Editor's Corner: Lack of preventive care in the US may hurt hospitals

Editor's corner
A hospital.
Ron Shinkman

Bold statements are fairly rare from the heads of large hospital systems, but Robert Ostrowsky, the head of RWJBarnabas Health, made a pretty strong assertion in a recent interview with the Asbury Park Press: Hospitals should keep their communities healthy. But they don't.

“It’s not easy because no one is willing to pay for that right now, meaning I don’t get reimbursed by insurance companies to keep somebody healthy and the government doesn’t seem to want to pay us to keep someone healthy,” Ostrowsky told the publication. “They all prefer to pay us when someone gets sick and they want us to spend less when that person is sick. That’s where the concentration has been. But an ounce of prevention. If they would take X number of dollars and say, 'Here, use it to keep people healthy,' actuarially, that will show you eventually spend less on sickness care.”

That needs to change for a variety of reasons that have begun to cascade into something profound. Princeton economist Alan Krueger has recently published a study (.pdf) showing a strong correlation between poor health and lack of workforce participation.

According to data he analyzed from the Bureau of Labor Statistics, 43 percent of men in the U.S. who are not in the workforce or looking for a job reported their health as being fair or poor, compared to 12 percent of employed men and 16 percent of those who are unemployed (no job, but looking for one). Such rates are also higher than average for women out of the workforce, but far lower compared to men.

“While it is certainly possible that extended joblessness and despair induced by weak labor demand could have caused or exacerbated many of the physical, emotional and mental health-related problems that currently afflict many prime age men who are out of the labor force, the evidence in this section nonetheless suggests that these problems are a substantial barrier to work that would have to be addressed to significantly reverse their downward trend in participation,” Krueger noted.

Healthcare and the lack of proactively addressing patient health plays a direct role in this issue. Krueger's research indicates that 34 percent of the men out of the workforce were suffering from at least one disability. That rises to 42 percent of those between the ages of 40 and 54, and it's even higher among white men. Among those who are merely unemployed, almost no one reports a disability. If this group could have avoided disability through proactive community healthcare delivery, there is scant evidence this has occurred.

Those out of the workforce say their levels of pain are 88 percent higher than those who work. Forty-four percent say they take pain medication every day. A separate survey undertaken by Krueger included in the study indicated the percentage of men disenfranchised from the workforce who take pain meds is even higher. Two-thirds take prescription painkillers.

Again, this goes to lack of preventive healthcare delivery--it's simply easier for providers to write a prescription than deploy a complex exercise or lifestyle regimen that might improve health and reduce pain. Some other unsettling forces from the business side of healthcare also play a role. Most notably is Purdue Pharma looking the other way on potential abuse of its OxyContin painkiller, marketing it based on the dubious claim its effects lasted for 12 hours, increasing the risk of abuse, and also taking a significant period of time to reformulate its pills to make them less likely to be abused.

Despite their being disenfranchised from the job force, the men in Krueger's study appear to play a significant role in the presidential election. As a recent CNN/ORC poll in Ohio shows, Donald Trump enjoys overwhelming support among white men and men who lack college degrees--the same cohorts most likely to be disabled and out of the workforce.

Whatever your thoughts about Trump's worldview or policies, he has unambiguously declared his intent to repeal the Affordable Care Act and block granting Medicaid payments to states--something that has a strong likelihood of occurring if he is elected. A recent Commonwealth Fund/RAND study concluded that Trump's healthcare policies could cause as many as 19.5 million Americans to lose their health coverage--hardly a promising fiscal development for hospitals. It would no doubt would push them to seek more bucks rather than proactively keep the population healthy.

In sum, Ostrowsky is right. Lack of proactivity on population health is not only making more Americans sick and keeping them out of the workforce, it makes them more likely to lash out against the only institutions that could play a role in their being healthy again. It is a negative feedback loop that could have disastrous consequences for the population and hospitals if it is not aggressively addressed. – Ron (@FierceHealth)