The rest of the cost story

There were two panels of six each at the Providence Business News Health Care Reform Summit, held at the Crowne Plaza Providence Warwick on Oct. 20. While many issues were discussed, the central issue of most concern to businesses is the cost crisis in health care. While this was discussed in some detail, the elephant in the room was not mentioned, much less analyzed.

The first panel came close when it identified the rate of use of services as the primary culprit. That is true, given that fee increases given to providers over the past decade have been relatively small. For many years, use increases, or “utilization” as insurers call it, have been in the double-digit range.

No one discussed why that is. The cynical might hypothesize that doctors and other providers are “churning” and driving up use because fees are flat. While there are always bad apples, for the most part that is not what is driving utilization increases.

The bad guy? Chronic illness.

- Advertisement -

America may be the wealthiest nation in the world, but it is also the unhealthiest of the industrialized nations. That is the conclusion drawn by U.S. Health in International Perspective: Shorter Lives, Poorer Health (2013), a report published by the National Research Council and the Institute of Medicine that compared 16 high-income peer countries with the United States. A few key findings of the report include:

n Two-thirds of American adults are overweight, and one-third are obese.

n One-third of Americans are pre-diabetic or diabetic.

n Four of six leading causes of death in America are related to unhealthy diets.

n The United States ranks 112th out of 122 nations on the obesity scale.

More and more Americans are becoming chronically ill. According to a 2014 National Health Council summary, “Generally incurable and ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40 percent of the total population of this country.” The Centers for Disease Control and Prevention states that more than 75 percent of all health care costs are due to chronic illness.

So, even a “broken” health care delivery system does not make us chronically ill, nor do insurer profits. We do that to ourselves. And it apparently is wicked hard to adhere to the three basic requirements for healthy living: a good diet; moderate exercise; and no smoking. Only 2.7 percent of Americans do all three consistently.

Even a superb delivery system can do little if we continue to live increasingly unhealthy lives and become more and more chronically ill. To address this might seem like curing world hunger, and to make it work, most workplace wellness programs are at best only mildly effective.

The best venue to start remains the workplace. Well north of 100 million Americans work full time daily, so we have the numbers. But it is clear that wellness in the workplace has been ineffective. We must understand why that is and what to do about it. •

James E. Purcell is the former CEO of Blue Cross & Blue Shield of Rhode Island. He is also an attorney and operates a national consulting practice on workplace wellness.

No posts to display