Why health screening?
"The doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease" - Thomas Edison, 1902
The ROI view: Preventive care pays
Chronic disease drives 74% of healthcare cost
U.S. Healthcare is a $2.4T industry (2008) growing at 7%. Most of this is spent on curing illness as opposed to promoting, achieving and maintaining health. Healthplans really are 'sick-plans'. Only 3% of healthcare spending in the U.S. is targeted at prevention. This is counterproductive because 70% of Healthcare costs are driven by behavior (smoking, obesity, lack of exercise, uncontrolled hypertension and cholesterol). These behaviours lead to the big four chronic conditions (Cardiovascular disease, Cancer, Diabetes and Obesity) which combined drive 74% of the total healthcare cost. Six in 10 adults over the age of 18 have at least one chronic condition
Employers bear the brunt of these costs since they cover about 75% of the health insurance premiums for their covered employees, with family coverage costing on average $12,700 in 2008.
In a typical U.S. company the sickest 15% of employees will drive 78% of medical expenses.
Beyond this direct cost of preventable disease unhealthy employees are less productive because of sick days, presenteeism and lower quality work. Furthermore, as preventable disease progresses so do healthcare costs and productivity losses.
What can employers do?
There is good news in all of this: 80% of Heart disease, 30% of cancers, 80% of diabetes (Type 2) and nearly all weight problems can be addressed or prevented by behavioral changes and disease management, including proven medication.
If employees who are at risk or have undiagnosed disease can be identified and encouraged to see their physician treatment can be simple and cheap. Compare for instance average hospital charges for treating an acute heart attack of $54,000 in 2007 with the cost of cholesterol medication of less than $50 per year for generic statins.
Many employers have begun to pursue preventive programs and to promote workforce health. Safeway for instance has been very public about their success.
The medical view: Preventive care works
Simple lifestyle changes, in some cases together with medication can drive risk factors down substantially:
- Diabetes can effectively be managed through a combination of diet, insulin, weight control and other diabetes medications. Uncontrolled diabetes presents numerous health risks like heart disease, blindness, reduced circulation which in turn can lead to infection, ulcers or gangrene.
- High blood pressure can be managed through medication, exercise, weight control. Unmanaged it has no symptoms, until a major cardiovascular event strikes. It is one of the simplest issues to diagnose.
- High cholesterol can effectively be managed through diet, exercise, weight control and medication. Like high blood pressure it has no symptoms until it's too late.
- Smoking cessation programs can be very effective in reducing the incidence of lung cancer. It is important to tie the right incentives into a smoking cessation effort, otherwise the rate of recidivism is high.
- Depression can effectively be treated with antidepressants. Unmanaged it leads to high losses of productivity and even suicide
- Sleep apnea, which is a critical illness especially in professions like trucking or operating heavy machinery, can effectively be treated through a variety of measures depending on the causes.
In all of these cases (and there are more) the first step is to diagnose and monitor the disease progression. In addition we have found incentives to be critical to encourage employees to participate in a screening and in maintaining a healthy lifestyle.