Richter: Prevention key to health care reform

Amid the noisy rhetoric that is dominating our nation’s discourse, it is important to remember that health care reform fundamentally revolves around three basic needs: the need to control costs, the need to maintain quality and the need to expand access to care.

The debate must end in a general agreement on how to deliver, administer and pay for health care in a manner that is effective and fiscally sound. One component is essential to transforming our ailing health care system, and therefore is the key concept that must be part of any agreement. That component is prevention.

Focusing on prevention will ensure that whatever money we put into the system will return not only to our economy in the form of healthier citizens needing fewer costly treatments, but to our homes and to our families, where health care assumes a value far beyond any monetary concern.

Our nation cannot hope to rein in costs without addressing the burden of chronic diseases, which are a primary driver of health care costs. More than 75 cents of every dollar spent on health care in this country goes toward treatment of chronic diseases such as heart disease, diabetes, cancer and asthma. Chronic diseases also are the leading cause of death and disability in the United States, underscoring the need for bold approaches to contend with the costly and devastating effects such conditions have on individuals, their families and our communities.

To combat chronic disease, reform legislation must include incentives to motivate medical providers to focus on prevention as much as treatment. Not only would this improve patient outcomes (because the majority of chronic diseases are largely preventable), it also would lower costs associated with avoidable treatments. Financial rewards could be offered to providers who reduce unnecessary treatments and tests while also achieving improved patient outcomes. This approach already has been proven to function successfully in a number of places, such as the Mayo Clinic, producing high rates of successful treatment at lower costs.

Another effort to support prevention should target individuals themselves — before they become sick. Workplace, community and school wellness programs should be expanded so that people can be educated and coached in methods to lower their health risks and then rewarded for healthy behaviors. This model has produced a 15 percent to 40 percent decrease in health care costs for individuals who participate. Such health promotion efforts would go a long way toward improving the health status of all Americans — particularly South Carolinians, who suffer a disproportionate burden of chronic disease and health disparities.

The S.C. Public Health Institute is working alongside the Partnership to Fight Chronic Disease and other state and local entities to seek solutions that enhance the health of South Carolinians. In the context of the health care reform debate, the institute currently is examining the burden of the uninsured and underinsured in South Carolina. Our report (available at www.scphi.org) highlights the growing problem of the uninsured and underinsured populations in our state and recommends convening a partnership to perform primary research. Available data offer a limited view of this problem — a problem that is being made worse by the recession. A better understanding of the scope of the problem will better inform possible solutions.

Regardless of the outcome of reform efforts at the federal level, we must improve the health status of South Carolinians. In order to truly expand coverage, improve quality and control costs, we must be willing to consider innovative approaches — especially those with proven track records. Our system of health care must include a greater emphasis on preventive care to address our nation’s No. 1 health crisis — ever-increasing rates of chronic disease.

Dr. Richter is executive director of the S.C. Public Health Institute and serves as a board member of the Partnership to Fight Chronic Disease.