Health care costs in the United States are astronomically high and, though the increase has slowed, are continuing to rise. What’s worse, Americans are sick and getting sicker, meaning more people are using health care, which drives costs up still further.
Some of this is inevitable: All of us will have to receive care at some point in our lives; yet many of the most prevalent chronic conditions are preventable.
As employers begin to reassess their health plans in light of the Affordable Care Act (ACA), it’s important that they consider what proactive steps to take to improve employee health and wellness while focusing on disease prevention.
Ultimately, the best way to keep health care costs down is to avoid getting sick in the first place. This is not a flippant remark but the real key to the crisis we’re facing. Many common chronic conditions and illnesses could be mitigated or prevented altogether by healthy lifestyles. Consuming a nutrient-rich diet, getting plenty of exercise and avoiding dangerous habits like smoking all play a huge role in maintaining overall health. Consider this: If fewer people needed to use health care, then even if the costs per patient stayed the same, the overall costs would be far less.
As they are, health care costs are incredible. Health care comprises one-sixth of the total U.S. economy, and in 2011 alone it cost $2.7 trillion, or $8,680 per person. Yet some $700 billion of that is spent on wasteful or redundant care. Many doctors over-treat patients, which can do more harm than good and drive up costs. Hospitals charge outrageous prices for services and supplies, as Elisabeth Rosenthal has reported for the New York Times in her ongoing series, “Paying Till It Hurts”:
Chronic Conditions and Lifestyle Issues
Perhaps the most controllable and prevalent factor in our rising health care costs is unhealthy lifestyles. More sick people mean higher costs, and too many Americans are sick. In fact, according to the Centers for Disease Control and Prevention (CDC), 50 percent of Americans suffer from at least one chronic illness, such as heart disease, obesity or diabetes. Nearly one in four Americans has multiple chronic conditions.
Some chronic illnesses are genetic or caused by factors outside the person’s control. Too many of these conditions, however, are either due to, or exacerbated by, controllable factors. For instance, the Journal of the American Medical Association recently published findings that indicate hyperlipidemia (high cholesterol and triglycerides) is one of the fastest-growing diseases. It also accounts for the highest costs: Spending on this condition rose 14 percent from 2000 to 2010.
Obesity is a leading risk factor for many of the most common chronic conditions, especially diabetes and cardiovascular disease. In 2012 alone, 22.3 million people in the U.S. were diagnosed with diabetes, costing the health care system $245 billion. Diabetics are urged to see their doctor four times a year and have to take numerous expensive medications. Cardiovascular disease kills one in four Americans even though losing just 10 pounds can decrease the risk of contracting it, according to the American Heart Association.
Despite the indicators that obesity can lead to deadly diseases, it remains prevalent across the U.S. Seventy-eight million adults and 12.5 million children are classified as obese. In 2009, Americans paid $152 billion in direct medical costs for conditions related to obesity. These conditions aren’t just killing people—they also lead to lost productivity in the workplace and create a drag on the overall economy. According to the American Diabetes Association, absenteeism and reduced productivity due to diabetes cost the U.S. $69 billion in 2012.
Bad habits, too, contribute to the problem. Smokers account for high health care costs—smoking is one of the highest burdens of disease in the U.S.—and they cost employers an estimated $5,816 per year. Our sedentary lifestyles are not helping, either, adding to 15 percent of health care costs. Clearly, employers have a vested interest in making sure their workers stay healthy.
Screenings and Coaching
As the ACA is fully implemented, employers are doing what they can to manage costs, care for their employees and run their businesses effectively. Many are looking to offer new health plans and exploring new coverage for their employees. Prevention and wellness should be key to any health care plans they adopt or changes they implement.
What should this look like? The optimal model is one based on prevention and health. People should get regular health screenings from a medical professional, to detect problems and nip potential diseases in the bud. This expense will actually drive down health care costs, as healthy people do not need pricey treatments, intensive clinician care or drugs. Ideally, employers should model this behavior by getting screened themselves and offering annual screenings for all employees, as well as coaching on how to make healthier lifestyle choices.
Even if comprehensive preventive screenings aren’t feasible, regular wellness screenings and coaching are a good way to identify potential problems. Also, employees should consult a doctor about what to do to stay healthy. This includes getting health-history reviews and blood tests and consulting a health professional about lifestyle factors.
Healthy Workplace Cultures
Good health can be fostered or maintained only in a healthy environment and culture. This means employers and communities should offer prevention and wellness programs and create work environments and cultures that encourage people to live healthy lifestyles. Organizational and community health assessments are essential to identifying strengths and weaknesses in the environment and to promoting positive social, emotional and financial health. Negative environments can often cause the stress and anxiety that lead to individuals’ health problems in the first place.
A healthy culture is better not only for employees but also for businesses, as it enables them to reduce their health care costs and maintain a high level of energy, engagement and happiness among workers. What’s more, it is good for the economy as a whole.
Ultimately, of course, getting healthy and staying that way is the individual’s responsibility. It’s up to each person to make the choices that will promote health and prevent disease. A healthy outlook and social-emotional health are critical to good mental and physical health.
A nutritious diet is essential for maintaining a healthy weight, lowering cholesterol and getting necessary nutrients. Prevention and wellness programs can play a role in teaching individuals what to eat, what to avoid and how to read nutrition labels. Regular exercise is important, as well, to prevent obesity and associated chronic conditions, to maintain cardiovascular health and to boost energy levels. This is critical for people whose jobs require them to sit most of the day. The American Heart Association recommends 30 minutes of exercise five days a week.
If enough people take more initiative to stay in good health, there will be fewer sick people to treat. This means lower costs across the board, because even if the costs of particular treatments stay the same, there won’t be nearly as many people to care for. Individuals, employers and health care providers must work together to create and maintain a broad culture of wellness. This culture can—and should—start in the workplace.
We are not helpless in the face of rising health care costs:
- Companies must make smart choices when adopting health care plans, develop employee wellness and prevention programs, and cultivate positive, health-promoting environments.
- Individuals have to take responsibility, get yearly screenings, and make the necessary lifestyle changes to get and stay healthy.
In the end a healthy population is the best guarantee against skyrocketing health care costs, and employers can take steps that will help us get there as a nation.
Dee Edington, Ph.D., is the founder of the University of Michigan's Health Management Research Center and chairman of Edington Associates LLC. Dr. Edington is the author or co-author of more than 500 articles and presentations and has written/co-written several books, including Zero Trends: Health as a Serious Economic Strategy.
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