Prevention and Healthcare Crisis: Reducing Medical Services Demand

1. Sonoma State University Prevention & the Healthcare Crisis 2004

2. Reducing Health Care Costs by Reducing the Need and Demand For Medical Services • Overall costs were $838 billion in 1992, or more than $3,000 per person. • More than 30 million Americans are uninsured, partly because of rising premium costs. • The approach largely ignored focuses on reducing the need and demand for medical services.

3. Preventive Health and Cost Savings • treatment of hypertension • reducing the rate of low-birth-weight infants • smoking cessation • nutrition education and weight reduction • exercise and stress management • appraisal of health risk

4. The main reason to invest in prevention is to promote health and extend life, improve functioning and prevent suffering. • "The Role of Prevention in Health Reform", Russell, Louise B., Ph.D., The New England Journal of Medicine, July 29, 1993;329 (5):352-354.

5. Cardiovascular disease The estimated cost for cardiovascular disease in 1994 by the American Heart Association is 128 billion dollars.

6. 1 of 2 women in the US dies of heart disease or stroke • less than 33% identified heart disease as the leading cause of death. • More women identified breast cancer as the leading cause of death. • Although 90% of the women reported that they would like to discuss heart disease or risk reduction with their physicians, more than 70% reported that they had not.

7. Walter C. Willet MD MPHProfessor of MedicineChairman of the Department of NutritionHarvard • Moderately easily achieved lifestyle intervention* results in 82% reduction risk of coronary artery disease…. This is much more important than Statins *No cigarette smoking, moderate physical activity and easy diet changes

9. Nutrition is the Keystone of Prevention The prevention of disease could result in enormous cost savings to physicians and hospitals. • Kretchmer, Norman, The American Journal of Clinical Nutrition, 1994;60:1.

11. The Lyon heart trial o Adjusted risk ratios ranged from 0.28 to 0.53 o The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction • Circulation 1999 Feb 16;99(6):779-85

12. Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate During a follow-up of 4 years. reduction of risk in experimental subjects compared with control subjects was: • 56% (P=.03) for total deaths • 61% (P=.05) for cancers • 56% (P=.01) for the combination of deaths and cancers. • Arch Intern Med 1998 Jun 8;158(11):1181-7

13. To Supplement or Not To Supplement: Is it a Question? • improved intakes of certain micronutrients in particular vitamins C, E and beta-carotene would reduce health care costs by 25% for cardiovascular disease, 16% to 30% for a variety of major cancers and 50% for cataracts. • Lachance, Paul A., Ph.D., DSc, Rutgers, The State University of New York, New Brunswick, NJ 08903-0231, U.S.A.)

15. Exercise Americans would pay almost any price for a pill that contained all the benefits associated with exercise: increased life expectancy, improved mental health, and decreased disability. Scientific research has shown repeatedly that exercise can benefit both the body and mind. • Statement of Dr. Terrie WetleDeputy Director, National Institute on AgingSenate Special Committee on AgingHearing on Healthy Aging September 14, 1999

16. Physical Activity and Prevention • Self-directed, moderate-level physical activities which include gardening, yard work and walking with a goal of 30 minutes of activity per day at least 5 days per week. • "Public Health Focus: Physical Activity and the Prevention of Coronary Heart Disease", Morbidity and Mortality Weekly Report, September 10, 1993;42(35):669-672

17. Physical Activity and Prevention • Coronary artery disease cost $47 billion. • Cost of physical inactivity was $5.7 billion. • Elevated serum cholesterol (>than 200 ug/dL) cost of $7 billion. • For each quality-adjusted life-year gained the direct cost was $1,395

18. Physical Activity and Prevention • Physical activity classes 2 to 3 times per week, for 30 to 45 minutes per session • For each worker, the intervention program saved $679 in medical claims per year, a return of $6.85 on each dollar invested. • Other examples of work-site programs have been estimated to cost employers about $100 to $400 per employee, per year. The estimated rate of return is about $513 per employee per year, including reduced health care cost and reduced loss of productivity.

20. Emotion, Cancer and Heart Disease • Specific emotional factors are 6 times more predictive of those who will develop cancer or coronary heart disease than cholesterol, blood pressure or smoking in following over 2,000 subjects in Germany over a 13 year period. • "Emotional Health, Cancer and Heart Disease", Crawford, Robert J.M., The New Zealand Medical Journal, March 1993;10:87

21. Psychosocial Components • psychosocial treatment can improve survival. • Those who had a mild or moderate depression had a risk-adjusted 6.5-fold higher likelihood of death compared to MI patients who were not depressed. • Those who had psychological stress upon entry into the program had a 3.5-fold increase in the risk of a subsequent cardiac event in the next 2 years.

22. Job Stress and the Risk of Coronary Heart Disease • 6895 men & 3,413 women between 35 and 55 followed for 5.3 years • imbalances between personal efforts and rewards were associated with a 2.15-fold higher risk of new coronary heart disease. • Job strain and high job demands were not related to coronary heart disease. • Low job control was strongly associated with new disease. • "Two Alternative Job Stress Models and the Risk of Coronary Heart Disease," Bosma PH, et al, Am J Public Health, January 1998; 88(1):68-74

23. "hostility" is cardio-toxic • Large National Institute of Health studies ultimately demonstrated that it is this "hostility" component of Type-A behavior which is cardio-toxic and coronary-prone • Mark Goodman, Ph.D., M.A. "Pilot Findings of a Percutaneous Transluminal Coronary Angioplasty Restenosis Prone Prevention Program," Mayo Clinic Proceedings, May, 1997;172:487

24. Putting it all together…

25. Walter C. Willet MD MPHProfessor of MedicineChairman of the Department of NutritionHarvard • Moderately easily achieved lifestyle intervention* results in 82% reduction risk of coronary artery disease…. This is much more important than Statins *No cigarette smoking, moderate physical activity and easy diet changes

26. Ornish’s Lifestyle Demonstration Project • Angiographically documented CAD severe enough to warrant revascularization. • The cost of the 1-year program averaged $7,000 per person. • Reduction in angina comparable to that achieved with revascularization • The average cost for PTCA (with cardiac catheterization) was $31,000, and for CABG was $46,000. • The average cost savings per patient was $29,529

28. Reducing Health Care Costs by Reducing the Need and Demand For Medical Services • Widespread implementation of preventive strategies requires a collaboration among business, labor, the insurance industry, government and universities. • Reducing the need and demand for medical services is a positive solution bringing better health for the individual and ultimately lowering health care costs. • Fries, James F., et al, The New England Journal of Medicine, July 29, 1993;329(5):321-325.