Why healthcare is more than just about medicine

Seth Berkowitz, MD, MPH, of the MGH Division of General Internal Medicine

Why is it that we are discussing about healthcare mostly in terms of medicine? Ok, true, since the term "obesity pandemic" was coined we are also talking about diet as a major contributor to population healthcare. But if diet is part of the equation isn’t is reasonable to expect that other factors will be involved as well?

According to this blog published by Huffington Post, one recent study estimated that one in three patients enter the hospital malnourished, while another determined that the cost of treating patients with nutrition related risks is 20 percent higher than that of treating well-nourished patients with the same disease.

It was surprising for me that the recently published Berkowitz et al. paper is reported as a first of its kind, precisely because it should be have been investigated much earlier. The basic premise of the study is that unmet basic resource needs, such as difficulty affording healthcare, medications, food and housing, may contribute to worse healthcare quality indicators. The specific contribution of this paper is that it maps the association of various unmet needs with priority clinical conditions and health service use patterns.

Patients were screened for unmet needs and enrolled in a six month programme to link them with community resources. Specifically, the authors looked for patients reporting unmet basic resource coupled with health service use patterns such as frequent emergency department visits (>2 in the preceding year) and frequent clinic 'no-shows' (>1 in the preceding year).

The most common types of needs reported were:

  • »   difficulties affording healthcare (46.5%),
  • »   food (40.1%)
  • »   utilities (36.3%).

Patients who reported unmet needs were more likely to:

  • »   exhibit depression,
  • »   diabetes
  • »   hypertension
  • »   be frequent ED users
  • »   have frequent 'no-shows' to clinic

Conclusion? Sometimes things that should be simple and affordable, like food or money, money for transportation to the clinical appointment, lack of knowledge, even!, can have the greatest impact on health care costs. Healthcare costs can be reduced to a fraction by addressing these issues: medication adherence is improved, there are fewer missed doctors' appointments, lower hospital readmission rates, improved energy levels, and reduced complications.


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