A commentary by two doctors in the current Journal of the American Medical Association suggests that it’s time to differentiate between healthcare and health harm. Although the data are imprecise, the authors suggest the benefits delivered by US healthcare may not outweigh the aggregate harm imparted.
In other words, you can never have too much health. Yet your health can be harmed by the overuse of medicine or by the costs of funding healthcare.
How does that work? First there’s direct harm from healthcare, including adverse physical and emotional effects from all the usual stuff associated with everything from excessive use to misdiagnoses to conflicting treatments.
Second, the authors suggest, there’s indirect harm. This comes from the fact that healthcare costs increasingly divert resources from education, jobs, and environmental quality—all important determinants of your health.
Healthcare’s objective should be to improve health, they say. Yet its primary emphasis has been on producing services. And fee-for-service payments tend to encourage the use of more treatments, new technologies, and extra testing. These additional services and their costs can actually harm health.
The fix? To begin with, study health harm to improve healthcare. Specifically, we need to understand the tradeoffs involved in healthcare interventions and expenditures in order to guide healthcare reform efforts. While more people need access to healthcare, that’s not enough. Healthcare reform needs to improve how medicine is practiced: centering it on patients, organizing it around primary care, and curbing health harm, including excessive healthcare use and spending.
How about this Rx: Fewer drugs, cleaner water, better air, healthful food, more exercise, education, jobs…