money, however. It will add to total costs.
Our system is fundamentally broken and in need of replacement. Perhaps if we had a MediSave account like in Singapore Americans would have more control over how our health care dollars are spent and could focus more on prevention.
Read more at WSJ: The Case for Preventive Healthcare