Beyond Health Promotion: Reducing Need And Demand For Medical Care

PROLOGUE: Most of the recent reforms in health care delivery have been aimed at providing services more efficiently, and very few have considered the economic advantages of actually improving health. The authors of this paper argue that we have been too much consumed with the supply side of the health care equation and too little concerned with the demand side. The best way to reduce costs and improve health at the same time, they suggest, is not just to control the services provided but also to reduce the need and demand for care. An integrated system of population-based health care delivery would join the tenets of health promotion—self-efficacy, behavior modification, and long-term management of health and disease—with traditional approaches to diagnosis, treatment, and prevention. This paper presents three models for such a system. James Fries is a professor of medicine at Stanford University in Palo Alto, California. C. Everett Koop, former U.S. surgeon general, is senior scholar at the Koop Institute in Bethesda, Maryland. Jacque Sokolov, a physician, is an independent consultant specializing in health promotion, managed care strategies, and health policy in Santa Monica, California. Carson Beadle is director of William M. Mercer, Inc., in New York City. Daniel Wright is a managing partner of the Tau Group, a health care consulting firm in Montgomery, Alabama. The authors are members of the Executive Committee of the Health Project, a nonprofit public/private consortium of health opinion leaders dedicated to improving health outcomes and reducing demand for medical care. ABSTRACT: A population's medical need represents its illness burden. Medical demand represents the service level requested for a particular need. Medical care costs are, in large part, a function of need and demand. Our review of health education programs designed to reduce health risks and reduce costs identified thirty-two programs with documented effectiveness, generally achieving claims reductions of 20 percent. Specific program features including chronic disease self-management, risk reduction, and increased self-efficacy appear important. A broadened definition of health promotion focused on increased personal responsibility for health-related actions and directed at improvement of long-term health outcomes also could reduce health care costs.