$750 billion is a lot of money. It is more than the GDP of many countries. And, according to a recent article published on Medical Consultants Network – it is the amount of money wasted each year by our fabulous health care system. Unimaginable as it may seem, the report from the Institute of Medicine found that the amount of money wasted (roughly 30 cents on every medical dollar) is more than the budget of Medicare ($716 billion per year).
Also – the IOM report actually identified the areas of waste (adjusting for some overlap in categories), which include the following:
- medical services ($210 billion per year) – 27%
- delivery of care ($130 billion per year) – 17%
- administrative service costs ($190 billion per year) – 25%
- prices ($105 billion per year) – 14%
- failures ($55 billion per year) – 7%
- ($75 billion per year) – 9.8%
The purpose of this article is to look a bit closer at each of these segments of waste, and look to see how a change in lifestyle behavior may actually have an impact on them (or not). Our goal is to see a relationship and a potential solution where many do see a connection. In looking at a prudent (and small) expenditure on wellness programs, health care executives, government agencies, and private companies can see a positive ROI AND less waste within the system – in part because less services are being rendered.
If unnecessary medical services accounts for the largest percentage of waste, then adopting a more vigorous and healthy lifestyle may do much to curb many of these expenses. Take heart surgeries. It has been estimated that 1/3 of these surgeries are unnecessary. In choosing a more active lifestyle, the odds of a physician recommending either an initial or secondary heart procedure are reduced dramatically. Another area is cancer care. After initial surgeries and medical procedures, survivors are in many times left to their own devices for long term recovery. Recent reports suggest that maintaining a long-term exercise program reduces health care costs for up to 10 years post-diagnosis. The same can be said for diabetes care. Reducing body weight by just 10% can impact glycosylated hemoglobin, blood pressure, and other co-morbidities. If we saved even 1/3 of the costs of unnecessary medical expenses solely due to a more active lifestyle – it may save 9%of the overall cost of care – or about $70 billion.
Inefficient care delivery is a bit tougher to diagnose, but if look at the fastest growing segment of healthcare – home health; we see that there are a lot of companies vying for the home care market. Companies that are promoting wellness are betting that home care patients who engage in regular lifestyle activities such as walking, balance training, better nutrition practices, and overall strength exercises may improve both the number and severity of falls, strokes, and bouts of hypoglycemia (leading to dizziness), and reduce the odds of suffering an acute symptom. Part of our mindset in the US is “watchful waiting”, which (as a health promotion professional) makes no inherent sense at all. Here the medical profession is basically giving up and waiting for something to happen – then administer care (which is much more expensive, time consuming, and wasteful by its nature).
Even a quick look into the front office of most private practice doctor’s offices, one views the volumes of patient charts and reports that must be completed to varying degrees for liability and billing purposes. Most doctors don’t have the time to review charts to the detail necessary to know all about their patient’s condition (to their credit, they can rely on their medical experience to handle many types of conditions that come across their desks during their day). To have their staffs work through all of this information for billing purposes is inefficient at best, and wasteful to a large degree. Even with the advent of online billing and computer apps to smooth transitions, it is still time consuming to fill out the paperwork necessary to get the reimbursement. Again – exercise may reduce the number and severity of many types of conditions (such as a diabetic in good control, vs. someone who has one or more complications). Or – a patient with minor arthritis who still conditions regularly, vs. a patient with a more advanced state of arthritis, needing multiple interventions.
Many have seen charts of persons who are in a revolving door pattern with their health care providers – they are massive. Most charts of persons how are in good physical condition (and need less interventions) are small. This is what we should strive for.
In conclusion – the plight of our healthcare system is a large problem. However – over the past couple of decades, exercise has established itself as one of the least expensive “prescriptions” available. We have a national network of providers (health clubs, hospital wellness centers, YMCAs, JCCs, Rec Centers, and homes); we have more and more fitness providers, and more in medicine willing to refer to these types of programs.
Time will tell as to the ultimate success of wellness and fitness programs as part of our national discourse on prevention and cost effective treatments. However – knowing what we know – we can either NOT participate in the debate, or put on a pair of walking shoes and make a difference, or stand by idly as costs continue to escalate and the health of the nation continues to decline.
Eric Durak is President of Medical Health and Fitness – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.