Incentivising healthy living to reduce healthcare costs
“Prevention is better than cure”, a long-term strategy “green paper” for the National Health Service launched by the Secretary of State for Health in the UK 12 months ago continues to stir debate about public health and the role of the NHS in preventive medicine. It argues for a substantial shift in funding in that direction. In the UK in 2018 (check), £97bn of public funds were spent on treating disease but only £8bn on preventing it.
He is of course absolutely right. Intervention in the later stages of disease costs far more and is far less likely to defeat the disease than earlier intervention. If the disease does not arise in the first place, that’s obviously the best of all. The potential savings from adequate preventive measures are game-changing and could be directed to much needed areas such as reducing waiting times for treatments or bulking up services in parts of the country that face a shortfall in adequate services. And people will live and work longer, more healthy lives.
The preventive steps that the Health Secretary had referenced included “people choosing to look after themselves better, staying active and stopping smoking,” and “making better choices by limiting alcohol, sugar, salt and fat”. He is paying credence to the notion that we are what we consume and that lifestyle choices we make have a profound influence on our health. Such a notion is as obvious as it is ignored for all practical purposes by far too many, including within the medical profession.
Nutritional science is still regarded by many medical professionals as a branch of alternative medicine, to be treated with a heavy dose of disdain. Part of the problem lies in the fact that claims about the benefits of certain foods, and other naturally occurring substances (nutraceuticals), are not required by regulation to be substantiated to the same level as claims about the effects, and general safety, of pharmaceuticals.
But that’s because foods and other products that are naturally occurring are generally “safe to eat” and do not pose a threat of dangerous side effects in the way that powerful synthetic pharmaceuticals do. Moreover, that lower regulatory standard does not mean that naturally occurring foods and other products cannot be as beneficial for health as proven pharmaceuticals: the evidence is all around us that they very much are – from the different life expectancies among different societies within rich countries with different lifestyle and nutritional cultures to much that the medical profession itself acknowledges, including the effects of consuming too much sugar-sweetened beverages and restricting the intake of fats that result in high cholesterol levels.
In any event, scientific studies continue to support the arguments for many naturally occurring substances. To cite one recent study of more than 25,000 healthy middle-aged men and women over five years, researchers from Harvard Medical School found there was a 40 per cent reduction in heart attack risk among the participants that took fish oil capsules containing omega-3 fatty acids versus those that took a placebo. The study concluded the preventive effect of omega-3 exceeded the 15 per cent reduction in heart-attack risk offered by taking aspirin, and there were no side effects. Yet, which is your doctor more likely to recommend to reduce the risk of heart attack? And what does that tell us about the primacy of pharmaceuticals?
Even if we take the argument for prevention by better nutrition at face value, how then to influence the population to improve their lifestyles and to make health choices that they do not currently make? In some countries with major private health insurance coverage, innovative insurance companies are starting do this by offering premia discounts to customers that make healthy choices in food bought and fitness classes attended. This is no different from progressive motor insurance providers whose customers get reduced premiums by installing motion tracking devices that measure the way they drive in terms of speed, cornering and braking. It works. Not only do premiums go down, so do accidents. Obvious.
What about countries where the health industry is dominated by a national health service, such as the UK? How can its citizens be incentivized to make the same choices? The UK Health Secretary suggested “harnessing digital technology” as a form of “predictive prevention”.
This indeed makes sense and much of the cornerstone technology already exists in the form of wearable devices that download health data to apps in real time. In the future, those devices will go further and deeper to capture more of our essential health data, make sense of it and provide instructions, all before it’s too late. The world’s technology giants are prioritizing customer healthcare as a new business area, with innovation being rapidly stepped up. At the moment, their products are expensive and inaccessible to large parts of the population – essentially that part of the population that would benefit most – and their business models are not aimed at the true mass market. That should change given the scale of the opportunity for entrepreneurs and investors and new market entrants must be encouraged.
For individuals, the benefits are clear from early warning to real-time intervention – Apple Inc. is proudly publicizing the “saved lives” from its new health focused Apple Watch – but awareness and affordability issues must be tackled. Here the government can step in with incentives akin to those offered by insurers – perhaps through credits that can be allocated against the contributory cost of treatment in old age.
What we are witnessing is the harnessing of technology for preventive health outcomes. This is sure to be one of the most exciting areas of healthcare innovation and socioeconomic development in the near future.