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Are Hospitals Really Moving toward Health vs. Sickness?

by Scott MacStravic

As I read through a recent report - “Health for Life: Better Health, Better Health Care” from the American Hospital Association 2008 - I was happily surprised by the extent to which it called for a “Focus on Wellness”, which was the title of an entire section of the report. It cited not only the sickness care costs attributable to the growing epidemic of chronic conditions, but the absences associated with them, as well, indicating an awareness of how hospitals, themselves, as well as other employers bear both the direct (healthcare, disability and workers compensation) costs of illness and injury, but the lost productivity costs, as well.

This call for a greater focus on wellness as part of its “national framework for change” was not limited to the modest kinds of “community benefit” efforts hospitals have typically invested in. Such efforts often address one or two wellness initiatives, such as flu shots for their own employees and the medically underprivileged, or focus on the poor and frail, as part of their mission, PR and tax-exemption maintenance strategies. In this report, wellness was one of the five basic changes needed for the entire country, and for all the health system stakeholders.

This wellness focus included the call for efforts to prevent or at least reduce the incidence and prevalence of illness and injury in the first place, along with measures to manage chronic illness once it has arisen. It addresses the health risk conditions and behaviors that employee and population health management efforts by employers, insurers, and governments have been investing in for some time. This suggests, at least, that hospitals are finally being asked to become part of the solution to the healthcare/cost crisis, rather than the part of the problem they have been up to now.

It includes data on how hospitals and other providers have seriously underperformed in both the wellness and sickness domains, including the bare majority of patients who receive recommended treatment for their sickness, high rates of medical errors, and the minority who get recommended preventive care. The latter cannot be blamed entirely on providers, of course, since consumers are at least half of the problem, and third-party payers have done relatively little to improve the situation.

While not blaming themselves or providers for the poor state of healthy behaviors among consumers, it cites examples of how bad that domain is, and the high price consumers are paying for it in terms of both avoidable sickness care use and shortened life expectancy/quality. It also cites how much positive impact relatively modest reductions in risk behaviors and conditions could have, such as a 10% reduction in average cholesterol levels yielding a 30% reduction in the incidence of coronary artery disease.

It is not clear how much the AHA intends or will invest in directly addressing the real healthcare problem, namely the lack of enough health. Clearly, reductions in the incidence and prevalence of disease and injury will cause a major reduction in hospital utilization and revenue, at least compared to a future without as much of both. But this report at least suggests that hospitals and physicians might seek to align their efforts with the interests of all the other stakeholders in the system, for a change.