Discuss why it is more important to prevent than treat disease, including the role of health psychologists.

A. Around 10% of our population incurs c. 70% of medical care expenses; the healthy people making up around 50% of our population incur c. 3%. This difference shows the importance of prevention for controlling medical care expenses.
1. Health psychologists can contribute to lowering these costs, because:
a. Most of the medical expenses are for chronic diseases, e.g. cardiovascular disease, cancer, diabetes, and chronic lower respiratory diseases; and
b. Unhealthy behaviors make major contributions to the development of these diseases.
2. People with good health habits incur half the lifetime medical costs as people with poor health habits.
3. But long-term good health can be expensive too, because people who live longer have more years of life for accumulating medical expenses.
4. Short-term, an important means of lowering medical service needs is prevention through promoting good health behaviors.
B. Increases in available medical technologies have fed common beliefs that modern medicine can cure anything, leading to people's relying too much on medicine, instead of on good health behaviors for prevention and self-management for chronic conditions.
C. The USA will need to make significant changes in its health care system to contain medical care expenses.
1. As health care reform affects them all, insurers, hospitals, and doctors have all resisted change.
2. Many other industrialized nations do better at providing the best quality of medical care more cost-effectively than the USA currently does.
D. Our medical care system has not changed its orientation toward providing acute care.
1. But our country's needs (and those of other industrialized nations) have shifted.
2. Chronic illnesses are now the leading causes of death and disability rather than
acute illnesses, yet the system has not adapted to meet these changing needs.
1. Management of chronic illnesses is an important need, as almost 70% of US deaths are caused by these.
2. Undertreatment, overtreatment, and mistreatment abound in chronic disease care.
a. As an example, stroke patients were undertreated, in that 20-30% had diagnosed hypertension but received no treatment for it.
b. 30% of primary care clinic patients were overtreated for asthma diagnoses despite lacking evidence of symptoms.
c. Medical provider errors, which occur alarmingly often, cause mistreatment.
3. Shifting from hospital-based and physician-based care to a team approach, including patient education to improve monitoring and self-care, and access to necessary medical care, is needed for our health care system to provide more effective management of chronic illnesses.
E. Primary prevention is typically most cost-effective. This includes:
1. Immunizations against diseases.
2. Programs encouraging lifestyle changes.
3. A 2001 research study concluded healthy lifestyle can extend life by 10 years.
4. Life expectancy and health expectancy can be improved through primary prevention initiatives tailored for different age groups across the life span.
F. Secondary prevention involves screening people at risk for developing diseases.
1. Since the number of people at risk can far exceed the number who will develop
the diseases, screening can be very expensive and not cost-effective.
2. Physicians' time costs too much for them to focus on health education.
3. Hospitals focus on acute care rather than on prevention services.
4. More cost-effective provision of health education can be made by:
a. Public health agencies,
b. Health educators,
c. And health psychologists.
5. Expanding these providers' roles in the health care system may not only help
contain medical care expenses, but also help provide better health care.