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If health care cost reduction is really a priority, this kind of research can’t be ignored. I think we do need to look at limiting care for people who are, say, 75 or 80 or older. Maybe they just get hospice care?

But, we still have to recognize that the lifetime health care costs for someone are not just driven by their illness. They are also driven by how they react to illness. For example, I did research looking at the claims rates of commercially insured people across four health plans and one employer group based on their response, strong agreement or strong disagreement, to this statement, “I only go to the doctor if I am really sick or injured.” The total sample combining all health plans and employer group was over 40,000 members. In every case the health care costs were lower for the people who agreed with the statement—the non health proactive folks. For three health plans, the cost difference was $500 per person per year lower. For the last health plan and the employer group, the costs were lower by nearly $2,000 per person!

The percentage of the more expensive “health proactive” people (i.e., who strongly disagreed with the statement) varied, but the average percentage was 17%. If we apply this percentage to the U.S. adult population, it means that about 36 million adults are generating between $18 billion and $72 billion in health care costs because of the way they think and react to illness—not because of the illness itself!

I pretty sure that all the items on a typical health risk assessment are there because they are factors recognized as contributing to health care costs. So, why not some measure to capture a person’s propensity to seek care? It seems to me that it’s a “risk factor” in terms of generating health care costs just like any other, and probably one fairly easy to treat.

Based on the findings of the above research, today’s focus on creating more health proactive, engaged consumers is fueling the health care cost crisis, not reducing it. Pretty much every drug commercial on TV says, “Talk to your doctor to find out of XXX drug is right for you.” “Simple blood tests might be needed.” Well, in my mind no doctor can really know if some drug is right or wrong for me by talking over the phone. That means paying $75 to $150 for an office visit, not to mention my loss in productivity time and the costs of gas. I also need blood tests so that’s another $80 to $100 dollars. The costs could be as high as $300 before I get any treatment, and that’s money spent that hasn’t done anything for my health! And let’s not forget that medical errors are the 8th leading cause of death in the U.S. above auto accidents. So my risk of dying from the medication I might eventually get is greater than my risk of dying in a car accident on my way to or from the doctor’s office.

I believe that many DM interventions contribute to the problem as well and do not show cost savings because they all focus on patient engagement in costly medical solutions, rather than health solutions.

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