Prevention can be a waste of money

21Jun09
PDA Health Coach

PDA Health Coach

This is true if it is done in the traditional approach of the current medical model. The problem with the current medical model is that it is hinged on doing things to people for which the tax payer, insurance company or individual can be billed. If you do nothing to the patient then you have nothing to bill for and you’ll eventually have to close up shop.

This is how we now have things called the Biophysical-25o, or the executive physical, or the total body scan. These things done to the patient cost a ton of money and there is no real way to determine if life, limb or long term dollars were truly saved. Often times many of the conditions discovered would have never progressed to any disease states.  That is not to say that these tests are not without merit, but that perhaps the clinical utility of the test needs to be placed in the context of the individual to whom they are aimed.

Tests are not benign. Before anyone orders a test or undergoes a test this one question must be answered. What are you going to do with the results? If the answer is nothing then why are you doing the test? Unfortunately many times this question remains unanswered, and the test yields a result that requires another test.  That test yields a result which requires y 2 more tests which yield an inconclusive result, and requires more tests only to arrive at let’s just wait and see and re-test in 6 months. Another step  which is becoming more common is to consult surgery and have it removed and at least you will have piece of mind.

If your primary care were delivered by a health care provider that had a relationship with you over time and knew you as well as a trusted friend or close family member perhaps we would still believe our doctors to have our best interests at heart and in mind when they made a particular recommendation. Unfortunately due to excessive regulation and the current structure for payment the health care providers have been incentivised to make recommendations and then justify them as opposed to having a justification and performing a test to confirm a clinical suspicion.  Health care is now in a state of putting the cart before the horse and desperately trying to correct the situation.The question now is how do we correct the incentives and control the cost?

A few years ago I read a line in relation to health care economics: a dollar spent on health care is a dollar of income to someone somewhere. Everyone should realize that health care is far beyond the expense of the direct care provider it includes expenses of indirect care providers as well. Consider the stakeholders in health care doctors, nurses, pharmacists, therapists, social workers, suppliers, drug companies, training programs and schools, not to mention all the various health agencies.  Is it any wonder that a Tylenol that costs less than a penny to make is sold for $10?

Given all of this is it possible for prevention to actually save money? As a Nurse Practitioner I would argue resoundingly yes. How? By refocusing the attention on the patient.  By actually spending some time with the patient I can find out what is actually causing the patient pain and suffering, and what is the reason for not sticking to a therapeutic recommendation of eating less, exercising, quitting smoking, getting enough sleep, having meaningful relationships, and host of other lifestyle contributors to disease and ill states of health. None of these mentioned culprits can be tested for with a scanner. In fact the testing for these maladies is quite inexpensive in the grand scheme of medical technology. The problem is many patients, insurance companies and government payers are not willing to pay for this kind of investigation.  In order for a clinician to make a living they will need to wade through 20-30 patients a day and it’s impossible to have any sort of meaningful conversation with a patient given that time constraint.

I and many other health care providers as a result are opting out of 3rd party payers because we want to have meaningful therapeutic relationships with our patients. We want to make recommendations that are truly in their best interests consistently. I want the patient to provide truly informed consent to the care they receive, and I want to be seen as someone they can trust to give them the same advise I’d give my wife or my mother.

Prevention can be a waste of money but it can also be tremendous value added money saver if it is rendered skillfully.



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