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Monthly Archives: January 2011


The current Prognosis for U.S. Business:

Footing for at least 1/3 of this nation’s healthcare expenditures, the continually rising costs in this sector is a cancer that threatens the life of U.S. Business. In the past 2 decades healthcare expenditures have increased 300%; a rate that is 5 times that of inflation for this same time period.  This represents 16.2 % of GDP (gross domestic product), giving our nation the unflattering distinction as the leader of the industrialized world in this category.(1)  Based on the current spending trajectory, by this nation’s tricentennial nearly one half of its collective productivity will be consumed by healthcare expenditures. (2) Characterizing this issue as a terminal illness is not simply a convenient medical metaphor; absent an unprecedented fundamental change in how healthcare is provided in the near future, the long-term prognosis for U.S. Business is certainly a grim one.  

The Diagnosis: US Business became so fixated on cost they have completely forgot about value

For the past 3 decades Corporate Americas’ prevailing healthcare strategy has been to outsource to third-party payers. While initially cost-effective, based upon the statistics just cited, this is clearly no longer the case. In its effort to survive spiraling health care costs, US Business has adjusted its strategy to cost shifting to its employees.This has only served to deepen the crisis by disenfranchising the workforce during an economic climate in which US business can ill afford to do this. While US unemployment is at its highest post Depression rates, recruitment and retention of talent and successorship are also at a critical mass in our nation; at the same time, global competition has never been more intense. Most importantly, cost shifting is only postponing the inevitable need to grapple with what, after all, is the elephant sitting on the sofa; an overvalued healthcare system. By conservative estimates 1 dollar of every $3 spent on healthcare in this country is wasted outright.(3)

This physician’s proposed course of Treatment

Sound business principles dictate that curing the malignant growth in health care spending be derived from novel combinations of proven remedies already in existence. In house strategies, such as on site wellness programs is one such proven remedy. Such programs have consistently demonstrated healthy returns on investment of $3 to $6 return on every $1 invested. While still an emerging trend, on site health services have higher employee participation and employer satisfaction rates than most other health programs. (4) In contrast to the negative PR generated by cost shifting, companies offer on site programs to stay competitive in the marketplace and use such programs as a recruitment and retention benefit. While clearly a breath of fresh air, in-house strategies have inherent limitations that keep them from making any more than a small dent in our current healthcare crisis. However, with some creativity these limitations may be easily overcome. When organizations have  invested in on site wellness programs they typically realized returns quickly. Unfortunately, due to the inherent selection bias of such programs, these returns seem to plateau just as quickly. Selection bias would predict that those employees most likely to participate  in an on site wellness program will be those already wellness minded. As a result if this phenomenon, these programs will tend to help those employees that least need it while leaving those employees that have the most to gain, behind. Overcoming this limitation would require a method to easily identify those employees that would derive the greatest benefit from an on site wellness program and provide them with the incentives to take part in it. Such methods of employee selection will appropriately raise the ethical and legal concerns regarding an employees privacy and a multitude of other such issues. However, with what this physician has in mind, such issues will be of no concern. Before addressing this issue, it is necessary to provide the clinical background information upon whicn this authors solution for healthcare is founded. Please stay tuned for my next post, The Neuroscience of a Service Based Economy

 

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Mitchell R. Weisberg, MP, MD

(1) http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358 http://www.measuringworth.com/ppowerus/.

(2)  http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

(3) http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system

(4)  http://www.hewittassociates.com/_MetaBasicCMAssetCache_/Assets/Articles/2010/Hewitt_Survey_Findings_TheRoadAhead_2010.pdf


As we embark upon the 5th decade of the Information Age, our health and our performance has never been so intertwined. In the first decade of the new millennium 80 cents of every dollar in the United States came from the Service Sector. To me, an Internist and Psychopharmacologist, Service means Cognitive Functioning. In other words, as compared to just a generation or two ago, we derive our livelihood in this nation primarily by using our brains a lot more than our brawn. Consequently, the meaning of health has changed dramatically. The primary impairment to our work performance is no longer just our backs, our wrists or our shoulders; it’s our Cerebral Cortices.

When we think about this from an Evolutionary perspective, this makes perfect sense. 100 % of the 1 or 2% difference between Chimpanzee and Human DNA went into the design of the Human Cerebral Cortex; the seat of our superior ability to reason, speak, discover, create and deceive. For better or for worse, it follows, that the part of us that makes us distinctly human,  our Cortex needs to be in command of the rest our beings; when it’s not,  our health and our performance is rendered suboptimal.

From this vantage point, one will see just how arbitrary the border separating the mind from the body is. For example, 9% of Americans suffer from a major depressive episode each year. Amongst people with Type 2 Diabetes, 25% have a major depressive episode annually. A single chronic health condition is associated with a nearly three-fold increased risk of Depression! What’s more, in people that have both Type 2 Diabetes and Depression, those that have their depression treated have much improved control and reduced complication rate of their diabetes than in those that do not have their depression treated. The implication of this for me as a physician is that for me to optimally treat Type 2 Diabetes, the most common chronic condition in the United States, I must also be able to optimally treat depression.

I use Diabetes and Depression simply as a graphic example of the folly and the danger of the prevailing view of the separation of Mind and Body that continues to persist in our society in general and in our healthcare system in particular. With our ability to perform in our world being such a cerebral experience, anything from a bad night’s sleep, to skipping meals to chronic pain or having multiple chronic health disorders will have an effect on a persons’ ability to learn, work or interact socially with family members friends and co-workers. The time has come where we must completely reject this concept of the separation of  mind and body or physical and mental; our lives and our livelihoods depend on it!

Welcome to the Evolution.

References

http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml 

http://www.nimh.nih.gov/science-news/2010/diabetes-and-depression-associated-with-higher-risk-for-major-complications.shtml 

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Mitchell R. Weisberg, MD. MP