Health care vs. disease care

Moderated by Tom Sabulis

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By Kenneth Brigham and Michael. M.E. Johns

The current trajectory of Medicare costs cannot be sustained. Politicians propose a variety of solutions, all of which intend to cut the cost of care for people who have a disease. While some of those solutions are creative and might work in the short run, there is a major flaw in the rationale: The cost of disease care will continue to increase. We cannot afford disease care for all who will need it unless we can decrease their numbers. Halving the incidence of chronic disease would save over a trillion disease-care dollars.

To accomplish that, we must change the paradigm. The concept of “predictive health” — health rather than disease and prediction of health status rather than diagnosis as the focus — is a radical shift that can decrease the burden of disease. Much of the knowledge, science and technology that make this possible exists, and more is on the way. The barriers are the professional, social, economic and political stakes in disease care.

The relationship between education and health makes the point that, more than a biologic fact, health is a consequence of the entire human experience. Although we spend more on “health” care than many other countries, we spend about the same as most of them on the combination of health care and social programs. Health is clearly influenced by broader social factors. Education, social infrastructure and safety nets for the less fortunate, as well as access to care, are integral to a people’s health.

Waiting for disease to happen is missing the opportunity. Predictive health defines health in the context of biology, behavior and environment. It evaluates that integrated experience and designs personally tailored changes in behaviors that can forestall or prevent diseases that compromise quality of life, and cost an arm and a leg (often literally) to take care of. In the long run, this could decrease the numbers of people who need disease care.

At the Emory Georgia Tech Predictive Health Institute’s Center for Health Discovery and Well Being®, healthy people have their health profile defined, personal action plans developed and goals facilitated by a “health partner.” The early results indicate improvements in biologic heath (BMI, blood pressure, blood lipids, etc.), well-being (decreased depression and stress), and even some evidence of improved brain function. People They are healthier, and their risks for developing chronic disease are decreased.

Changing paradigms is difficult, but if we are to avert an economic cataclysm, we have to do it. There may be short-term efficiencies, but the iceberg is out there awaiting its encounter with this disease care Titanic. The costs of complex disease care will continue to increase; decreasing the demand for such care is the only long-term solution. Predictive health can do it, if there is enough foresight and fortitude to invest some dollars in keeping people healthy.

We may have the best disease care system in the world, but we do not have the best health care system — yet.

Kenneth Brigham is professor of medicine emeritus at Emory University. Michael M.E. Johns is professor in the Schools of Medicine and Public Health at Emory.

6 comments Add your comment


January 27th, 2013
10:25 am

Along with destroying what’s left of our economy, Obamacare will prove to be a most wonderful social engineering tool for the psychotic control freaks of the Left.

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January 26th, 2013
8:16 am

This short essay is more confusing than enlightening and contains falsehoods. The U.S. does not have the best healthcare system as evidenced by survivals and multiple measurements. We also spend twice as much as most developed countries on healthcare. As former administrators in academia, Brigham and Johns apparently have little insight into the business of medicine or the large number of Americans who have little access to sophisticated healthcare. Current profits of private insurance companies have been enormous with many C.E.O.s and their vice presidents draining billions into their own retirement funds. The for-profit hospital corporations (e.g., HCA which currently owns Emory) have also drained billions into stock holder and management pockets without providing patient care or improving facilities as guaranteed in their original contracts. Pharmaceutical companies have marketed products for unproven and even dangerous indications with management staff creating overheads of 100 percent or more for life-saving medications. Adequate control of cigarette smoking, obesity, and gun violence has not yet been achieved. The Affordable Care Act will begin to fix this cess-pool of greed by limiting private insurance profits, expanding Medicaid coverage, increasing physician reimbursements for Medicaid delivery, increasing law-enforcement over-sight of all these crimes, and increasing participation of all citizens in the funding of healthcare.


January 26th, 2013
7:36 am

Let us take a person with emphasima. Gasping for breath, barely breathe, fearful of dying. Goes to hospital in total distress. The Dr. says, “it is not the purpose of the medical facility to make her more comfortable and turns the person away. Now, would this be disease control? Cannot cure the disease but can control it?If it is, I am all for it. Certainly, mitigating suffering is what I would say,is high priority. The person had a lot of insurance but medicare had to cover some, and would not pay.
This particular hospital in Watertown,N.Y. is really state of the art for patient comfort. Rooms that are four star. Gigantic facility for a small city. None the less, she was turned way.

[...] Health care vs. disease careAtlanta Journal Constitution (blog)The current trajectory of Medicare costs cannot be sustained. Politicians propose a variety of solutions, all of which intend to cut the cost of care for people who have a disease. While some of those solutions are creative and might work in the short … [...]

An observer

January 25th, 2013
10:00 pm

So much quackery!