The Private Sector: Be well

Too much focus on sickness, not enough on prevention leads to health-care crisis

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Much attention has been paid in recent months to a "health-care crisis" as the cost of quality health care continues to rise beyond inflationary levels, squeezing people out of health insurance altogether or reducing their benefits.

However, what seems to be lost in the debate about what to do about the crisis is, in my mind, a very simple solution.

With effective wellness programs embraced by all of us -- including employers, health-care providers and insurance carriers -- we can dramatically improve the health of our population, thus decreasing our reliance on an overburdened "sick care" system. In the long run, we can stem the tide of racing increases in health insurance premiums and, more importantly, improve the quality of life of our population.

Many communities have outstanding physicians and hospitals. However, being excellent at treating disease is not the same as helping people be healthy. The definition of health is the freedom from disease.

Unfortunately, most medical care institutions do not function as "health systems" because they already are overburdened with disease management. Clearly, this is not because they do not want to focus on maintaining or achieving health, but because they are not paid to keep people healthy. They are paid to treat people who are not healthy.

Logic would indicate that health insurance providers will benefit if they use payments from subscribers to help prevent disease, thus reducing the amount of money they pay to treat disease. In addition, if employers had on-site programs that contributed to wellness, they too would save money. The major reasons for high health-care costs to employers are employee obesity, depression and stress, all addressable by on-site wellness programs.

There are several issues that need to be addressed in the effort to have wellness programs, but all are easily answered.

Why not use health insurance premiums to promote wellness?

Some believe that there is a lack of effectiveness of wellness programs. While this may have been more true in the past, it is no longer an adequate excuse. Another concern is that by the time someone benefits from a wellness program promoted by one health insurance provider, the person may have switched to another provider. But that is not a problem if all insurance carriers promote wellness.

Some argue that adding wellness programs would raise the health insurance cost to the employer. This may be true, but if health-care utilization is decreased by effective wellness programs, the cost of health insurance premiums that the employer pays will decrease. Yes, it may take a few years, but is it not time to start somewhere to change the downward spiral? All good things are worth waiting for.

How can the likelihood of health be enhanced and the risk of disease development reduced?

Health is achieved by not being overweight or smoking, being physically active and optimistic, having friends to interact with, enjoying religion or being spiritual, eating a healthy diet and finding activities that calm the brain when one is experiencing high levels of stress. These are all behaviors that will contribute to a high quality of life. Indeed, as a further incentive to health insurance providers (and individuals), those who remain healthy as they age have a shorter demise than individuals who have chronic disease. Being healthy while alive is much less costly than living with chronic illness and dying over many years.

Who will pay?

A changing of the way health insurance providers and employers view health is needed. Ample data show that the workplace can have profound negative effects on an individual's mental and physical health with related high costs to the health insurance provider. Thus, a partnership between employers and health insurance providers can have a significant effect on health and health insurance costs.

Paying to keep people healthy will be more beneficial than waiting for them to become ill and then paying to get them better. This does not even address the moral and ethical questions of the importance of a high quality of life in which one is not a burden to himself or herself or family members and dignity is maintained as one ages.

Who will lead the effort to unite the health insurance providers and employers?

It is time to bring the leaders of health-care systems, health insurance providers, and leaders of industry, communities and government together to initiate a new culture. One where the quality of life is addressed while we continue to take justifiable pride in our ability to manage disease.

In short, a radical change in culture is required, yet the benefits are enormous. I would argue that not only is this change possible, but it also is necessary if we are to avoid sinking further into a black hole of exponentially rising health-care costs and not achieving the highest quality of life possible.


Dr. Bruce S. Rabin is a professor of pathology and psychiatry and medical director of the UPMC Healthy Lifestyle Program.


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