If you wake up in the morning with a sore throat and aching joints, you might get yourself to the doctor. The doctor might examine you, give you a diagnosis and prescribe medication. You’ll go home, take the meds, and get better. You probably won’t visit or hear from your doctor until the next time you get sick.
What we’re describing is one of the ways patients experience a reactive or ‘sick care’ healthcare system. This system has (almost) perfected how it addresses acute healthcare needs and chronic illness but, as we know all too well, it’s plagued by rising costs that offer little or no long-term rewards.
In the US, healthcare expenditure almost doubles the average expenditure of comparable countries. The US ranks highest for per capita spending on physicians and pharmaceuticals. Administration costs are also higher than other similar countries when you look at them as a proportion of healthcare costs in total. Unfortunately, these higher costs don’t translate to better outcomes. We have the lowest life expectancy among these countries.
This is what the sick system looks like:
- A large percentage of the cost flows to medication. If you search for the biggest healthcare companies in the US, you’ll find that most of them specialise in pharmaceuticals. Many of these organisations talk about their commitment to cost-cutting and better healthcare delivery, but few even mention the term ‘prevention’ unless they’re discussing opioid addiction.
- Hospitals and clinics are the dominant centre of healthcare delivery (“all beds must get filled.”). Decentralised models must be explored for individuals to access preventive services without leaving their homes or workplaces. In other countries, it’s widely and generally accepted that the Emergency Room (ER) is for exactly that – for example when you have a car accident – for everything else, see a physician.
- A not-good-enough incidence of preventable diseases, even those for which vaccines have existed for decades. In 2018, The Lancet published the results of a study looking at a healthcare quality and access index based on the incidence if 32 avoidable diseases. The US ranked 29th.
- Promotion of healthy lifestyles is important but is reliant on the consumer at the end of the day; a long day. That consumer who has easy access to countless unhealthy choices, and less time and energy to make healthy ones.
- Tech start-ups that aim to improve access to preventive healthcare must overcome tremendous obstacles in healthcare from regulatory to working in complex environments to high costs and risks to giant monopolies to long sales cycles. At best, they’re acquired, and their innovation is somewhat dissolved into a larger company’s complex infrastructure and overall vision.
It has long been recognized that one way of turning this around is to transform the healthcare system from a reactive to a preventive one. After all, the holy grail for reducing healthcare costs and contributing to longer, healthier lives must surely be to stop the onset of illness before it arrives. Right? But what does that mean in practical terms:
- Move the resources upstream from hospitals, drugs, and physicians to screening and health promotion. This is difficult to do given the burden of disease and the ongoing need to treat sick people. However, there is hope with some plans and providers who are enthusiastic about transformation in this space.
- Interoperability – the dream - between healthcare providers, policy makers, insurers, employers, and private industry, amongst regulatory obstacles, and when interoperability happens, is still forced. Until this becomes systematic, prevention-as-priority will only happen in pockets.
- Motives and incentives need to change.
- Where physicians are involved in your health, they promote healthy living and prevention. Acceptance and use of technology and value-based structures can support this.
Proactive and predictive healthcare are terms we get excited about.
Easier ways to medically and genetically screen which aim to anticipate illness before it arrives are all around us. However, until our healthcare system changes its view from treatment to prevention, and for clarity, that means where money is spent on maintaining good health, we won’t have the significant change we’re looking for.