Who is counting, and how to count?

Are we wasting billions of dollars that should be devoted to improving the nation’s health?

It is distressing to see the disproportionate focus employers have on the cost of initiatives to create healthy and engaging workplaces relative to the amount of money channeled into traditional health care. The disparity in spending is startling, but, as a great allegory shared in the 1980s in actuarial circles well captured:

Sure it costs a lot but, say the Downstreamers, what else can decent people do except to provide whatever is necessary when human lives are at stake.

Friday’s publication in the Lancet comes as an important reminder that more accountability should be asked for on the money spent, as significant costs don’t necessarily directly relate people’s lives being at stake.  This exacerbates the existing problems of focusing on cure rather than prevention, and build on the latest population based evidence on what costs most, and how that is changing over time.  Employers (funding most of the health care spending in working age populations in the US) need more transparency on what they are really paying for and approach this requiring the same accountability as would apply in other parts of the business. An unfortunate position of (ir)rationality.

Let’s all count what really matters – people’s lives and according spend money optimally (with accountability) to protect and maintain health & prosperity.

And the introduction to the Lancet article highlights why it’s important to improve the quality of data, aligned with evidence based guidelines on ‘how to count’ (emphasis added):

Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries.

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