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How Much Global Influence Does the US Have In Health Care?

by Scott MacStravic

Fred Fortin’s discussion of “Soft Power” suggests the potential for the US to lead by example in the healthcare arena, whereas it has lost influence to a significant degree in other areas, thanks to dropping behind on environmental issues and championing democracy.  Given the amount of money the US spends in healthcare, and its leadership in technology applied thereto, the potential might seem great.

The problem is that our “lead” in healthcare seems to be mainly in our proven ability to spend far more per capita than any other nation on earth, while getting far less return on our investment in terms of the health of our population.  The one area where we might offer leadership is in proactive health management (PHM), where we have a large industry devoted to reducing the incidence and prevalence of disease and injury, as well as managing existing chronic diseases in order to reduce their crises, complications, and worsening over time.

All other nations in the world share problems related to out-of-control increases in the incidence and prevalence of disease and injury, either infectious diseases in underdeveloped countries, or chronic diseases in developed.  The reason we have not created leadership in this arena is that we have not proven to be cost-effective in doing anything about the problem.

Our government keeps coming up with the same conclusions, and publishing them for all the world to read, that disease management, as practiced here, has not proven to work.  Moreover, the majority of PHM investments are still evaluated in terms of reducing the rate of increase in healthcare costs, where many other countries in the world, as well as many employers in this country, have long since added the far greater returns that are being achieved in improving workforce productivity and performance.   Besides, preventing chronic diseases will clearly save a lot more money than managing them.

The rest of the world is often leading the US.  Because insurers, employers and the government (plus taxpayers, of course) share the burden of paying for sickness care, most of the wellness, risk reduction and disease management efforts we have been involved in for the past few decades have been aimed at controlling sickness care costs.  They have usually been piecemeal, rather than strategic, and looking for short-term rather than lasting payoff.

In Europe, plus countries like Australia, South Africa, etc. that are equally well “developed”, governments often bear the burden of sickness care costs.  This does not mean that employers are unconcerned with employee health, however.  For one thing, many employers bear part of the burden, or offer private health insurance for workers when use such fringe benefits to recruit and retain the talent they need.  And for another, they have found that healthier/happier employers are significantly more valuable to their employers than are unhealthy/unhappy ones.

European firms, particularly those in the UK, have found that employee health and well-being efforts pay off in significantly reduced absence rates, as well as reduced productivity impairment when at work (“presenteeism”).  Dramatic reductions in turnover have been achieved, along with on-the-job injuries and sick leave costs.  And those that have looked have often found positive impacts on revenue as well.

Healthier/happier employees tend to deliver higher quality products and services, increasing customer satisfaction and loyalty.  Their enthusiastic recommendations of their firms’ products and services, along with the word-of-mouth “advertising” by more satisfied customers have been credited with significant increases in new business and added revenue.  While many other factors in the handling of employees contributes to these same results, any health improvement effort that does not is likely to miss a substantial amount of value already being delivered.

Until and unless the US qualifies to and actually takes a leadership role in the measurement and management of all the factors that affect employee productivity and performance, it will not be entitled to such a position in proactive health care, any more than it is in reactive sickness care.  While our country enjoys one of the highest productivity levels in the world, that is more due to technological innovations and working employees harder than most other countries.  When it achieves such pre-eminence via managing employee health and happiness better than anyone else, it may justify a leadership position in proactive health as well.


2 Comments »

  Alfred J. Fortin wrote @ May 30th, 2007 at 11:38 pm

Thanks Scott for your well thought out rejoinder to my post (as usual!). I wouldn’t disagree with you much on the critique of American health care. My arguments, however, have to do with the benefits to America’s image that could result from a national policy of an expanded thoughtful engagement on health care with other nations. In my experience in China and elsewhere, there is an excitement about American health care that cannot be denied, one that other countries want deeply to tap into. The heat of debate, experimentation, and innovation here is very hot right now. The typically American values embedded in this panoply of activity are also very attractive. And relative to most nations in the world, we do have a lot to offer and a certain responsibility that goes with it as well. But it is a two-way street and this is only to the good. We interrogate, we learn, we incorporate, we innovate and we give back. It’s a good deal if we can only get our people to sit at the international table.

  Patrick J Gauthier wrote @ July 31st, 2007 at 1:28 pm

I agree with so much of what you’ve said in your posting and would add that the American system creates (as opposed ot having been “created by”) an identity crisis that makes matters worse. Citizens of other developed countries identify their health and healthcare in a single context. That is, as a resident of Canada, France or the UK, one’s health and healthcare is simply a function of being a person-citizen and obtaining what is needed to alleviate symptoms or cure disease.

In America, healthcare issues are compounded by the fact that seeking healthcare has to be initiated, percieved and navigated through a prism that requires citizens identify with one sub-population or another.

A person-citizen in America may belong to an employer-sponsored HMO, PPO, POS, indemnity, self-funded, fully-insured or MSA plan. A person-citizen may qualify for Medicare, Medicaid or both. They may also qualify for SSI. Their children may qualify for S-CHIP. A US citizen may qualify for Workers Compensation, STD, LTD, and perhaps even benefits like those offered by Aflac. Someone may qualify for benefits entiteld to pregnant women who cannot afford pre-natal care, temporary assistance to families that includes healthcare, criminal justice healthcare (probationers and parollees and prisoner re-entry) and so on. Cities, counties and states offer coverage of various sorts….if only we knew which sub-population we belonged to!

The degree to which we have fragmented and stratified our society and healthcare delivery system has - in turn - fragmented the delivery system and the doors through which people enter. While our intentions have been good (offering as many people access to healthcare as possible), the net-effect of stratifying the delivery system to match population-type is that people get confused, marginalized and disaffected. I think this has had an impact on the degree to which we have allowed our own systems to stratify. In short, we are exhausted and mystified by all of the complexity and when we don’t understand something, we experience fatigue and back off.

Subsequent to the fatigue and confusion is a reluctance to engage with the healthcare system and we know what impact that has: Americans, I suspect (and verify when I read Commonwealth Fund and IOM reports) are slow to engage their disease process with appropriate healthcare. I want to suggest that our chronic disease, poor self-care and costly care will be positively impacted by a change in terms of identification. When Americans begin to see themselves as one population caring for itself in one healthcare system, they will seek care earlier in a preventive fashion and remain compliant with healthy behaviors and treatment plans over the course of their lives. One lifetime, one person, one healthcare system. The quality and cost of other countries’ healthcare systems has an individual citizen dimension. They use and engage their systems for effectively and efficiently than do Americans because they aren’t hypnotized by them.

Fragmentation and stratification - however well-intentioned - leads to fragmented healthcare-seeking, fragmented treatment plan compliance and disaffection with the system to the extent that disease worsens and cost of care rises.

Patrick Gauthier

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