Our Health, Our Culture, Our System, Our Failure?

There have been a lot of crazy options floated in the health care world about ways to decrease costs, increase treatment adherence, and the like. There have also been a lot of crazy paranoid ideas put forth, including the legendary “comparative effectiveness equals death panels” diatribe.

Meanwhile, the incidence of chronic conditions continues to climb – and with that, the cost of maintaining our current system.

There are many issues in the current health care system that are driven by factors unrelated to the care of the patients themselves. That is truly a sad state of affairs, but the reality that we must face.

But with that said, there is a question that swirls around this: is the health care system itself fully to blame? Or is there a cultural issue that is inherent to our health care woes?

A recent study indicated that in a group of heart attack survivors that were given free heart medications, only 50% actually took the medication. Even with cost eliminated, they still refused to take the medication - co-pay or no co-pay.

In the same article, Dr. Eric Peterson of Duke University noted that

"Adherence in America is miserable"

But why?

Before we answer that, let’s look at another concept being proposed: giving the patient a financial incentive to take the medication. The lead author of the study, Dr. Choudhry, notes that

"There are some concerns about paying patients, but providing positive financial incentives is the next step in the game … If you call this value-based insurance, we call that VBI 2.0. It’s the next innovation”.

I have a suggestion: forget about giving patients financial incentives. This is beyond outrageous. If your own health isn’t enough incentive, then give the treatment to someone who values it.

Perhaps the health care system is failing patients by not using the principles of adult education to teach them effectively. Perhaps the system is failing by not promoting and fostering patient education, independence, and adherence.

But perhaps more important is the cultural impact. Yes, there are issues of cost and access, but there are also issues regarding a patient’s self-perception of their role in their own health. They are used to being fixed and being passive participants in the process. Take a pill, it will solve the problem. Have this procedure, it will solve the problem. Empowerment? That has become an oft-used and poorly-understood term in our system.

Maybe the problem with our health system isn’t that we need to pay patients to adhere to the care we provide. How about a novel concept: people simply need to be responsible for their own health. Your own health and livelihood should be plenty of incentive.

Photo credits: jking89