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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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May 1, 2013 Volume 77, Number 5
Residents' Review: Future of Health Care: Is Preventive Care the Missing Link? Vimal Desai, M.D.


In the past 75 years, medical advances have occurred at an astounding pace. Unbelievable progress has occurred in surgical technique, understanding of disease pathophysiology, novel treatments and physiologic monitoring. Unfortunately, it has proven difficult to realize all of the promises of this enhanced knowledge, as advances in patient education and preventive care have not kept pace. We are well aware that preservatives such as BPA cause cancer, saturated fats lead to heart disease, alcohol results in MVAs and hepatic failure, and stroke, diabetes and smoking lead to countless issues. So far, we have not been sufficiently successful in translating this knowledge into improved outcomes for our patients. Society must redirect its efforts from a reactionary approach to that of enabling and supporting individuals to prevent problems in the first place.

Despite increased understanding of the most intricate mechanisms of disease and having a consensus that prevention is the best medicine, we continue to treat the end stage of the most preventable diseases rather than prevent them. How many patients do you see who require health services secondary to preventable disease such as smoking, alcohol, intoxications, lack of health care or a combination? In my view, patient education can help combat these problems head-on. For example, children and parents need to be educated early on the long-term, unseen high costs of eating low-cost fast food meals as opposed to more nutritious options. Physicians, including anesthesiologists, should discuss the ramifications of lifestyle choices with their patients. However, a systemic change is needed to address the problem in an effective way.

Interestingly, two-thirds of all adults believe that the U.S. health care system should place more emphasis on chronic disease prevention care, and more than four in five Americans (84 percent) favor public funding for such prevention programs.1 Does simply increasing access to insurance increase access? Will this incentivize physicians to focus on better outcomes rather than pay-per-treatment plans?

As we are all aware, health care spending is a serious concern in our country. Total health care cost in 2010 was $2.6 trillion and more than 25 percent, or $600-750 billion, was completely avoidable.2 As the U.S. population continues to grow, the number of health care consumers and the cost incurred by the health care system will continue to rise. In 2008, the World Health Organization (WHO) estimated that we spend 15.2 percent of our GDP on health care. Merely three years later in 2011, U.S. health care expenditures rose to 17.4 percent of GDP. The U.S. spends an approximate average of $8,000 per person, while the rest of the world spends no more than half that amount. For comparison, the Netherlands, which ranks second to the U.S. in health care expenditures, spends 12 percent of its GDP.3 Could this be due, in part, to the increased focus on preventive care in other nations? Countries such as India and the U.K. have at least one to two months in residency focusing on preventive medicine. It is an integrated part of the health care culture. Many believe this approach is driving down their health care costs, improving the quality of health and increasing lifespans.4 It is likely that a heightened systemic interest in preventive care could have similar benefits here. Trust for America’s Health estimated that investing $10/person per year for preventive care will drop health care cost by $16 billion over five years.5 If one does the math, that is $5.60 of savings for every $1 spent.

Our battle to improve health care outcomes, quality of life, and to drive health care costs down is a multifaceted struggle that must start with preventive health care measures. We have to face the facts, learn from health care models and start implementing our advancements in research and understanding of disease processes. Preventive medicine may be the tool to prevent a health care collapse of access and resources. The initial investment may increase short-term cost; however, long-term savings are undeniable and absolutely necessary to ensure a quality health system accessible to a growing population.



Vimal Desai, M.D. is a CA-1 resident, Case Western Reserve Medical School, Metrohealth Medical Center, Cleveland.

References:
1. National Center for Chronic Disease Prevention and Health Promotion. The power of prevention: chronic disease … the public health challenge of the 21st century. Center for Disease Control and Prevention website. http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf. Published 2009. Accessed March 20, 2013.
2. Office of the Actuary, Centers for Medicare and Medicaid Services. National health expenditure projections 2011-2021. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/. Accessed March 21, 2013.
3. Countries. World Health Organization website. http://www.who.int/countries/usa/en/. Accessed March 20, 2013.
4. World Health Organization Europe. Gaining health: the European strategy for the prevention and control of noncommunicable diseases. http://www.euro.who.int/__data/assets/pdf_file/0008/ 76526/E89306.pdf. Published 2006. Accessed March 20, 2013.
5. Levi J, Segal LM, Juliano C. Prevention for a healthier America: investments in disease prevention yield significant savings, stronger communities. Trust for America’s Health website. http://healthyamericans.org/reports/prevention08/. Published February 2009. Accessed March 20, 2013.