by Christopher Cornue

A continuing look at the Commonwealth Fund’s recent report, Bending the Curve: Options for Achieving Savings and Improving Value in US Healthcare Spending finds us reviewing their second area of focus – that of Promoting Health & Disease Prevention. By lowering the incidence of disease through increased public health initiatives and improved care, significant cost savings can be realized in our health care system. Chronic disease is their primary focus, making the assertion that prevention of continued dependence upon healthcare will curb costs significantly. Research conducted by the Centers for Disease Control & Prevention suggest that medical costs for individuals with chronic disease represents 75% of total health care expenditures. Their three primary areas of health promotion & disease prevention are:

• Reducing Tobacco Use
• Reducing Obesity
• Positive Incentives for Health

Reducing Tobacco Use – tobacco usage, including cigarette smoking, is arguably the single most avoidable cause of death in the US. Lung cancer, respiratory disease, heart disease and stroke have all been associated with tobacco usage. During the late 1990s, the CDC estimated that cigarette smoking led to $75 billion in health care expenditures and close to $100 billion in lost productivity. The Bending the Curve Report recommended the increase of the excise tax on cigarettes from $0.39 to $2.39. The additional revenue would be funneled to: 1) CDC’s national tobacco control programs; 2) development of grants to states for their own programs, providing they adhered to minimum tobacco control standards such as banning smoking in workplaces and enclosed locations.

Reducing Obesity – obesity has become an increasing problem in the US over the past several years, with the share of national health expenditures related to obesity falling in the 5-9% range. This presents a significant opportunity in reducing costs and combating this issue. The report recommends establishing a new tax on sugar-sweetened beverages at a rate of $0.01 per 12 ounce serving. These revenues would be used to create grants for states to develop individualized obesity prevention programs, providing they met specific minimum obesity control requirements. Additional suggestions offered in this report: 1) requiring restaurants to display nutritional information; 2) requiring schools to ban sugar-sweetened soft drinks; and 3) enforcing requirements for healthy meals in schools.

Positive Incentives for Health – it has been suggested that our own personal behavior (i.e., smoking, diet, physical activity, etc.) has a significant impact on our health and mortality. Therefore, if we take ownership and change these behaviors, our health can be improved and the costs related to treating disease can be reduced. Disease management and wellness programs which encourage individuals to embrace healthy behaviors are becoming increasingly present in our society. Federal grants to states to develop and promote these programs and encourage insurance companies to incentivize individuals to participate are examples of policies in Bending the Curve. Additionally, broadening the rules for Flexible Spending Accounts to allow for participation in programs to quit smoking or control weight would encourage participation.

On a side note, it’s important to state that these activities don’t need to wait for approval at the Federal or State levels. Action can be taken community by community. An example of this is a developing initiative in Chicago. I had the fortunate opportunity to attend a kick-off meeting this week, hosted by the American Medical Association and the Chicago Department of Public Health – “Building a Healthier Chicago.” Though in very early states, experts and concerned groups assembled for a day-long discussion about necessary efforts to create a healthier Chicago. Many of the initiatives and policies brought forth by the Bending the Curve report were discussed as plausible initiatives that a community can tackle. More information about this will be provided as it develops. Stay tuned …