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Sustainable Health Care:
What Is It? And How Do We Get There?

In the United States we pay more per person (double) for our health care than in any other nation, yet we get less for our money in terms of prevention of deaths that could have been averted by medical care:


From Davis, Karen. Oct 23, 2008 New England Journal of Medicine (NEJM)

When broken down by region of the country, the areas of the United States with the highest medical spending do not have lower mortality rates. In fact, there is a slight inverse correlation with money spent and mortality rates. For example when looking at spending on myocardial infarction (heart attack) percent survival after one year actually declines with the more money spent:


From Skinner et al, 7 Feb 2006, Health Affairs

Across all diagnoses, regional increases in health care spending does not translate into a healthier population with lower rates of disease:


From Fisher et al, NEJM 26 Feb 2009

Ten percent of the population accounts for 70% of health care costs. The most expensive “diagnoses” are:

  • Heart Disease (mostly atherosclerotic)
  • Motor Vehicle Accidents
  • Acute Respiratory Infections
  • Arthropathies (diseases of the joints)
  • High Blood Pressure
  • Back Problems
  • Mood Disorders
  • Diabetes
  • Stroke
  • Cardiac dysrhythmias (usually caused by atherosclerotic heart disease)

Interesting details on both direct and indirect costs of these conditions:


From Druss et al, July/August 2002, Health Affairs

In 1996 dollars the “sickest” 1% of the population cost $56,000 per person that year, while the “healthiest” 50% of the population cost $122 per person per year.

So What Exactly is Sustainable Health Care?

Sustainable health care is engaging the most successful and cost-effective medical therapies to provide the healthiest population. It includes treatment and prevention. Sustainable health care is:

  • a philosophy,
  • an economic proposal,
  • a medical care plan;
  • and a sense of personal responsibility on the part of every person living in this country

(Feel free to add your thoughts in the comments section at the end of this post)

Sustainable health care takes a commitment on everyone’s part to bring to the public the best, most cost-effective treatments. “Everyone” means:

  • you and me
  • physicians, nurses, nurse-practitioners, and other health care professionals
  • hospitals, nursing homes, and other medical institutions
  • insurance companies
  • pharmaceutical companies
  • medical device companies
  • the federal and state governments

I don’t mind my taxes paying for “Universal Health Care Coverage”; however, I would like “Universal Health Care Coverage” to be accompanied by a “Universal Commitment to Maintain Personal Health”.

Most serious medical conditions are preventable and are consequences of unhealthy lifestyle: poor eating habits, lack of exercise, smoking, and other self-destructive behavior.

If we’re all going to be paying into a universal coverage system, we all need to make a collective effort to control costs by reducing the incidence of diseases that are modifiable and preventable by lifestyle changes.

Behavior modification works if it’s done at a societal level. For example, smoking rates have dropped from over 50% of the population to under 20% with public education.

The obesity rate, however, has gone the wrong direction: Two-thirds of Americans overweight or obese up from about one-third thirty years ago.

Reduction in obesity rates is likely to require a collective community effort as with campaign EPODE in France. EPODE (Ensemble, prévenons l’obésité des enfants or Together, let’s prevent obesity in children)

(more on EPODE in English) was launched in January 2004 in 10 towns in different regions of France and over a single year produced an 8% reduction in childhood obesity compared to a 17% increase overall in France during the same time period.

The most effective treatments are not necessarily the most costly

For example, the reduction in mortality rates from heart disease over the period spanning1986-1996 can be attributable to 2 of 3 factors, two of which are very cheap to implement:

  1. daily aspirin for prevention and treatment of heart disease (inexpensive)
  2. administering beta-blockers after heart attack (reduces subsequent mortality by 25%) (inexpensive)
  3. and thrombolytic therapy (drugs and procedures to “bust” clots)  (expensive)

(From Skinner et al, 7 Feb 2006, Health Affairs)

world on a new plant sproutI can think of four inexpensive and highly effective ways to implement sustainable health care in ob-gyn:

Contribute your thoughts for upcoming posts in this topic by commenting on these questions:

Name one “low barrier” way the following entities can implement sustainable health care?

  • patients
  • healthcare providers
  • pharmaceutical companies
  • medical device companies
  • federal and state governments
  • you and me
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{ 2 comments… add one }

  • Brian March 4, 2009, 2:02 pm

    Name one “low barrier” way the following entities can implement sustainable health care?..
    Providers get their sites promoting wellness in a non- media scare way boosted up the search rankings.
    If I’m searching for say diet advice – what results do I get vs what great and sensible (trustworthy) medical advice should I get.
    I’m sure GOOG/MSFT/YHOO etc would be open to allowing search parameters on health q’s to get practical guidance..and allow physician advice to float above less helpful guidance.

    • Shelley Binkley March 4, 2009, 7:34 pm

      @brian The best advice-giving sites are ones with no or minimal commercial interest. For example, the nih.gov and cdc.gov sites offer relatively un-biased information. Not that other medical info sites are biased, but if you navigate to a site and see tons of ads for pharmaceuticals, I’d keep looking. One way to assess credibility of advice, is to compare several sources, e.g. see: http://healthewoman.org/2009/02/20/how-to-get-the-most-out-of-internet-medicine/

      TY v. much for the comment, look forward to more dialogue on sustainable HC.

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