Those of us
who have spent careers in healthcare have experienced tremendous and dramatic
change. Those changes have been spread over a number of years and most have
been changes in the ways providers have been paid for their services. To be
sure, this is a very critical issue affecting healthcare workers, institutions
and consumers. Many other changes have been dramatic as
well.
These
changes and probable future changes in healthcare will offer the most dramatic
threats to the provision of services. Advances in medical technology and
medical science provide many potential benefits although they may be
unaffordable. Genetic engineering and super-specialist physicians and
scientists are ushering in a new era in healthcare, albeit, such "new science"
may be unaffordable. Adding to the problem are shortages of critical health
professionals and the requirement for more highly specialized staff, both
resulting in higher payrolls. Business, industry and the public want and expect
the very best in facilities, equipment and staff, even if in the future, they
may be unaffordable. In fact, many businesses and industries are passing more
and more of the cost of care to their employees by reducing coverage, and
providing insurance plans where employees have higher co-payments and
deductibles. The indications that healthcare is becoming unaffordable are
showing up everywhere.
The American public has asked for a cure for every health
problem, and researchers, hospitals, and providers have responded by developing
the most comprehensive health system in the world, yet it is becoming less and
less affordable. Tremendous expenditures have been made, and great progress has
been made, although certain diseases, including some forms of cancer, some
kinds of heart disease, and other diseases persist as health issues for
Americans.
Considering all the changes and trends, it is essential that we
turn our focus to wellness. The attempt of many to develop the Health
Maintenance Organization (HMO) concept has essentially failed. Rather than
truly creating organizations that focused on the maintenance of health, a
worthy and appropriate idea, HMOs became just another mechanism for negotiating
discounts from providers. The way to genuinely reduce costs to the public is to
initiate wellness programs and to provide incentives for people to practice
wellness. We know that many costly services are not necessary if people will
focus on wellness. We also know that people who practice wellness have
balanced, wholesome lifestyles. Below are some possible, if somewhat radical,
changes in our healthcare systems that would wake up Americans to the wellness
approach to health
- As the
baby boomers move into the Medicare program, Medicare will either fail by going
broke, or become an agency that offers very limited services, probably rationed
to those who have the greatest need. All providers should be able to bill the
Medicare patient the difference between the cost of care and what Medicare (the
government) pays. Currently Medicare pays hospitals about 85-90% of their cost
of providing services to Medicare recipients. A Medicare recipient could avoid
these charges by participating in a wellness program, certifying that he or she
has actively practiced wellness as part of their life style. This would clearly
give Medicare recipients incentives to focus on wellness.
- States,
with federal financial participation, are having serious problems providing
Medicaid to an ever-increasing number of eligible recipients. Medicaid coverage
should be available first to persons who practice a prescribed wellness
program. Catastrophic coverage should be available to all Medicaid recipients.
This provides incentives and rewards to Medicaid recipients to learn about and
practice wellness, thereby assuring a greater return for our healthcare
expenditures
- Business
and industry should provide for catastrophic health benefits for all their
workers. If the employee has "earned" broader coverage by active participation
in a wellness program they will have broader, more comprehensive coverage.
Participating in a wellness program reduces risk of disease and injury, keeps
people productive at the work place, and results in happier, healthier people,
which is a major advantage for employers. Broader coverage and elective
services should be the reward for those who have "earned" this extra
benefit.
The
above is a "sketchy" concept of the future health system focusing on wellness.
It should be pointed out that the wellness approach should be holistic, with
proper attention and resources to provide for the physical, psychological,
social, and spiritual well being of individuals. This may seem idealistic, but
true wellness must be holistic. For what is the body without a mind? Or a mind
without a spirit? And what is the worth of life without social interaction? The
wellness of the whole person is where the focus must be.
Many ideas and concepts exist about
wellness, yet very little research has been done on the development of holistic
wellness. Even less research has been documented on the value of wellness to an
individual and to society, in general. We Americans should dedicate ourselves
to not just having the best health care in the world, but having holistic
health and wellness that is the envy of the world.
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