Personal Responsibility and Healthcare: Behavior can make a big difference
Part of the cost control contemplated in the Affordable Care Act (ACA) is holding physicians accountable for cost and quality. But how can physicians be held accountable for non-compliant patients or patients who do not take responsibility for their own health? Personal responsibility and healthcare costs are inextricably linked. It is estimated that more than half of our health care expenditures are for self-induced medical problems. Smoking, drug and alcohol addiction, lack of exercise, noncompliance with prescribed medical treatment plans, and lack of caution to prevent potential injuries, all add billions of dollars to medical costs yearly. Obesity alone has taken on epidemic proportions, with the United States spending $174 billion a year to treat diabetes, and at least $147 billion on health problems related to overweight and obesity. Tobacco still costs this nation more than $150 billion a year. According to the Centers for Disease Control and Prevention (CDC), nearly 75 percent of Americans report they do not always take their medications as directed; one in three never fill their prescriptions; and proper adherence approaches only 50 to 65 percent in patients with chronic conditions, such as diabetes and hypertension An article in the New England Journal of Medicine (NEJM) reported that poor medication adherence contributes significantly to medication-related hospital admissions in the United States, at an estimated cost of at least $100 billion annually. Lifestyle behaviors are difficult to change, and solutions to effect behavioral modification have been largely unsuccessful to date, despite huge community efforts and even legislation. Some patients have developed a sense of entitlement of care, taking no responsibility for abusing their health but expecting every conceivable means of treatment be used to cure them, no matter the expense. They, in turn, blame the health care delivery system for its high costs. This is unfortunate, since there likely would be more than enough money in our health care system to help patients with illnesses that could not be prevented if the rest of our population practiced healthy living. Other patients would like to change but need to be taught what to do. Others face economic and cultural obstacles that prevent wellness, which we must address. As physicians, no matter what our specialty, we do have a strong role to play in every one of our patient encounters, because if we don’t discuss healthy living with our patients, who will? Only the individualized approach will work along with peer and affinity group influence. We physicians alone cannot accomplish this. We need the collaborative effort of community, parents, schools, hospitals, insurance companies and businesses.
Houston Facial Plastic Surgeon, Russell Kridel, MD, is currently a member of the AMA Board of Trustees and the immediate past chair of the AMA Council on Science and Public Health.
Any views expressed on this blog should be considered personal views of Dr. Kridel and are not official statements of AMA policy (which is set by the AMA House of Delegates) nor are they official descriptions of actions of the AMA Board of Trustees.